The super specialty of complex abdominal wall reconstruction continues to evolve
based on advanced techniques built upon the shoulders of those who created the
initial stages of component separation at the end of the twentieth century. With the
advent of technological advances such as robotic surgery, a refined approach has
been developed which allows for bilateral myocutaneous flaps creation from an
extraperitoneal plane, specifically preperitoneal, known as the extended
preperitoneal (eTEP) approach. The robotic platform offers numerous ergonomic
advantages to the surgeon which allow for performance of a complex reconstruction
of the abdominal wall with attention to detail in all aspects of hernia repair including
dissection of the hernia sac and reduction of the hernia contents, a primary repair of
the defect under minimal or no tension, plication of associated rectus diastasis, and
mesh implantation as a preperitoneal/retrofascial/retromuscular sublay. This SOC will illustrate the robotic extended totally extraperitoneal (eTEP) approach for
ventral hernia repair with plication of associated rectus diastasis as a useful adjunct
to the minimally invasive surgeon’s toolset and the most recent novel technique for
complex abdominal wall reconstruction.
