Robotic General Surgery

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SECTION 2 • Discipline-Based Practice - General Surgery

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FIGURE 6.1 Intraperitoneal view of the myopectineal orifice. A, Unlabeled. B, Landmark anatomy. C, Locations of commonly identified hernia defects.

l Two 8-mm working ports: positioned transversely relatively to central trocar (spaced 8 cm lateral to central trocar). l Unilateral inguinal hernia necessitating heavyweight mesh ( Figure 6.2c ): l A 12-mm central trocar (camera port): 2 cm ceph alad from umbilicus and 2 cm toward groin of interest. l Two 8-mm working ports: slight triangulation toward groin of interest (1-cm offset from central trocar, spaced 8 cm lateral to central trocar). l Plan for fascial closure of 12-mm central trocar with interrupted slow absorbing multifilament suture. l Unilateral or bilateral inguinal hernia repair in patients with symptomatic umbilical hernias; bilat eral inguinal hernias necessitating heavyweight mesh ( Figure 6.2D ): l A 12-mm central trocar (camera port): Placed through the umbilicus. Peritoneal Flap Development From the console, the surgeon now progresses through a minimally invasive transabdominal preperitoneal inguinal hernia repair. The peritoneal flap is initiated at Copyright © Wolters Kluwer, Inc. Unauthorized reproduction of the content is prohibited. 2024 l Two 8-mm working ports: positioned transversely relatively to central trocar (spaced 8 cm lateral to central trocar). l Plan for fascial closure of umbilical defect with an open technique utilizing interrupted slow- absorbing monofilament suture in a transverse orientation. Upon placing trocars, the previously defined mesh and sutures are placed in the abdominal cavity to min imize future instrument exchanges or requirements for advanced bedside assistance. The robot platform is docked to the patient’s right side with initial instruments including the fenestrated Force bipolar and monopolar curved scissors.