One‐step totally robotic Hartmann reversal and complex abdominal wall reconstruction with bilateral posterior component separation: a technical note

• Published in: Colorectal disease Vol. 25; no. 7; pp. 1523 - 1528
• Main Authors: Douissard, Jonathan, Dupuis, Arnaud, Ris, Frederic, Hagen, Monika E., Toso, Christian, Buchs, Nicolas C.
• Format: Journal Article
• Language: English
• Published: England Wiley Subscription Services, Inc 01-07-2023
• Subjects: Abdomen; Abdominal Muscles - surgery; Abdominal wall; Abdominal Wall - surgery; abdominal wall reconstruction; Abdominoplasty - methods; colostomy closure; Gastrointestinal tract; Hartmann reversal; Hernia, Ventral - surgery; Herniorrhaphy - methods; Humans; parastomal hernia; posterior component separation; Reconstructive surgery; Rehabilitation; robotic surgery; Robotic Surgical Procedures - methods; Robotics; surgical complications; Surgical Mesh - adverse effects; transversus abdominis release; ventral hernia; abdominal wall reconstruction; surgical complications; ventral hernia; parastomal hernia; Hartmann reversal; posterior component separation; transversus abdominis release; colostomy closure; robotic surgery
• ISSN: 1462-8910; 1463-1318
• DOI: 10.1111/codi.16583

Aim
This paper describes a robotic approach to combined gastrointestinal continuity restoration and complex abdominal wall reconstruction after Hartmann's procedure complicated by large midline and parastomal hernias.
Methods
A robotic Hartmann reversal is performed, followed by robotic retromuscular abdominal wall reconstruction of all ventral defects with bilateral posterior component separation using the double‐docking approach. Surgical steps are thoroughly described, and the accompanying video highlights critical steps of the procedure, anatomical landmarks and technical details relevant to successful completion.
Results
Complete restoration of the anatomy was achieved with an operative time of 6.5 h. Mobilization occured on day 1, and bowels were opened on day 3. Surgical discharge was possible on day 5. No intra‐operative surgical complication occurred and follow‐up at 6 months showed no recurrence or mid‐term complication.
Conclusion
Combined minimally invasive reconstruction of the gastrointestinal tract and abdominal wall was feasible using a robotic system. In addition, potential advantages of postoperative rehabilitation and reduced surgical site complications are suggested. Prospective evaluation of the technique is ongoing.