The patient was met in the preoperative holding area, patient, consent, site and procedure to be performed confirmed. All questions answered. The patient was transported to the operating room and placed on the table in supine position, boney areas padded, sequential compression devices applied to the bilateral lower extremities and secured with straps. General anesthesia was induced, and patient was intubated without issue. Preoperative Ancef was given. Timeout was done and all were in agreement.
I accessed the peritoneal cavity with a Veress needle through the [umbilicus/LUQ] and insufflated the cavity to 8 mmHg. Then I used optical trocar technique to place an 8mm port in the left upper quadrant. There was no visceral injury with this or the Veress needle. Two additional 8 mm robotic ports were placed under direct vision without injury to triangulate the pelvis. I noted an [hernia]. The robot was docked, and we took our place on the console.
On the [left/right] side I created a preperitoneal flap exposing the myopectineal orifice, exposing the pubis medially and the lateral abdominal wall laterally. I reduced the direct hernia which contained fat. There was a patent deep inguinal ring without hernia sac or contents. I made sure to free the inferior peritoneum enough to allow for flat mesh placement. The fascia of the direct hernia space as well as the internal ring were re-approximated with size 2-0 V-lock suture in a running fashion. A 9 x 11 cm ProGrip mesh was placed over the myopectineal orifice with wide overlap of the defect. The medial edge was over the pubis and the inferior edge laid flat. The peritoneal flap was closed with size 2-0 V-lock suture in a running fashion. The abdomen was desulfated, the robot undocked and the incisions closed with 4-0 Vicryl and 5-0 plain gut and dressed with Steri-strips.
The final count was correct. The testicles were palpated in the scrotum.
Dr. [attending] was present or available for the entire case.
Service: GS (green)
Author: Garrett Skinner