Hernias are one of the most common surgical conditions worldwide, and recurrent hernias present a significant challenge for surgeons. Recurrent hernias often arise due to previous inadequate repair, tissue weakness, or complications such as infection or mesh failure. Bilateral recurrent hernias, affecting both sides of the abdominal wall, further increase the complexity of surgical management. Traditional open or laparoscopic approaches can be difficult in such cases due to adhesions, distorted anatomy, and limited access.

The advent of robotic-assisted surgery, particularly with the Da Vinci Surgical System, has transformed the repair of complex hernias. Robotic repair provides enhanced visualization, precise dissection, and advanced suturing capabilities, offering a safe and effective solution for recurrent bilateral hernias.

Indications for Robotic Hernia Repair

Bilateral recurrent hernia repair using the Da Vinci system is indicated in patients who:

Have recurrence after previous hernia repairs, either open or laparoscopic

Present with bilateral inguinal, ventral, or incisional hernias

Require complex dissection due to adhesions or scar tissue

Need precise mesh placement in a confined anatomical space

Dr. R. K. Mishra and other experts recommend robotic repair for cases where conventional laparoscopy may be challenging, as the robotic system provides greater dexterity and control.

Advantages of Da Vinci Robotic Repair

Robotic-assisted surgery offers several advantages over traditional approaches:

Enhanced 3D Visualization – High-definition magnification allows clear identification of hernia defects, previous mesh, and vital structures such as nerves and vessels.

Improved Dexterity – Robotic instruments mimic the movements of the human wrist, enabling precise suturing and dissection in tight spaces.

Minimized Trauma – Gentle tissue handling reduces the risk of nerve injury, bleeding, and chronic pain.

Efficient Mesh Placement – Robotic suturing allows secure fixation of mesh in large or recurrent defects.

Faster Recovery – Patients experience less postoperative pain, shorter hospital stays, and quicker return to normal activities.

Preoperative Preparation

Comprehensive preparation is critical for successful robotic hernia repair:

Patient Evaluation: Detailed history of prior surgeries, imaging studies (ultrasound, CT scan, or MRI) to assess defect size, previous mesh placement, and adhesions.

Anesthesia Assessment: General anesthesia is required.

Informed Consent: Discussion of risks, benefits, alternatives, and the possibility of conversion to open surgery.

Preoperative Optimization: Weight management, control of comorbidities, and bowel preparation if indicated.

Surgical Technique
Patient Positioning and Port Placement

The patient is positioned supine with slight Trendelenburg tilt for optimal exposure.

Typically, three to four robotic ports are placed along with assistant ports for suction, retraction, and stapling if necessary.

The Da Vinci robot is docked, providing the surgeon with a magnified 3D view and instrument control.

Adhesiolysis and Dissection

Dense scar tissue and adhesions from previous repairs are carefully dissected.

Robotic precision minimizes the risk of injury to surrounding structures such as bowel, bladder, or epigastric vessels.

Hernia sacs are identified and reduced, and any residual mesh is assessed.

Defect Identification and Preparation

The recurrent hernia defects on both sides are clearly delineated.

The preperitoneal or intraperitoneal plane is developed for mesh placement.

Care is taken to avoid tension and ensure proper coverage of the defects.

Mesh Placement and Fixation

A synthetic or biologic mesh is selected based on defect size and patient factors.

Robotic suturing and tacking allow precise fixation without causing nerve entrapment or folding of the mesh.

Overlap of at least 3–5 cm beyond the defect margins ensures durable repair.

Closure and Completion

The peritoneum is closed to cover the mesh and prevent adhesion formation.

Ports are removed, and incisions are closed with absorbable sutures or skin adhesives.

Postoperative Care

Pain Management: Usually mild, managed with oral analgesics.

Early Ambulation: Encouraged to reduce the risk of deep vein thrombosis and promote bowel function.

Diet: Normal diet can often be resumed within hours unless extensive adhesiolysis was performed.

Follow-Up: Assessment for wound healing, recurrence, and chronic pain. Patients are advised to avoid heavy lifting for several weeks.

Outcomes

Clinical experience with robotic bilateral recurrent hernia repair shows:

High success rates with low recurrence

Reduced postoperative pain compared to open repair

Minimal wound complications due to small incisions

Rapid recovery and early return to daily activities

Improved cosmetic results

Robotic surgery allows surgeons to tackle complex recurrent defects that would otherwise require extensive open procedures, making it a preferred option in specialized centers.

Risks and Complications

Though generally safe, potential risks include:

Bleeding or hematoma formation

Infection at port sites or mesh site

Injury to bowel, bladder, or nerves

Chronic pain due to nerve irritation

Rarely, recurrence if mesh fixation is inadequate

Dr. R. K. Mishra emphasizes that careful planning, meticulous dissection, and precise mesh placement are key to minimizing complications.

Conclusion

Da Vinci robotic repair of bilateral recurrent hernia represents a significant advancement in minimally invasive surgery. By combining enhanced visualization, superior dexterity, and precise mesh placement, robotic-assisted surgery allows safe, effective, and durable repair of complex hernias. Patients benefit from reduced postoperative pain, faster recovery, and excellent functional and cosmetic outcomes. In the hands of experienced surgeons, robotic bilateral recurrent hernia repair sets a new standard for managing challenging hernia cases.