This educational surgical video showcases an Advanced Robotic Approach to Right Direct Inguinal Hernia, demonstrating a step-by-step Robotic TAPP (Transabdominal Preperitoneal) Repair performed at World Laparoscopy Hospital (WLH).

In this detailed procedure video, viewers can observe precise robotic port placement, anatomical dissection of the preperitoneal space, reduction of the hernia sac, mesh placement, and peritoneal closure using advanced robotic technology. This video presentation highlights the advantages of robotic surgery, including enhanced dexterity, superior visualization, and improved surgical ergonomics.

This robotic surgery video is ideal for laparoscopic surgeons, robotic surgery trainees, and medical professionals seeking advanced insights into minimally invasive hernia repair techniques practiced at WLH under expert guidance.

A Step-by-Step TAPP Repair at WLH

Inguinal hernias are among the most commonly encountered surgical conditions worldwide, with direct inguinal hernias representing a defect through the posterior wall of the inguinal canal due to weakness in the transversalis fascia. While conventional open and laparoscopic approaches have served well for decades, the rise of robotic-assisted Transabdominal Preperitoneal (r-TAPP) hernia repair has marked a significant evolution in minimally invasive hernia surgery. At the World Laparoscopy Hospital (WLH) — a global center for advanced laparoscopic and robotic surgical training — this approach combines precision, ergonomic safety, and optimized patient outcomes through a structured, step-by-step robotic protocol. 

Why Robotic TAPP for Direct Inguinal Hernia?

Robotic TAPP builds on the principles of standard laparoscopic TAPP but adds key technological enhancements:

Three-dimensional high-definition visualization of the surgical field.

Wrist-articulated robotic instruments enabling refined movements and precise dissection.

Improved surgeon ergonomics, reducing fatigue during complex intra-abdominal maneuvers. 

Compared with conventional laparoscopy, robotic systems have been shown to facilitate more efficient dissection and suturing — often leading to reduced operative times despite initial docking steps — and provide consistent view and access to key anatomical landmarks. 

Step-by-Step r-TAPP Repair at WLH
1. Preoperative Preparation

Patients are evaluated with a complete clinical examination and imaging if needed. A direct hernia is confirmed on clinical and/or imaging examination. Prior to surgery:

Ensure bladder evacuation to reduce the risk of injury.

Administer general anesthesia and place the patient in a slight Trendelenburg (head-down) position to assist with exposure. 

2. Port Placement and Robotic Docking

A pneumoperitoneum is established, typically through a small umbilical incision. Three robotic trocars are placed:

One 10 mm port for the camera near the umbilicus.

Two 8 mm working ports lateral to the midline at the level of the umbilicus.
After port placement, the robotic platform (e.g., Da Vinci system) is docked, connecting the instruments to the robotic arms. 

3. Diagnostic Inspection

Upon entering the abdominal cavity, the surgeon inspects the anatomy to:

Confirm the right direct inguinal hernia.

Identify landmarks such as the inferior epigastric vessels, Cooper’s ligament, and the hernia defect itself.
This step is crucial in tailoring the repair strategy. 

4. Peritoneal Incision and Preperitoneal Flap Creation

A linear peritoneal incision is made several centimeters above the hernia defect. The peritoneal flap is developed laterally toward the anterior superior iliac spine, exposing the preperitoneal space. Proper plane development prevents visceral injury and optimizes mesh placement. 

5. Hernia Sac Reduction and Dissection

In a direct inguinal hernia, preperitoneal fat and any protruding sac are gently reduced back into the abdominal cavity. Robotic articulation permits careful dissection around sensitive structures (e.g., vas deferens, spermatic vessels) with minimal trauma. 

6. Mesh Placement

A sufficiently large synthetic mesh — often polypropylene or a lightweight variant — is positioned to cover the myopectineal orifice, including potential sites for direct, indirect, and femoral hernias. Wide coverage is essential to prevent recurrence.

At WLH, surgeons emphasize proper mesh orientation and flat deployment to avoid wrinkles, folds, or tension, significantly enhancing long-term outcomes. 

Depending on surgeon preference and patient anatomy, the mesh may be:

Secured with sutures/tacks,

Or left without fixation when appropriate, reducing nerve irritation risk. 

7. Peritoneal Closure

The peritoneal flap is then meticulously sutured closed over the mesh using absorbable barbed or standard sutures. This step restores normal peritoneal anatomy and prevents bowel from contacting the prosthesis. 

8. Final Checks and Undocking

After confirming mesh position and hemostasis, the robot is undocked. Ports are removed and small incision sites are closed — often with absorbable sutures or surgical glue — leaving minimal scarring. 

Benefits of the Robotic Approach

Robotic TAPP at centers such as WLH offers multiple advantages:

Enhanced surgical precision due to three-dimensional magnification and wristed instruments.

Minimal postoperative pain and smaller incisions.

Quicker recovery with shorter hospital stays (often same-day discharge). 

Potentially lower recurrence rates, as precise dissection and mesh placement reduce defect retensioning. 

These benefits make robotic TAPP a compelling option for direct inguinal hernias, particularly in patients who are good candidates for minimally invasive surgery.

Conclusion

The robotic TAPP approach to right direct inguinal hernia repair represents a significant advancement in modern hernia surgery. At institutions like World Laparoscopy Hospital, the structured, step-wise technique — grounded in meticulous anatomical understanding — maximizes surgical accuracy, improves patient comfort, and shortens recovery time. As robotic platforms continue to integrate into general surgery, procedures like r-TAPP are positioned to become preferred techniques for both standard and complex hernia repairs.