RESUMO
The principle of targeted separation or weakening of individual components of the abdominal wall to relieve tension in the median line during major abdominal reconstruction has been known for over 30 years as anterior component separation (aCS) and is an established procedure. In search of alternatives with lower complication rates, posterior component separation (pCS) was developed; transversus abdominis release (TAR) is a nerve-sparing modification of pCS. With the ergonomic resources of robotics (e.g., angled instruments), TAR can be performed in a minimally invasive manner (r-TAR): hernia gaps of up to 14â¯cm can be closed and a large extraperitoneal mesh implanted. In this video article, the treatment of large incisional hernias using the rTAR technique is presented. Exemplary results of a cohort study in 13 consecutive patients are presented. The procedure is challenging, but our own results-as well as reports from the literature-are encouraging. The rTAR is becoming the pinnacle procedure for abdominal wall reconstruction.
Assuntos
Parede Abdominal , Hérnia Ventral , Hérnia Incisional , Músculos Abdominais/cirurgia , Parede Abdominal/cirurgia , Estudos de Coortes , Hérnia Ventral/cirurgia , Herniorrafia , Humanos , Hérnia Incisional/cirurgia , Telas CirúrgicasRESUMO
The principle of targeted separation or weakening of individual components of the abdominal wall to relieve tension in the median line during major abdominal reconstruction has been known for over 30 years as anterior component separation (aKS) and is an established procedure. In search of alternatives with lower complication rates, posterior component separation (pKS) was developed; transversus abdominis release (TAR) is a nerve-sparing modification of pKS. With the ergonomic resources of robotics (e.g., angled instruments), TAR can be performed in a minimally invasive manner (r-TAR): hernia gaps of up to 14â¯cm can be closed and a large extraperitoneal mesh implanted. In this video article, the treatment of large incisional hernias using the rTAR technique is presented. Exemplary results of a cohort study in 13 consecutive patients are presented. The procedure is challenging, but our own results-as well as reports from the literature-are encouraging. The rTAR is becoming the pinnacle procedure for abdominal wall reconstruction.