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Background <p>Incisional flank hernias pose a particular challenge due to scarred, retracted fascial edges and complex regional anatomy. This study evaluates a robotic-assisted technique employing progressive intermittent intracorporeal fascial traction (Vicryl 0 sliding-knot) combined with barbed-suture augmentation (STRATAFIX™ Symmetric PDS 0) in large-volume defects.</p> Methods <p>Between June 2023 and January 2025, 13 patients with symptomatic incisional flank hernias underwent repair with the da Vinci X<sup>®</sup> system. A macroporous polypropylene mesh was implanted. Patients were followed up at 1-, 3-, and 6-months including ultrasound, VAS pain scoring, and recurrence screening.</p> Results <p>Median total operative time was 167&#xa0;min (IQR 117–193.5), console time 141&#xa0;min (IQR 104.5–176.5). The median defect size was 138.75&#xa0;cm² [IQR 55.5–249]. Meshes with a median size of 433&#xa0;cm² [315-572.5] and a mesh-to-defect ratio of &gt; 3:1 were implanted. Pain scores remained stable at median VAS 2/10 on postoperative days 1–3. One patient developed seroma (Clavien-Dindo I); no Clavien-Dindo ≥ II complications occurred. No hernia recurrences were observed till the six months follow-up. Median length of stay was 2 days (IQR 2–3).</p> Conclusion <p>Progressive intracorporeal fascial traction with sliding-knot technique and barbed-suture reinforcement allows safe, tension-reduced repair of large incisional flank hernias, resulting in low pain levels, brief hospitalization, and no early recurrences. Longer-term, comparative studies are warranted.</p>

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Robotic-assisted treatment of flank hernias with progressive intracorporeal fascial traction (PIFT): A novel technique for secure fascial adaptation

  • 期刊论文

  • 出版模式：

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  • 发表日期：

    2025年11月19日

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  • Anna Hannebauer,
  • Ahmed Al-Mawsheki,
  • Maximilian Bockhorn,
  • Fadl Alfarawan

摘要

Background

Incisional flank hernias pose a particular challenge due to scarred, retracted fascial edges and complex regional anatomy. This study evaluates a robotic-assisted technique employing progressive intermittent intracorporeal fascial traction (Vicryl 0 sliding-knot) combined with barbed-suture augmentation (STRATAFIX™ Symmetric PDS 0) in large-volume defects.

Methods

Between June 2023 and January 2025, 13 patients with symptomatic incisional flank hernias underwent repair with the da Vinci X® system. A macroporous polypropylene mesh was implanted. Patients were followed up at 1-, 3-, and 6-months including ultrasound, VAS pain scoring, and recurrence screening.

Results

Median total operative time was 167 min (IQR 117–193.5), console time 141 min (IQR 104.5–176.5). The median defect size was 138.75 cm² [IQR 55.5–249]. Meshes with a median size of 433 cm² [315-572.5] and a mesh-to-defect ratio of > 3:1 were implanted. Pain scores remained stable at median VAS 2/10 on postoperative days 1–3. One patient developed seroma (Clavien-Dindo I); no Clavien-Dindo ≥ II complications occurred. No hernia recurrences were observed till the six months follow-up. Median length of stay was 2 days (IQR 2–3).

Conclusion

Progressive intracorporeal fascial traction with sliding-knot technique and barbed-suture reinforcement allows safe, tension-reduced repair of large incisional flank hernias, resulting in low pain levels, brief hospitalization, and no early recurrences. Longer-term, comparative studies are warranted.