Procedure: The patient was brought into the operating room. The patient was identified as correct patient. The patient was placed on operating table in supine position. Endotracheal General anesthesia was induced. Perioperative antibiotics were given. A time out was completed, verifying correct patient, procedure, site, positioning, implants and/or special equipment, blood loss, need for ICU, prior to beginning this procedure. Abdomen was prepped and draped in the usual sterile fashion.
A small 5 mm incision made in left upper quadrant and peritoneum entered via optiview and pneumoperitoneum achieved. Underlying bowel inspected and no iniury identified. A 12mm long laparoscopic port was inserted in the middle and*8 mm robotic port inserted just above and anterior of ASIS on*left side of abdomen. LUQ port was changed to 8mm robotic port. Mini lap inserted through 12 mm port and Robot was docked. A 30 up camera and scissors with cautery and Maryland*grasper were used. Above findings noted. Omental and small bowel adhesions were taken down and then preperitoneal fat taken down around the hernia defects to place the mesh.. Hernia defects measured and were*closed with permanent 0 Stratafix running suture. *An Atrium mosaic mesh was taken and trimmed to measurements and 2 Vicryl*0 suture were placed at the center of the mesh and in the centre of one half and mesh was rolled and inserted in the peritoneal cavity through 12 mm port. The Vicryl*sutures was then brought out through the skin using carter thomason at center of hernia defects to approximate the mesh to abdominal wall. The periphery of mesh was then sutured in place with running 2-0 Stratafix. The center of the mesh was fixed in same manner using 2-0 Stratafix. *At the conclusion of case the mesh was fixed with abdominal wall without tension or folds. The Vicryl sutures was then cut flush with the skin. All needles were removed. Robot was undocked. Using laparoscopic camera, minilap*were removed and peritoneal cavity was inspected for hemostasis.
Left middle*12mm port site wound closed with Vicryl*0, figure of eight sutures using carter thomason. Port site wound closed with Monocryl 4-0 subcuticular stiches and Dermabond placed.
All instrument, lap pad, needle count was correct x2 at the end of the procedure. The patient tolerated the procedure well and was extubated in operating room and transported to postanesthesia care unit in stable condition