Robot-assisted laparoscopic repair of a huge sliding inguinal hernia of the urinary bladder, left ureter and sigmoid colon

Abstract

Objectives: We are presenting a challenging case of huge sliding inguino-scrotal hernia with herniated bladder, left ureter and sigmoid colon. We are presenting robotic approach as an alternative for classic open approach. Methods: Our patient is an 82-year-old male who presented with an enlarged scrotum with dull pain that was worsened with ambulation. Additionally, he complained of lower urinary tract symptoms, specifically prolonged voiding, and urinary hesitancy. Work up, including cross sectional imaging revealed a large left inguino-scrotal herniation of the bladder, along with the left ureter and sigmoid colon. Our patient desired restoration of his anatomy in hopes to improve his pain and voiding difficulty. Through shared decision making the patient elected for hernia repair with possible left orchiectomy via a robotic approach. After hernia contents were reduced, a 4 × 6 inches polypropylene and ePTFE mesh secured with 3-0 V-loc Proline suture. In the video, we show our technique for robotic approach for huge inguino-scrotal hernia repair. Results: Our operation proved successful with a total operative time was 3 hours and 50 minutes and estimated blood loss of 30 cc. He was admitted overnight for postoperative monitoring and tolerated a regular diet beginning the morning of postoperative day 1. He regained bowel function on postoperative day 2 and was subsequently discharged on postoperative day 6 due to social situation and placement with an uncomplicated hospital course. Conclusion: Robotic approach is a feasible and safe option for management of huge inguino-scrotal hernia with involvement of multiple organs.

Keywords

• Robotic
• Minimally invasive
• Hernia
• Bladder
• Mesh