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

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.