Minimally invasive surgery allows many operations to be performed through small access sites for surgery, using a high-definition camera and dedicated instruments.
The aim is not simply to reduce the size of the incisions, but to perform the necessary operation while limiting trauma to the abdominal wall and the risk of infection.
The technique is chosen according to the condition and the patient.
Minimally invasive surgery does not mean always using the same procedure: access, surgical plane and reconstructive technique must be tailored to each case.
Why minimally invasive surgery matters
Compared with large surgical incisions, minimally invasive approaches reduce trauma to the abdominal wall and the surgical wound.
The main benefits may include:
The benefit in terms of wound complications is particularly important in ventral and incisional hernia surgery because of the lower rate of wound and mesh infection.
Laparoscopic surgery
Laparoscopy uses a camera and surgical instruments introduced through small access sites. All surgeons are at the operating table and operate while viewing the surgical field on a high-definition monitor, working inside the abdomen through cannulas that accommodate long instruments.
Main benefits
- smaller surgical access sites;
- wide anatomical view;
- less wound trauma;
- fewer wound infections in selected procedures;
- ability to explore multiple regions through the same access sites.
Robotic surgery
Robotic surgery also uses small access sites but adds high-definition three-dimensional vision and articulated instruments controlled by the surgeon through a console. One surgeon sits at the console to guide the robot, while the others are at the operating table beside the robotic arms.
The robot enables:
All laparoscopic operations and many complex open procedures can be performed using the robotic platform.
Minimally invasive abdominal wall procedures
Abdominal wall surgery is one of the fields in which the evolution of minimally invasive techniques has most significantly changed surgical treatment.
Benefits
viewing the abdominal cavity from within → identifying all defects;
limiting the extent of the incisions needed to reach the defect;
less tissue trauma → faster recovery and less postoperative pain;
reduced risk of wound and mesh infection.
However, no single minimally invasive technique suits everyone; the choice depends on:
TAPP and r-TAPP
The TAPP — TransAbdominal PrePeritoneal repair technique is one of the main minimally invasive techniques for treating:
- inguinal hernias
- femoral hernias.
- 1First stepThe peritoneal cavity is entered and the inguinal region inspected; this allows us to identify:
- bilateral hernias
- associated femoral hernias
- 2Second stepAfter returning the hernia sac and its contents to the abdomen, a large mesh is placed to cover all inguinal openings (preventing hernias from developing at other sites too)
Large mesh covering all inguinal openings. - 3Third stepThe mesh is covered with peritoneum so that it does not come into contact with the bowel
The same procedure can be performed using:
- Laparoscopy: TAPP
- Robotics: r-TAPP
TEP and r-TEP
The TEP — Totally Extraperitoneal repair technique allows inguinal hernias to be treated by working directly in the preperitoneal space, without entering the peritoneal cavity. Indicated for:
- Inguinal hernias
- Femoral hernias
It offers the same benefits as TAPP and shares the same technical steps, except for the final step, as the peritoneum is never opened.
The same procedure can be performed using:
- Laparoscopy: TEP
- Robotics: r-TEP
eTEP and r-eTEP
The eTEP — Enhanced-view Totally Extraperitoneal repair technique extends the principle of the extraperitoneal approach to ventral and incisional hernia surgery.
It may be indicated for:
It allows:
- 1First stepworking in the retromuscular space of the abdominal wall through 3 small skin incisions
Creation of the retromuscular pocket. - 2Second stepreconstruction of the midline
Midline reconstruction using sutures. - 3Third stepplacement of the mesh in the retromuscular position, separated from the peritoneal cavity and the bowel.
Mesh placement. 
Retromuscular plane for the mesh.
The same procedure can be performed using:
- Laparoscopy: eTEP
- Robotics: r-eTEP
peTEP and r-peTEP
The peTEP technique is a pre-aponeurotic endoscopic technique that allows certain midline defects to be corrected through small access sites.
It can be used in selected patients with:
- umbilical hernias
- epigastric hernias
- rectus diastasis
- multiple defects of the linea alba
- some lateral defects
Through 3 small skin incisions, the surgeon:
- 1First stepprepares the preperitoneal space
- 2Second stepreconstructs the midline using sutures
Midline reconstruction using sutures. - 3Third stepplaces the mesh in the preperitoneal position
Robotic peTEP: preperitoneal mesh placement.
It can be performed using:
- laparoscopy: peTEP
- robotic surgery: r-peTEP
miSAR® and p-miSAR®
The miSAR® — Minimally Invasive Stapled Abdominal Wall Repair technique is a minimally invasive technique developed for midline reconstruction.
Indicated for:
- Midline ventral hernias
- Umbilical hernia
- Epigastric hernia
- Rectus diastasis
- Midline incisional hernias
The procedure allows:
- 1First stepa mechanical reconstruction of the abdominal wall
- 2Second stepplacement of the mesh in the retromuscular position through small surgical access sites that remain below the underwear line
The variant p-miSAR® uses the same procedure but remains within the preperitoneal plane throughout.
TAR and r-TAR
The TAR — Transversus Abdominis Release technique is an advanced reconstruction technique used primarily for large abdominal wall defects and complex incisional hernias.
This technique uses release of the transversus abdominis muscle to increase the mobility of the abdominal wall compartments, facilitate closure of the defect and create a large retromuscular space for mesh placement.
In complex minimally invasive reconstruction, the robotic platform can be particularly useful for dissection and suturing in deep planes (r-TAR).
IPOM and r-IPOM
This procedure involves placing an intraperitoneal mesh to bridge the defect (IPOM) or after suturing the defect(IPOM-plus). It is a simple, quick technique, but it involves placing a foreign body in the peritoneal cavity.
Indications (increasingly limited)
- Emergency surgery in obese patients
Minimally invasive abdominal surgery
Minimally invasive surgery is not limited to the abdominal wall. Laparoscopy and robotics are used in many areas of general surgery, both for planned operations and, when clinical conditions permit, in emergency surgery.
Minimally invasive pelvic floor surgery
Pelvic floor prolapse can simultaneously involve the rectum, vagina, uterus and bladder.
Where indicated, a laparoscopic or robotic approach allows surgeons to work deep within the pelvis through small access sites and can be used for reconstructive procedures and suspension of the pelvic organs.
Procedures:
It is important to assess the pelvic floor alongside the abdominal wall because both systems contribute to the same balance of pressure and function.
Gallbladder surgery
A laparoscopic cholecystectomy is one of the most established minimally invasive procedures in general surgery.
It is used primarily to treat symptomatic gallstones and gallbladder complications, including many forms of cholecystitis.
It involves removing the gallbladder through 3 or 4 small skin scars.
In selected cases, it can also be performed using a robotic platform.
Minimally invasive colon surgery
Laparoscopic and robotic surgery can be used to treat many conditions of the colon, both benign and malignant.
Indications may include:
- complicated or recurrent diverticulitis;
- strictures;
- polyps that cannot be treated endoscopically;
- colon and rectal tumours;
- some intestinal complications.
The minimally invasive approach allows bowel resections and reconstructions to be performed with smaller abdominal incisions than conventional surgery.
