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. 2021 Mar 24:48:e20202879.
doi: 10.1590/0100-6991e-20202879. eCollection 2021.

Image Inversion during Xi Robotic ventral hernia repair: making it even more effective

[Article in English, Portuguese]
Andre Luiz Gioia Morrell  1   2   3   4   5 , Alexander Charles Morrell-Junior  1   2   3   4   5 , Allan Gioia Morrell  1   3   4   5 , Jose Mauricio Freitas Mendes  1   2   3   4   5 , Alexander Morrell  1   2   3   4   5
Affiliations

Image Inversion during Xi Robotic ventral hernia repair: making it even more effective

[Article in English, Portuguese]
Andre Luiz Gioia Morrell et al. Rev Col Bras Cir. .

Abstract
in English, Portuguese

Introduction: currently, there are several clinical applications for robot-assisted surgery and in the hernia scenario, robot-assisted surgery seems to have the ability to overcome laparoscopic ventral hernias repairs limitations, facilitating dissection, defect closure, and mesh positioning. Exponentially grown in numbers of robotic approaches have been seen and even more complex and initially not suitable cases have recently become eligible for it. An appropriate tension-free reestablishment of the linea alba is still a major concern in hernia surgery and even with the robotic platform, dissecting and suturing in anterior abdominal wall may be challenging. This article reports a technical image artifice during a da vinci Xi-platform robotic ventral hernia repair allowing the surgeon to establish a more familiar and ergonomic manner to perform dissection and suturing in anterior abdominal wall.

Technical report: a step by step guided technique of image inversion artifice is described using detailed commands and figures to assure optimal surgical field and ergonomics whenever acting in robotic ventral hernias repair with the da Vinci Xi-platform. Our group brief experience is also reported, showing an easy and reproducible feature among surgeons with safe outcomes.

Conclusion: we consider that image inversion artifice is a simple and reproducible feature in robotic ventral hernia repair. Through a step-by-step guide, this report enables the creation of an artifice providing a comfortable operative field and allowing the surgeon to achieve its best proficiency in hernia surgery.

Introdução:: as qualidades da cirurgia robótica em diversos campos da cirurgia minimamente invasiva são notórias e, no cenário de hérnias abdominais, ela tem se mostrado capaz de superar as limitações da laparoscopia facilitando a dissecção, o fechamento do defeito herniário e o posicionamento da tela. O número de abordagens robóticas cresceu exponencialmente e casos ainda mais complexos e inicialmente inadequados tornaram-se recentemente elegíveis para uma cirurgia menos invasiva. A reconstrução adequada da linha alba e livre de tensão ainda é uma grande preocupação na cirurgia de hérnia e, mesmo com a plataforma robótica, dissecar e suturar na parede abdominal anterior pode ser um desafio. Este artigo relata um artifício técnico com inversão de imagem durante a correção de hérnia ventral robótica com a plataforma Da vinci Xi, permitindo ao cirurgião estabelecer uma maneira mais familiar e ergonômica de realizar dissecção e sutura na parede abdominal anterior.

Nota Técnica:: uma técnica guiada passo a passo com artifício de inversão de imagem é descrita usando comandos e figuras detalhadas para garantir campo cirúrgico ideal e melhor ergonomia ao cirurgião sempre que atuar na correção de hérnias ventrais robóticas com a plataforma Da vinci Xi. Nossa breve experiência de grupo também é relatada, mostrando-se uma técnica fácil e reprodutível entre cirurgiões com resultados seguros.

Conclusão:: consideramos que o artifício de inversão de imagens é uma característica simples e reprodutível na correção de hérnia ventral robótica. Por meio de um guia passo a passo, este artigo detalha a criação de um artifício técnico que proporciona um campo operatório confortável ao cirurgião atingindo sua melhor proficiência em cirurgia de hérnia.

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Conflict of interest statement

Conflict of interest: no.

Figures

Figure 1
Figure 1. A: Image with the perspective of the anterior abdominal wall in the upper quadrant of the surgeon display, acting in the “ceiling” / B: Visualization of a less comfortable and usual layout when approaching defects of the anterior abdominal wall.
Figure 2
Figure 2. A and B: Suture performed with pronation movement in a backhand maneuver, less comfortable and slower when compared to the forehand supination movement.
Figure 3
Figure 3. A: Endoscope disposed with 30 degrees looking up, before rotation / B: Endoscope after rotation, disposed with 30 degrees looking down / C and D: Display at the console to access instruments reassignment.
Figure 4
Figure 4. A: Visualization generated with the image inversion artifice, allowing a surgical field in the lower corner of the screen, acting on the “floor”. B: Handling the structures and handling the needle in its most comfortable form.
Figure 5
Figure 5. A: Performing a suture using supine forehand movements, more ergonomic, comfortable and habitual for the surgeon when compared to pronation of the backhand wrist.
Figure 6
Figure 6. da Vinci Xi platform and surgeons console.
See this image and copyright information in PMC

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