Robotics in diastasis recti is used because of the structural features it allows and not only because of the small access routes through which the surgery is performed.
Indeed, with robotic instrumentation, it became possible to operate on diastasis recti by exploiting the pre-peritoneal space.
With the placement of the reconstruction in the pre-peritoneal plane, the main critical point of laparoscopic techniques, namely the contact of the mesh with the viscera, has been solved .
Also solved by the same principle was the main weakness of endoscopic techniques, namely the proximity of the mesh to surface tissues.
The particular pre-peritoneal workspace together with the versatility of the robotic instruments allowed us to achieve " the ideal " reconstruction in the position orthotopic of the linea alba (i.e., in its natural location), without the introflexions or extroversions typical of other techniques.
Robotics, the full expression of mini-invasiveness
Robotics allows operation through small access routes, which have been further reduced in caliber with the latest generation of tools applicable to the platform.
The small size of the access routes is a highly valued aesthetic feature, but it is the reconstructive muscle-tendon structure that is the main prerogative of our interventions.
linea alba is restored to orthotopic position, that is, the original anatomical position , and the rectus muscles are aligned in plane, without introflexion or extroversion.
If a mesh is needed to make up for a tissue deficit, in addition to being ultralight, semireabsorbable and self-fixing, it will be placed in the pre-peritoneal plane remaining stable without the need for traumatic means of fixation.
Due to the pre-peritoneal location, the mesh will not come into contact with either the viscera or the superficial layers (as may occur in laparoscopy or endoscopy, respectively).
Thus, the concept of minimally invasive is not only related to small surgical access routes, but especially to the reconstructive structure, which must respect the original anatomy and not conflict with the viscera or superficial tissues.
An abdominal wall reconstructed with these criteria also becomes an ' excellent basis for possible additional work
Indeed, it is possible to combine R-Tapp robotic reconstruction with additional procedures such as liposculpture and excess skin removal, in the procedure we callThe Triad ®.
Characteristics of robotic platforms
The surgeon operates at a short distance from the patient having control of the procedure through a three-dimensional viewer and sophisticated "masters" for instrument management.
Through stereoscopic optics (two integrated cameras) the surgeon has a truly three-dimensional view, and thanks to unique fluorescence-Laser filters , anatomical structures otherwise invisible with normal laparoscopy can be highlighted .
Robotic instruments have 7 degrees of freedom in addition to a feature called "endowirst" that gives even more articulability than the human wrist.
Articulability is the greatest quality of robotic instruments and has been a great step forward compared to laparoscopy (which instead remains rigid and fixed on a single working axis).
Robotic instruments, because of these characteristics, allow them to adapt to and respect the anatomy in regions where it was not completely possible before, such as the pre-peritoneal space.
Thus, in robotic surgery, one works in extremely thin spaces with minimal impact and great precision.
Anasthesiologically , there is no variation from all other methods, all of which involvegeneral anesthesia.
Technique is key
To perform robotic surgery on the abdominal distasis, it is necessary, of course, to have the proper instrumentation, buteven more important than the instrumentation is the technique that can be performed with it.
Our technique belongs to the R-Tapp (Robotic Trans Abdominal Pre-Peritioneal) group and was developed from this category of surgery.
R-Tapp methods were initially used (in a simplified manner), for the treatment of hernias.
We are responsible for the further development and consequently the systematic application of this surgery for treatment diastasis recti.
Currently, after years of work, we have accumulated the largest operating case history internationally in R-Tapp robotic reconstruction for rectus abdominis diastasis.