TARUP technique in diastasis recti
Tarup is one of those techniques that involve opening and dissecting the posterior sheath of the rectus muscles from the contractile muscle substance. Although performable laparoscopically or robotically, it is akin to the traditional techniques of Rives and the like while structurally inheriting their degree of invasiveness.
Tarup and invasiveness: involves dissection of the rectus muscles
It is the opening of the protective sheath of the rectus muscles that we consider the main critical point of the technique.
All techniques with tendon sheath opening are distant from our reconstructive ideals because of the major dissection they involve, the anatomic subversion of the linea alba, as well as the presence of prosthetic bodies in direct contact with contractile muscle fibers.
Tarup learning curve is faster for inexperienced surgeons
Generally, it is easier for the surgeon with little specific experience to dissect the rectus muscle sheath, which is rather represented and coarse, than to create the pre-peritoneal space, which is by nature more delicate and thin.
In fact, some studies show that the Tarup technique is easier for inexperienced surgeons than other pre-peritoneal methods.
However, from the patient's point of view, one has to consider the level of invasiveness and above all what results structurally at the end.
There is direct contact between mesh and contractile fibers
As can be seen from the images, in Tarup there is the inevitable direct contact between the mesh and contractile fibers.
In addition, the midline suture is anchored only to the anterior sheath of the rectus being the posterior sheath interrupted at the dissection stage.
Therefore, at the structural level, the reconstruction of linea alba is only partial because the posterior sheath is excluded from the suture and without the possibility of rejoining anatomically due to the interposition of the mesh.
Behind the muscles or inside the muscles?
TARUP, the name of the technique: Robotic Transabdominal "Retromuscular" Umbilical Prosthetic, is not fully comprehensive.
Indeed, it should be specified that "retromuscolar" means not only behind the rectus muscles but also ... "inside" ... since the muscle sheath is opened and the materials placed within it.
Instrumentation is not sufficient to describe a technique
Although r-Tarup is a technique that makes use of robotic instrumentation, it is not in our preferences for the structural aspects described above.
From the patient's point of view, it is important not to fall into generalizations; defining a technique "in robotics" is not enough to describe it, and one needs to understand in detail what is done at the demolition/reconstruction level, considering the materials used and especially the anatomical space where they are placed.
The Tarup technique is performed under general anesthesia like all other techniques
At the anesthesiologic level, Tarup or r- Tarup always requires general anesthesia as do all the other techniques for rectus abdominis diastasis.