Robotic Approach Enables Minimally Invasive Repair of Hard-to-Reach Abdominal Hernias

Lateral abdominal wall hernias are uncommon defects that develop along the side of the abdomen and can be difficult to repair because of their proximity to the ribs, pelvis, muscles, nerves, and blood vessels. Previous operations may further complicate surgery by creating scar tissue and distorting normal anatomy. New findings now show that robotic surgery can enable effective minimally invasive repair of these hard-to-reach hernias.

The study was led by researchers at the Hebrew University of Jerusalem and Shaare Zedek Medical Center under the guidance of Raphael Hospital, in collaboration with Sheba Medical Center and Tel Aviv University. The robotic approach was evaluated in 39 lateral abdominal wall hernia repairs performed between 2018 and 2025. The findings were published in Hernia.

The robotic system allows instruments to bend and rotate in a wrist-like manner. It also provides a magnified three-dimensional view of the operative field. These features help surgeons reach the hernia, close the defect, and position a large reinforcing mesh behind the muscle, where tissue separates it from internal organs.

All 39 operations were completed robotically. None required conversion to open surgery or conventional keyhole surgery. Most patients returned home after one day, and no hernias recurred during a median follow-up of approximately 14 months.

Most patients recovered without complications and reported little postoperative pain. Two patients developed bowel obstructions and required another laparoscopic procedure. Both recovered without bowel resection.

The researchers noted that the study was retrospective, relatively small, and did not directly compare robotic surgery with other techniques. They also stated that longer follow-up will be needed to determine whether the repairs remain successful over many years. Even so, the findings suggest that robotic surgery may make repair of lateral abdominal wall hernias more precise and less invasive.

“Robotic technology is changing the boundaries of what surgeons can do through small incisions. In this case, it allowed us to reach one of the most unforgiving parts of the abdominal wall, an area surrounded by bone, muscle, nerves, and blood vessels, and rebuild the abdominal wall with remarkable precision. It transforms how we can approach an operation that has traditionally been exceptionally difficult,” said Dr. Michael Freund of the Hebrew University and Shaare Zedek Medical Center.

“We are entering a new era in which even highly complex operations can be performed with greater precision and far less disruption to the patient. In our study, every procedure was completed robotically, most patients returned home after just one day, and no hernias returned during follow-up. These are early results, but they offer a powerful glimpse of how robotic surgery could reshape complex abdominal reconstruction,” said Prof. David Hazzan of Raphael Hospital.

Related Links
Hebrew University