ArticleHernia : the journal of hernias and abdominal wall surgery2026
Robotic mini- or less open sublay for anterior abdominal wall hernia repair using the da Vinci single port robotic platform (SP MILOS): a preclinical feasibility study.
Article in Hernia : the journal of hernias and abdominal wall surgery, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
purposeEndoscopic Mini or Less Open Sublay (eMILOS) is a transhernial endoscopically assisted approach for anterior abdominal wall hernia repair that has demonstrated excellent long-term outcomes. Performed through a small skin incision directly over the hernia, the eMILOS technique minimizes additional access trauma, but remains technically demanding with conventional instruments. This study investigates the preclinical feasibility of adapting the da Vinci SP system to perform the transhernial SP MILOS technique.
methodsThis preclinical study evaluated the technical feasibility of performing daVinci SP MILOS hernia repair using human cadavers. The da Vinci SP robotic platform and its standard instruments were employed. Procedural steps, technical considerations, limitations, and potential advantages were systematically documented.
resultsThe procedure was completed through a 1.8-cm skin incision. Correct placement of the Access Port (AP) and defining the custom remote center (CRC) at the posterior fascial edge was essential for optimal trocar orientation and to limit collisions with the incision. The AP can be positioned below the skin or below the fascia depending on work flow and surgeon preference. The retrorectus space was developed robotically from xiphoid to pubis, with full 360° transhernial exposure. Transversus abdominis release and lateral dissection into the preperitoneal and pretransversalis planes were successfully achieved.
conclusionIn this preclinical cadaveric study, the SP MILOS technique provided 360° transhernial access to the retrorectus space without platform repositioning. Our initial experience supports its feasibility as a new single-port robotic option for ventral hernia repair, eliminating access trauma to the abdominal wall through a single, minimal skin incision.
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