Parietex progrip self fixating mesh

A laparoscopic 0° camera with three-dimensional visualization (Karl Storz, Tuttlingen, Germany) was used with an 11-mm disposable trocar at the umbilicus and two 5-mm disposable trocars for instruments on both sides of the umbilicus (trocars from Ethicon, Johnson & Johnson, Somerville, NJ, USA). Pneumoperitoneum was created with a Veress needle, with pressure maintained at 12 mmHg. Self-gripping monofilament polyester mesh (Parietex Progrip™ Self-Fixating Mesh; Medtronic, Minneapolis, MN, USA) was used, with a width of 16 cm and length of 12 cm for unilateral hernias, and a width of 28 cm and length of 13 cm for bilateral hernias. Care was taken to close the peritoneum properly after mesh placement using a barbed suture (V-Loc™ 90; Medtronic). The fascia at the umbilical trocar site was closed with a U stitch of absorbable suture, size 0 (Vicryl^® Plus; Ethicon, Johnson & Johnson). Two semireusable endograspers were used, in addition to disposable endoscopic scissors with monopolar cautery, and a reusable needle-driver.

In open surgery, an iodine-impregnated drape was used to cover the surgical field. Surgery was performed using a 6-cm long incision, and a standard Lichtenstein technique was used. A self-gripping monofilament polyester mesh (Parietex Progrip™ Self-Fixating Mesh, Medtronic, Minneapolis, MN, US) of 15 by 15 cm was tailored to a mesh with a slit for the cord and a width of 14 cm and a length of 9 cm. No additional sutures were used for fixation of the mesh.

Robotic operations were performed using the daVinci Xi system (Intuitive, Sunnyvale, CA, US) with a 0° scope. Three robotic 8 mm trocars were placed on a horizontal line at the umbilicus and on both sides with 7 cm between trocars. Blind entry of the blunt first trocar at the umbilicus was performed to create the pneumoperitoneum at 12 mmHg. Self-gripping monofilament polyester mesh (Parietex Progrip™ Self-Fixating Mesh, Medtronic, Minneapolis, MN, US) was used, with a width of 16 cm and a length of 12 cm for unilateral hernias, and with a width of 28 cm and a length of 13 cm for bilateral hernias. Care was taken to properly close the peritoneum after mesh placement using a barbed suture (V-Loc™ 90, Medtronic, Minneapolis, MN, US). Three robotic instruments were used (monopolar hot shears curved scissors, fenestrated bipolar forceps, and a large needle driver).