Robotic Repair of Right Bochdalek Hernia [VIDEO]

The following video of a Right Bochdalek Hernia Repair by Dr. Mazen Iskandar contains scenes of medical surgery.

This is Mazen Iskandar, presenting a case of a robotic repair of a right Bochdalek hernia. The patient is a 63-year-old female with history of an open Roux-en-Y gastric bypass in 2009, and with significant weight loss, who presented initially with a fat containing Bochdalek hernia that was surveilled and over time, it started having bowel as you can see here in the scan. So, given the enlargement and now that it’s containing intestines, despite minimal symptoms, the decision was made to proceed with surgery. The patient was placed in a supine position with a bump on her right side and lysis of adhesions was initially done laparoscopically to remove some of the adhesions related to her previous open gastric bypass. And forearms was used with the tip up and arm number four to be used for dynamic retraction.

Here, we are retracting the liver and lysing some of the adhesions between the liver and the hernia sac. And the hernia sac was reducing pretty nicely. Very similar to reducing a direct hernia or a paraesophageal hernia. Then I was able to start reducing the small intestine. My access port was used as an assistant Yankauer for suctioning. So, as you can see there was a lot of small bowel that was herniated. The colon which you can also see on the left of the screen was incarcerated, but by reducing the small bowel first, it gave more room for reduction of the right colon. After reducing all of the small bowel, we were able to then reduce the colon much more easily than if we had tried to reduce that in the beginning.

And here is the defect in the posterior diaphragm. We then proceeded to completely mobilize and reduce the sac, dissecting the sac away from the pleura. The goal was to completely reduce and mobilize the sac.

The edge of the sac is now visible. And complete mobilization and reduction of the sac was now achieved. We then proceeded to mobilize the sac away from the posterior diaphragm and mobilized the liver. We identified the vena cava, the porta hepatis, and we ensured that we were away from them. And so now, we are mobilizing the posterior diaphragm and the superior pole of the kidney to be better able to close the defect and reinforce it with mesh. Once we mobilized enough retroperitoneum, we proceeded to close the defect, which measured 6 centimeters with 2-0 permanent V-Loc.

And the defect closed without much tension.

We then measured the space for mesh placement and I opted to use a 9-centimeter Symbotex mesh. The mesh was placed into the pocket between the kidney and the diaphragm, and was fixated to the diaphragm and to the peritoneum using 2-0 silk sutures.

Then the excess mesh was trimmed to ensure that there is no mesh in contact with viscera. So, the mesh was tailored. And once the liver was dropped, the mesh was completely excluded. Thank you for watching.

source https://iskandarcenter.com/hernia-surgery/robotic-repair-of-right-bochdalek-hernia-video/