R PeTEP Suprapubic Diastasis Recti Repair with Inan Inverting Plication Suture IIPS

This video presents a robotic PeTEP suprapubic docking approach for the repair of diastasis recti, incorporating the Inan Inverting Plication Suture technique and wide extraperitoneal prosthetic reinforcement. The procedure is conceived as a fully preperitoneal and pre-fascia transversalis access, without entry into the retrorectus plane and without disinsertion of the posterior rectus sheath from the linea alba. This strategy aims to restore full abdominal wall function while preserving native abdominal wall mechanics and statics, allowing the patient to return to physical activity without functional restrictions. The operation begins with an initial, minimal laparoscopic dissection of the Retzius space performed prior to robotic docking. This preliminary step provides early access, anatomical orientation, and the creation of a stable working domain, enabling a smooth and controlled transition to the robotic phase. Once suprapubic docking is completed, the lateral pre-fascia transversalis spaces are dissected first, followed by synchronous midline dissection. This bilateral and midline progression is conducted with meticulous respect for tissue planes, resulting in minimal peritoneal tears and preservation of the integrity of the abdominal wall. After completion of the dissection, the diastasis recti is reconstructed using the Inan Inverting Plication Suture technique. This method aims to restore the midline by apposing the decussating fibers of the anterior and posterior rectus sheaths, which represent the strongest components of the rectus complex. Controlled inversion of the linea alba allows a tension-balanced closure and an anatomical reconstitution of the abdominal wall. The repair is subsequently reinforced with a large macroporous mesh measuring 30 × 26 cm, positioned extraperitoneally to ensure broad overlap and durable reinforcement in accordance with contemporary principles of abdominal wall reconstruction.

This case illustrates a standardized and reproducible robotic PeTEP strategy for diastasis recti repair, combining precise extraperitoneal dissection, a logical and tissue-respecting sequence of operative steps, and a functional midline reconstruction reinforced with an appropriately sized prosthesis.