Dietz Ulrich A, Kudsi O Yusef, Garcia-Ureña Miguel, Baur Johannes, Ramser Michaela, Maksimovic Sladjana, Keller Nicola, Dörfer Jörg, Eisner Lukas, Wiegering Armin
Klinik für Viszeral‑, Gefäss- und Thoraxchirurgie, Kantonsspital Olten, Baslerstrasse 150, 4600, Olten, Schweiz.
Department of Surgery, Good Samaritan Medical Center, 235 North Pearl St., 02301, Brockton, MA, USA.
Chirurg. 2021 Oct;92(10):936-947. doi: 10.1007/s00104-021-01480-z. Epub 2021 Aug 18.
The principle of targeted separation or weakening of individual components of the abdominal wall to relieve tension in the median line during major abdominal reconstruction has been known for over 30 years as anterior component separation (aKS) and is an established procedure. In search of alternatives with lower complication rates, posterior component separation (pKS) was developed; transversus abdominis release (TAR) is a nerve-sparing modification of pKS. With the ergonomic resources of robotics (e.g., angled instruments), TAR can be performed in a minimally invasive manner (r-TAR): hernia gaps of up to 14 cm can be closed and a large extraperitoneal mesh implanted. In this video article, the treatment of large incisional hernias using the r‑TAR technique is presented. Exemplary results of a cohort study in 13 consecutive patients are presented. The procedure is challenging, but our own results-as well as reports from the literature-are encouraging. The r‑TAR is becoming the pinnacle procedure for abdominal wall reconstruction.
在大型腹壁重建过程中，通过有针对性地分离或削弱腹壁的各个组成部分以减轻中线张力的原则，作为前入路成分分离术（aKS）已为人所知超过30年，并且是一种成熟的手术方法。为了寻找并发症发生率更低的替代方法，后入路成分分离术（pKS）应运而生；腹横肌松解术（TAR）是pKS的一种保留神经的改良术式。借助机器人技术的人体工程学资源（如成角器械），TAR可以以微创方式进行（r-TAR）：高达14厘米的疝间隙可以闭合，并植入一块大型腹膜外补片。在这篇视频文章中，介绍了使用r-TAR技术治疗大型切口疝的方法。展示了一项对13例连续患者进行的队列研究的典型结果。该手术具有挑战性，但我们自己的结果以及文献报道都令人鼓舞。r-TAR正成为腹壁重建的顶尖手术。
