Single-port robotic totally extraperitoneal inguinal hernia repair using a floating docking technique with the da Vinci SP system: feasibility across a spectrum of hernia complexity

The da Vinci SP system is applied to totally extraperitoneal (TEP) inguinal hernia repair, but clinical data remain limited. Full wrist articulation requires the instruments to extend beyond the cannula tip, which the preperitoneal space is too shallow to accommodate intracorporeally. We report a single-surgeon series using a floating docking configuration. We retrospectively reviewed 12 consecutive patients undergoing SP TEP repair. After a 2.5-cm infraumbilical incision and entry into the retrorectus space, the cannula was docked suspended approximately 9–10 cm above the skin, so that the instruments reached the operative field already articulating. Mesh reinforcement was performed in all patients. Patients were 11 men and 1 woman (91.7% male; mean age 57.2 ± 10.7 years), evenly split between sides; 10 primary and 2 (16.7%) recurrent, 8 indirect, 4 direct. Median operative and console times were 42.5 (IQR 38.8–46.8) and 40.0 min (IQR 33.8–42.2). All procedures were completed via a single port without conversion or additional trocars, including an incarcerated scrotal hernia and a recurrent hernia with dense adhesions requiring intracorporeal peritoneal closure. Mean hospital stay was 1.1 ± 0.5 days. Complications occurred in 3 patients (25.0%): fluid collection in all, urinary retention in one, managed conservatively. No recurrence occurred over a median follow-up of 6.9 months (IQR 4.1–8.7). SP TEP repair with floating docking was feasible across a range of hernia types and complexities, with no major early complications. Larger cohorts with longer follow-up are needed to assess recurrence and chronic pain.