Do not confuse robotics with laparoscopy
In robotics you can do everything you do in laparoscopy while you cannot do everything you do in laparoscopy.
That is why there are so many of the structural differences between surgeries performed robotically and laparoscopically.
Robotic surgery is structurally very different from laparoscopic surgery
Robotics and laparoscopy are both performed through small access routes but internally the reconstructions are structurally completely different :
-In our robotic surgery, the reconstruction is pre-peritoneal (has no contact with the viscera)
-In laparoscopy, on the other hand, reconstruction is of necessity intraperitoneal (where the mesh and fixation media are in direct contact with the viscera).
The position of the network is different
In robotics, the mesh has no contact with the viscerawhereas in laparoscopy it is in contact with the intestines.
The midline suture is different
The suture in robotic surgery is a central suture that approximates the medial margin of the rectus muscles.
Thus a true linea alba is recreated in orthotopic position (i.e., in its natural position) keeping the rectus muscles in plane and ensuring physiological function during contraction.
The interface between the two tissues sutured in robotics is tendon-on-tendon, which is ideal to promote healing of the reconstructed linea alba.
Laparoscopic suturing, on the other hand, is of necessity totally on the posterior side of the abdominal wall, so it results in unphysiologIc offsets of the rectus muscles with introflexion/extraflexion of the muscle margins.
Such sutures also inevitably include within them tissues foreign to tendon scarring such as parietal peritoneum and pre-peritoneal fat.
Why these structural differences ?
These substantial differences between the two reconstructions exist because laparoscopy has technical limitations related to the nonarticulability of its instruments.
In fact, in laparoscopy, instruments are rigid and work on a single axis, unable to articulate with the same degrees of freedom as robotic instruments.
The rigidity of laparoscopic instruments does not allow working in all regions of the pre-peritoneal space.
In laparoscopy, through the pre-peritoneal space , one can, for example, get to operate an epigastric or umbilical hernia but not a diastasis recti.
Therefore of necessity in laparoscopy the procedures are not pre-peritoneal but intraperitoneal and the utlized materials are inveitably in contact with the viscera.
Robotic platforms
In robotic surgery, the surgeon operates at a short distance from the patient having control of the procedure through a three-dimensional viewer and sophisticated "masters" for instrument management.
Through stereoscopic optics (two integrated cameras) the surgeon has a truly three-dimensional view, and thanks to unique fluorescence-Laser filters , anatomical structures otherwise invisible with normal laparoscopy can be highlighted .
Robotic instruments have 7 degrees of freedom in addition to a feature called "endowirst" that gives even more articulability than the human wrist.
'Articulability is the greatest quality of robotic instruments and has been a great step forward compared to laparoscopy (which instead remains rigid and fixed on a single axis of work, forcing the surgeon to use large spaces to maneuver and sometimes make unnatural gestures).
Robotic instruments, due to their articulability, allow them to adapt to and respect anatomy while working with minimal impact in confined spaces, with restrained and focused gestures.
Pneumoperitoneum in robotic and laparoscopic surgery
Both laparoscopy and robotics being "indoor" surgeries are performed with the aid of a (temporary) carbon dioxide layer calledPneumoperitoneum.
All laparoscopic and robotic surgeries routinely performed worldwide are based on this principle, and carbon dioxide is the most compatible gas for this use.
In fact, carbon dioxide is metabolized very efficiently by our body (which itself is a producer of it).
The need for pneumoperitoneum has existed for as long as laparoscopic surgery has existed, and the insufflation pressure is a function of the working space required for surgery (which has been greatly reduced with robotics).
In robotic surgery, therefore, carbon dioxide is used at minimal pressures because of the ability to work in smaller spaces than in laparoscopy.
Anesthesia is the same in all methods
Anesthesia in laparoscopic and robotic surgery for diastasis recti is exactly the same, viz. general anesthesia.
The choice of type of anesthesia does not depend on the surgical technique but on the diastasis itself, which extending over a specific body surface always requires general anesthesia.
Therefore, there is no light or soft anesthesia sometimes advertised as different from general anesthesia.
Conclusions
The main differences between robotic or laparoscopic surgeries for diastasis recti are in the reconstructive structure and not in the small access routes that both methods use.
Laparoscopic surgeries are surgeries that leave the reconstructive materials in contact with the bowel when completed.
This is not the case in robotics, where there is no contact of the reconstruction with the viscera.
So it is good to look beyond the more or less catchy commercial name of a technique and beyond the advertising campaigns where they talk about "micro-incisions" or things like that.
Interventions on diastasis recti should be evaluated primarily at the structural level, seeing and understanding the reconstructive arrangement.
