LAUSR

Ureterosciatic hernias are a very rare form of sciatic hernias. They are more likely to be present in females and are attributed to their wider and weaker pelvic floor. These hernias often occur in multiparous women or those with a history of chronic constipation. These con-tributors all result in increased abdominal pressures. Imaging typically shows a chronically obstructed and dilated ureter with associated findings of hydronephrosis and hydroureter. We present a case of a laparoscopic repair of a left sided ureterosciatic hernia. The video highlights the use of ureteral stents and placement of an intraperitoneal mesh to reinforce the floor. This video demonstrates a combined robotic and open technique for repair of a posterior perineal hernia. A 68-year old female underwent a coccygectomy for chronic back and coccygeal pain. She developed a perineal hernia with associated urinary and fecal incontinence. A pelvic MRI demonstrated rectal prolapse into the perineal hernia. We performed a robotic posterior dissection of the presacral space to mobilize the prolapsed rectum with a suture rectopexy. In the prone position, the patient then underwent a perineal hernia repair with The ‘‘plug and patch’’ technique is commonly used in open inguinal hernia repair. The ‘‘patch’’ mesh sheet covers the abdominal wall defect while the mesh ‘‘plug’’ reinforces the internal inguinal ring. Though technically not feasible laparoscopically, we have been able to replicate this approach using the dexterity afforded by a robotic platform with pre-peritoneal keyhole mesh placement and mesh plug placement into the inguinal canal. Our early experience with this shows favorable outcomes with minimal post-operative pain. Here we demonstrate the technique of our robotic ‘‘plug and patch’’ method. This video demonstrates a robotic approach for a third redo left flank incisional hernia, with the solitary kidney partially within the hernia through the 10th and 11th rib space. The technique involves a preperitoneal dissection and illustrates how to incporporate old mesh into the peritoneal flap, perform primary closure, and reinforce with a heavyweight mesh. There was no evidence of hernia recurrence on 3 month follow-up. We present the case of a pancreatic pseudocyst in a 4-year-old fol- lowing non-accidental trauma complicated by failure to thrive. We performed an endoscopic assisted laparoscopic pancreatic cystgas- trostomy with concomitant insertion of a 14 Fr gastrostomy tube. Under GA, a trocar was inserted at the base of the umbilicus and pneumoperitoneum was established. Following anterior gastropexy at the planned gastrostomy site, we gained access to the stomach lumen. With endoscopic visualization, we created our stappled cystgastrostomy. Finally, we placed the g-tube and released pneumoperitoneum thus concluding the case. The patient has been seen doing well at follow up. robotic re-exploration. We were to identify a single small defect in the anterior aspect of the hepaticojejunostomy. was repaired with horizontal mattress 5–0 Monocryl suture. The made an excellent recovery, and discharged 3 days later. case the viability of early robotic intervention for bile leaks, as opposed to the traditional dogma of approaching anastomotic leaks via an open approach. This is the case of a 74 year old patient who developed recurrence of pancreatic neuroendocrine tumor at the head of the pancreas following Whipple. Our plan was to perform a reoperative pancreatectomy robotically and redo the pancreatic anastomosis. The pancreatic mass is densely adherent to the underlying vasculature requiring meticulous dissection prior to reoperative pancreatectomy. Her Whipple had been pylorus preserving, giving us a full stomach to work with, allowing us to fashion a pancreaticogastrostomy robotically. The robotic approach allowed us to avoid working through prior abdominal incision and allowed for an expedited recovery.