Robotic Subcutaneous Only Repair (SCOLA) for Umbilical Hernia with Diastasis Recti

This is a video of the robotic subcutaneous-only repair or SCOLA repair for umbilical hernia with diastasis recti. This is a procedure that’s appropriate for patients with small hernias and diastasis who do not have excess skin that needs to be removed. And this would be an alternative to an abdominoplasty or tummy tuck, and it is essentially the same procedure without the removal of excess skin.

This procedure is done using three small incisions in the lower abdomen, and as you can see here, we are creating flaps between the muscle and the subcutaneous tissue. Here, you can see the umbilical hernia visible. Bipolar cautery is used to control any perforators and the fascia is visible at the bottom.

Here, we are now dissecting around the hernia. As you can see here, there’s an umbilical hernia containing preperitoneal fat that is being reduced and the hernia contents are dissected away from the umbilical stalk. The umbilical stalk is disconnected from the fascia and dissection continues towards the upper abdomen. Here you can see the umbilical defect.

After completion of the dissection, this is the space that is dissected and you can see here the diastasis, you can see the gap between the right and left muscles. We are using here marking pen to delineate or identify the edges of the fascia or the muscle on both sides with the diastasis in between. This will aid us in our plication.

The diastasis here is about four centimeters. We then use a permanent, non-absorbable suture to plicate the diastasis, taking bites between the right and left muscle. We take stitches starting from the subxiphoid area all the way down, taking good bites, and we try to take as many bites as possible before trying to cinch the suture to distribute the tension. As you can see, a nice ridge is forming between the left and right side.




Then we sequentially pull the stitches to tighten the plication, heading down towards the umbilicus and below the umbilicus. Two sutures here are used, and then we lock the sutures and divide them. Here we are measuring the space to see how big it is and to plan for a mesh. This could be done with or without mesh depending on the size of the hernia. Here we elected to use mesh.

We placed medium-weight micropores fully properly in mesh and fixated it at six or seven locations. Then we are tucking the umbilicus back to the fascia, to restore normal anatomy. Following that step, a JP drain is placed into the subcutaneous tissue as it is expected that these patients may form fluid collections, and this drain is typically removed in the office two weeks after surgery. And this is the final result. Thank you for watching.

Posted on January 24, 2023

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Dr. Iskandar, MD, FACS is a board-certified general surgeon with fellowship training in minimally invasive surgery and bariatric surgery. He is an accredited Surgeons of Excellence in Hernia Surgery by the SRC. The Iskandar Complex Hernia Center is one of only two North Texas Hernia Centers deemed Centers of Excellence. As a globally respected complex hernia expert, he specializes in complex hernia repair and abdominal reconstruction. He is also an Associate Professor of Surgery at Texas A&M School of Medicine.