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Endoscopic subcutaneous approach for component separation

J Daes, MD, FACS
Epublication WebSurg.com, Oct 2013;13(10). URL: http://websurg.com/doi/vd01en4033

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  • 2013-10-14
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This video describes the endoscopic subcutaneous approach for component separation. The patient is a 64-year-old woman with a history of progressive bulging of the abdominal wall and moderate pain. Physical examination revealed two central ventral hernias, measuring approximately 6 and 7cm in diameter. She had previously undergone laparotomy via a midline incision. The video shows in detail the steps of how to perform the endoscopic subcutaneous approach for component separation. We describe preoperative skin marking of the semilunar line under ultrasonic guidance, creation of the subcutaneous space, placement of the working port, division of the external oblique aponeurosis lateral to the semilunar line extending from the inguinal ligament to 4cm above the costal margin, mobilization of the external oblique from the internal oblique muscle, and finally measurement of the extension of the component separation.