Patient is placed in a supine position with the arms tucked and padded. The camera port can generally be placed at the paraumbilical position assuming the umbilicus is situated at least 15 cm from the xiphoid process (Fig. 35.17). Two 8 mm instrument trocars are then placed 10 mm apart from the camera port. The patient is placed in a slight reverse Trendelenburg position and the robot is then docked over the left or the right shoulder which allows for unimpeded access

Any technique that is novel or without randomized trials has its potential shortcomings, and not every patient is a candidate for laparoscopic defect closure. First, defect closure can result in significant fascial tension. While trans-abdominal buttressing sutures are routinely placed to offload tension onto the mesh for larger defects, closure of abdominal wall defects without significant laxity may result in excessive tension. This fascial strain may result in fascial dehiscence and possible hernia recurrence if insufficient mesh overlap exists. Also, because of the increased need for permanent trans- abdominal sutures there lies a greater risk for suture granuloma formation and possible suture abscess. It is, therefore, important to ensure all sutures are tied down appropriately and buried deeply within the sub­cutaneous tissue to reduce abscesses. Cosmetically, initial post­operative wounds may display signs of bunched up tissue over the repair. As discussed above, while this typically flattens out over time, it should be noted cosmetic benefits might not be apparent for weeks to months following repair.