A landmark milestone at Cleveland Clinic London — the first fully robotic complex abdominal wall reconstruction performed at the hospital, marking a significant step forward in minimally invasive surgery for patients with the most challenging hernia cases.
The patient presented with a large incisional hernia — a weakness and bulge in the abdominal wall that had developed following major trauma. Incisional hernias of this complexity have traditionally required open surgery: a long midline incision, significant blood loss, and weeks of painful recovery. For many patients, the prospect of open surgery is as daunting as the hernia itself.
Using the Da Vinci robotic surgical system at Cleveland Clinic London's state-of-the-art theatre at Grosvenor Place, Mr Smellie performed a complete reconstruction of the abdominal wall entirely through keyhole incisions — a procedure lasting three and a half hours that would previously have required open access.
"The robotic platform gives us the ability to perform operations of extraordinary complexity through incisions measured in millimetres. For patients who have already endured major trauma, avoiding a further large wound is not just cosmetically preferable — it fundamentally changes their recovery."
The procedure
The operation involved complete separation of the abdominal wall components — a technique known as component separation — followed by mesh reinforcement of the entire reconstructed wall. Throughout the procedure, Mr Smellie operated from the Da Vinci console, guiding four robotic arms with tremor-filtered precision and 10× magnified 3D vision. The procedure required meticulous dissection across multiple anatomical planes, a task that demands the degrees of instrument freedom and visual clarity that only the robotic platform provides.
Recovery — a day one milestone
Perhaps the most striking element of this case was the speed of recovery. Just 24 hours after a three and a half hour reconstructive procedure, the patient's day one medical evaluation was conducted in the Cleveland Clinic London restaurant — the patient walking independently and eating a normal meal. It is a moment that illustrates, more vividly than any statistic, what minimally invasive robotic surgery can achieve for patients who would previously have faced weeks of bed rest.
This case represents a significant milestone not only for Cleveland Clinic London but for robotic abdominal wall surgery in the UK. As robotic platforms become more widely adopted, complex reconstructions that once demanded the most invasive approaches are becoming routinely achievable through keyhole techniques — with outcomes that would have seemed remarkable only a decade ago.
Who might benefit?
Patients who may be candidates for robotic complex abdominal wall reconstruction include those with large or recurrent incisional hernias, hernias following previous open surgery or trauma, failed previous hernia repairs, and patients with complex abdominal wall anatomy. Mr Smellie offers consultations for all hernia types at Cleveland Clinic London — Portland Place and Moorgate — and welcomes both insured and self-pay patients.
