Mr Smellie now offers fully robotic repair of divarication of the rectus abdominis muscles — known in the United States as diastasis recti — using just three 8mm keyhole ports placed in the lower abdomen. The procedure allows the separated muscles to be plicated from the inside, entirely avoiding the large midline scar associated with traditional open abdominoplasty.
Rectus divarication — or diastasis of the rectus abdominis muscles (DRAM) — is a condition in which the two vertical muscles of the abdomen separate along the central linea alba, creating a visible bulge or ridge down the centre of the abdomen. It is most commonly seen in women following pregnancy, though it can affect men and women of all ages. The condition can cause not only cosmetic concern but also functional symptoms including back pain, core weakness, and a persistent feeling of abdominal laxity.
The problem with traditional treatment
Until recently, surgical repair of significant rectus divarication typically required an open abdominoplasty — a major procedure involving a long horizontal incision across the lower abdomen, direct plication of the muscles under vision, and removal of excess skin. While effective, this approach carries a substantial scar, significant recovery time, and the risks inherent in any large open operation. Many patients — particularly those who have otherwise recovered well after pregnancy — find the prospect of such an extensive procedure difficult to accept.
"The robotic approach allows us to achieve what abdominoplasty achieves for the muscles — a precise, durable plication of the linea alba — through three incisions each smaller than a centimetre, placed discreetly in the lower abdomen."
The robotic technique
Using the Da Vinci robotic surgical system at Cleveland Clinic London, Mr Smellie performs the repair through three 8mm ports placed in the lower part of the abdomen — in patients who have not had previous caesarean sections, which can alter the tissue planes required for this approach. The ports allow the robotic instruments to access the preperitoneal space, through which the entire length of the separated linea alba can be visualised and repaired.
The plication is performed using a running barbed suture to draw the separated edges of the rectus sheath back together along the full length of the divarication. The procedure achieves the same anatomical correction as open surgery — restoring the integrity of the abdominal wall and the function of the core musculature — without a large open incision.
Robotic repair vs open abdominoplasty
Who is suitable?
This technique is offered to patients with symptomatic or cosmetically significant rectus divarication who have not had previous caesarean section surgery. Prior caesarean section can create adhesions and altered tissue planes in the preperitoneal space that make robotic port-based access more complex, and these patients require individual assessment. All patients are reviewed in clinic with appropriate imaging before a surgical plan is agreed.
Patients with a concomitant umbilical or epigastric hernia — which frequently coexists with rectus divarication — can often have both conditions addressed at the same robotic procedure, avoiding the need for separate operations.
Recent evidence
The robotic approach to rectus divarication repair has grown substantially in the published literature over recent years, with several series now demonstrating its safety, reproducibility and durability.
- Arias-Espinosa L, Salas-Parra R, Tagerman D, Pereira X, Malcher F. Robotic-assisted endoscopic onlay repair (R-ENDOR) for concomitant ventral hernias and diastasis recti: initial results and surgical technique. Surg Endosc. 2024;38(9):5413–5421. doi:10.1007/s00464-024-11100-6
- Morrell ALG, Morrell AG, Morrell AC. A paradigm shift in Diastasis Recti surgery: The Bikini-line robotic approach. Rev Col Bras Cir. 2025. PMC12685241
- Mazzola Poli de Figueiredo S, Tastaldi L, Mao RD, Lu R. A Novel Robotic Approach for the Repair of Abdominal Wall Hernias With Concomitant Diastasis Recti: Outcomes and Long-term Follow-up. Hernia. 2024;28(4):1063–1068. doi:10.1007/s10029-023-02753-8
- Poli M, de Figueiredo S, Tastaldi L, Mao RMD, Lu R. Management of diastasis recti during ventral hernia repair: an analysis of the abdominal core health quality collaborative. Hernia. 2023. doi:10.1007/s10029-023-02753-8
- Jaro VZ, Marc K, Bart W, Klaas VDH. Five years of robot-assisted ventral hernia repair: initial experience and surgical outcome. Acta Chir Belg. 2024. doi:10.1080/00015458.2024.2304386
- Forester E, Sadiq A. Comparative analysis of the efficacy and functionality of abdominoplasty versus minimally invasive techniques in the surgical treatment of diastasis rectus abdominis in postpartum women. Surg Endosc. 2023. doi:10.1007/s00464-023-10540-w
- Bracale U et al. The Italian national consensus conference on the diagnosis and treatment of Rectus Abdominis diastasis in Post-gravidic Women. Hernia. 2025;29(1):213. doi:10.1007/s10029-025-03403-x
