Dr. med. Sebastian Lamm is an experienced and dedicated specialist in minimally invasive and robot-assisted visceral surgery at the Canton Hospital Baselland, coordinator of the reference center for hernia surgery there and head of the surgical daVinci program. With his expertise in state-of-the-art surgical methods, especially the daVinci surgical robot, he sets new standards in gentle and precise hernia treatment and ensures first-class care for his patients.
His treatment concept is based on minimally invasive procedures that, through the use of robot-assisted techniques such as eTEP and rTAPP, enable gentle mesh placement in the abdominal wall. Thanks to the reduced surgical trauma, pain, side effects, and ultimately recovery time are all decreased. Especially in complex hernia operations and in the treatment of rectus diastasis, Dr. Lamm leverages the advantages of robotic surgery to achieve optimal results with minimal strain.
In addition to his clinical work, Dr. Lamm places great emphasis on training and continuing education for young surgeons in robot-assisted visceral surgery. Through regular workshops and training sessions, he promotes knowledge transfer and plays a key role in further establishing cutting-edge surgical procedures in Switzerland. With his innovative approach and deep expertise, Dr. med. Sebastian Lamm offers his patients state-of-the-art, individualized treatment that combines the best possible therapeutic outcomes with the highest level of patient well-being.
The editorial team of the Leading Medicine Guide learned more about complex abdominal wall surgery using the daVinci robot in a conversation with renowned visceral surgeon Dr. med. Sebastian Lamm, who has been working with robotics at the Canton Hospital Baselland for almost ten years.
daVinci surgery has revolutionized minimally invasive surgery and opened up completely new possibilities, particularly in complex abdominal wall surgery. Using the highly precise surgical robot, procedures such as hernia repairs and abdominal wall reconstructions can be performed with maximum accuracy and minimal tissue trauma. This innovative technique enables better visualization, finer movements, and gentler treatment, leading to faster recovery times and a marked improvement in the patient experience. Especially in complex cases, robot-assisted abdominal wall surgery represents a significant advance over conventional methods.
Through three-dimensional, high-resolution imaging, the surgeon gains an enlarged, spatial field of view that goes far beyond the capabilities of conventional laparoscopy. This allows for significantly better orientation in the operative field and facilitates the identification of tissue structures, nerves, and vessels.
“Among the advantages of the robot-assisted approach, particularly in complex abdominal wall hernias, the technology enables operations that would not be feasible with traditional keyhole techniques. With three small access points, the camera and robotic arm can be deployed. The instruments are highly mobile and transmit the surgeon’s movements down to the equivalent of an elbow joint. This makes precise and technically demanding procedures possible that previously could not, or only with great difficulty, be performed minimally invasively. A major advantage for the surgeon is the comprehensive preparation possible on a simulator. Unlike earlier keyhole surgery, where much was ‘learning by doing,’ today’s surgeons can complete full training programs on dedicated simulators, including simpler operations, to perfect instrument handling and camera guidance. This training ensures the surgeon approaches the patient very well prepared—comparable to a pilot who has trained intensively in a simulator during their education,” explains Dr. Lamm, who also details the necessary training steps on the robot:
“The training is structured: There are manufacturer-defined simulations that must be completed with a certain score. In addition, there is training on models or in specialized training centers. Thus, a longer learning process is required before the first use on a patient. This includes various courses that progressively prepare for more complex procedures—starting with simpler operations and moving up to more complex abdominal wall hernias. Moreover, close supervision by experienced proctors is mandated. Initially, there is an observation phase at an experienced center, followed by hands-on proctoring at one’s own hospital. The proctor can intervene directly in the procedure via a second console or give instructions. This ensures a safe and structured introduction to robot-assisted surgery.” 
Robot-assisted technology significantly improves precision and safety in hernia surgery, particularly in complex procedures such as inguinal, umbilical, and incisional hernias, as well as in the treatment of rectus diastasis.
“It’s important to clarify at the outset that the term ‘robot’ in this context is somewhat misleading. Contrary to common assumptions, the robot has no artificial intelligence and does not perform operations autonomously. Instead, it is a supporting technology that is fully controlled by the surgeon. The surgeon operates a console from which the instruments are controlled. These instruments are so articulated and mobile that they can replicate, minimally invasively and robotically, all the movements that would be possible in open surgery. Another major advantage is the three-dimensional view provided by the dual cameras. The surgeon sees the operative field almost as through a microscope, with marked magnification. At the same time, camera stabilization ensures a steady image that the surgeon controls personally. This allows the image to be aligned precisely to the surgeon’s needs, ensuring optimal visualization at all times. In contrast to conventional keyhole surgery, where an assistant often holds the camera and the image is therefore less stable and less individually aligned, here the surgeon fully controls both the camera and the instruments. As a result, they work largely independently with a very stable, optimal image, which substantially improves precision during the operation,” Dr. Lamm emphasizes.
The minimally invasive approach with smaller access points reduces tissue strain, postoperative pain, and inflammation and promotes faster recovery. For rectus diastasis, the robot enables gentle correction with precise cutting and suturing, resulting in improved functional and aesthetic outcomes.
The use of daVinci technology in abdominal wall surgery is particularly advisable and often necessary in complex cases where conventional minimally invasive procedures reach their limits. This mainly concerns large, multiple recurrent, or complicated incisional hernias. 
At this point, Dr. Lamm notes: “In my view, the complex, modern surgical techniques that access behind the muscle or between the peritoneum and the rectus sheath are practically only feasible robotically. There are indeed experienced surgeons who perform such procedures minimally invasively with keyhole techniques, but this is extremely demanding, requires great experience and concentration, and significantly lengthens operative time. Therefore, these complex techniques are particularly suited to robotic use—not because they would be impossible with keyhole techniques, but because they can be performed far better robotically. And as for operative time, the robot is especially efficient, for example when suturing the abdominal wall where many stitches are required. Although it’s often assumed that robotic procedures take longer, the opposite is true in established centers: Complex abdominal wall operations today usually take one and a half to two hours, whereas they used to take five to six hours. Through the exchange of experience within the small community of robotic surgeons, the technique has greatly improved, so robotic procedures are now faster than conventional minimally invasive operations. The brief time to set up the robot at the start of surgery—a few minutes—barely matters anymore. For patients, the use of the robot means a gentler operation. Instead of a large abdominal incision with muscle detachment and extensive mesh implantation, only a few small incisions are needed, which halves the length of stay and markedly reduces complications such as postoperative bleeding and infections. Pain is generally lower as well, which, while still being investigated scientifically, is confirmed subjectively by surgeons and patients. This is because the robot’s instruments work precisely and steadily without unnecessary strain on the abdominal wall. In addition, many modern procedures can only be implemented technically with the robot, which is a major advantage in itself. Overall, robot-assisted surgery is at least as gentle and often even better than conventional methods.” 
Within robotic abdominal wall surgery, specialized techniques such as eTEP (Extended Totally Extraperitoneal Repair) and rTAPP (robotic transabdominal preperitoneal patch plasty) are used, both of which represent innovative approaches to hernia treatment.
The eTEP technique repairs abdominal wall hernias without opening the abdominal cavity by creating an extraperitoneal space and reinforcing the defect with a mesh. Robotic support ensures high precision and protects internal organs, thereby reducing pain and complications. The rTAPP technique combines transabdominal preperitoneal repair with precise robotic control, allowing exact placement and fixation of the mesh.
“The eTEP and rTAPP techniques refer to specific robot-assisted procedures for reinforcing abdominal wall hernias, particularly along the entire length of the rectus muscles. A typical example is an incisional hernia that can occur after an open operation, such as following a bowel obstruction or a vascular operation on the aorta. In such cases, the fascia tears and the bowel protrudes under the skin—this is called an incisional hernia. For repair, the midline is closed and a mesh is placed along the full length of the affected muscle to stabilize it. In the past, this was done via a laparotomy; today the mesh can be inserted minimally invasively and very precisely with the robot. The mesh is rolled up finely to introduce it into the body and then unfolded in place—sizes of 30 x 20 centimeters or more are possible. The suturing technique resembles the open method. The major advantage is that the patient does not need a large abdominal incision, resulting in significantly less operative trauma. Access is from the posterior plane without large transections, which shortens recovery time. The meshes used are generally the standard synthetic meshes also employed in open or minimally invasive procedures. In younger patients, such as women with rectus diastasis, bioresorbable meshes are increasingly used. These meshes dissolve in the body over time and are ideally replaced by the patient’s own collagen, ultimately creating an endogenous mesh. The data so far are promising, though it is not yet clear in the long term whether they offer the same stability as conventional polypropylene meshes. Another advantage of bioresorbable meshes is that they do not leave a permanent foreign plastic body behind. In light of the discussion about microplastics, this is an important aspect for some patients. If this technique continues to gain traction, plastic meshes may be used less frequently in the future,” Dr. Lamm explains.
The integration of daVinci surgery plays a decisive role in preventing long-term complications and recurrences in complex hernias by enabling exceptionally precise and gentle operative technique.
“Modern robot-assisted procedures achieve results that are technically at least as good as open operations. Whether they will deliver even better outcomes in the long term has not yet been definitively established. While open procedures are very precise, they entail greater tissue trauma because the muscle must be widely opened. It’s important to understand that every surgical procedure involves some degree of bodily injury, which should be kept as minimal as possible. In direct comparison, it is clear that patients after open operations often struggle to get out of bed, whereas patients after robot-assisted procedures are significantly more mobile the same day and have only small incisions, about eight millimeters in size. This difference not only affects pain but also greatly reduces the risk of wound infections and postoperative bleeding,” emphasizes Dr. Lamm. 
Photo Patients are mobile more quickly_AI generated
For very large incisional hernias with so-called “loss of domain,” in which a large proportion of organs such as the bowel, stomach, or pancreas protrude through the abdominal wall and only 50 to 60 percent of the organs remain in the abdominal cavity, open operations are often unavoidable.
Dr. Lamm elaborates: “In such cases, there are volume issues that require special combinations of techniques. However, the trend clearly points toward minimally invasive approaches, for example by releasing the lateral musculature or using botulinum toxin to improve muscle elasticity so the abdomen can be closed more effectively. The majority of cases, around 90 percent, can now be treated minimally invasively, while the complex exceptions usually have to be operated on openly. Obese patients benefit particularly from robot-assisted procedures because their thick subcutaneous fat does not need to be divided as in open surgery. Instead, the operation is performed minimally invasively behind the muscles, allowing for gentle treatment. Since severely obese patients generally have a higher risk of complications, weight reduction prior to surgery is ideal, even if it is often difficult to achieve in practice. There are modern medications, such as weight-loss injections, that can facilitate weight reduction in a reasonable timeframe, but their availability and integration into daily life are still limited. The importance of weight reduction is also reflected in the fact that the risk of hernia recurrence is significantly higher in obese patients, since the increased intra-abdominal pressure, especially in men with a high proportion of abdominal fat, places greater stress on the reconstruction. Therefore, optimizing body weight remains an important factor for the long-term success of hernia surgery.”
At the Canton Hospital Baselland, an increasing number of hernia operations are being performed with the daVinci robotic system. Already more than half of all incisional hernias are treated robotically, with the goal of further increasing this share. Patients do not bear any additional costs for the use of the robot, even though the system is expensive.
“Last year, we performed more than 200 robotic hernia operations, with an annual increase of about 15 percent. We have a very experienced, well-coordinated team. Even in straightforward procedures such as inguinal hernias, the robotic technology clearly enables a much more precise operation. While conventional keyhole surgery often requires compromises due to technical limitations, the robot allows a minimally invasive approach that comes very close to open surgery in terms of precision and technique. For example, we can fix meshes with absorbable sutures, even though this is not strictly required by guidelines. These details improve long-term results because precise fixation enhances stability and precise surgical technique helps avoid complications such as nerve injuries or postoperative bleeding. Our experience is also reflected in the HerniaMed registry, a German quality registry of certified centers: Compared to open procedures, we see fewer complications. This is less about the quality of open surgery and more about the fact that minimally invasive, robot-assisted procedures are gentler and safer—a trend confirmed not only at our center but nationwide,” notes Dr. Lamm, who concludes our conversation by focusing on the further development of robotics:
“Robotic surgical systems will certainly become significantly less expensive in the coming years as competing products gradually enter the market. Currently, the daVinci robot is the undisputed market leader and the only system that has been in clinical use for 20 years. New systems from other manufacturers are not yet at the same level as the daVinci, but as with any break in a monopoly, competition will ultimately drive innovation and substantially reduce costs. Although a robot-assisted operation currently costs about 1,000 euros more in material and, depending on system utilization, another 1,000 euros for use (purchase, maintenance) compared with a standard operation—an amount dependent on device utilization and seemingly high at first glance—this additional expense is greatly relativized in the long run: By avoiding reoperations, postoperative bleeding, or longer hospital stays through more precise and gentler procedures, costs to the healthcare system are also saved, and patients are spared unpleasant experiences and complications. Compared with other medical innovations, such as ongoing costs for expensive medications, the one-time additional cost of a robotic operation is probably not significant socioeconomically. Surgical progress always arises from the introduction of new techniques. For example, gallbladder surgery used to be performed openly; then came keyhole surgery, which initially caused more complications and drew much criticism. But it ushered in the era of minimally invasive surgery, from which patients continue to benefit today. These initial difficulties never occurred with the introduction of robotics because the operators were already experienced minimally invasive surgeons rather than novices. Robotics is indeed a new technique that must be learned, and switching quickly between keyhole and robotic techniques entails a learning curve, but fundamentally the approaches remain similar. If implementation is coupled with the training and proctoring described above, it can be integrated into daily practice without complications.”
Thank you, Dr. Lamm, for this informative foray into the world of robotic surgery!
