{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,26]],"date-time":"2026-09-26T14:18:24Z","timestamp":1790432304979,"version":"4.1.0"},"reference-count":16,"publisher":"BMJ","issue":"6","content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["BMJ Case Rep"],"accepted":{"date-parts":[[2025,5,15]]},"published-print":{"date-parts":[[2025,6]]},"abstract":"<jats:p>We present the first documented case in Spain of a large midline incisional hernia treated with botulinum toxin A (Botox A) in conjunction with robot-assisted transversus abdominis release utilising the Hugo robot-assisted surgery (RAS) by Medtronic (Minneapolis, MN, USA). The patient, a woman in her late 40s, was referred to our outpatient clinic due to two significant midline incisional hernias which were causing abdominal discomfort and constipation. Her medical history included a laparoscopic myomectomy that had been converted to open surgery, resulting in a sub-umbilical incision. This led to the development of a double-component midline incisional hernia: one at the umbilical level (site of laparoscopic access) and another located over the incision from the laparotomic conversion. Six weeks prior to surgery, we conducted preoperative ultrasound-guided electromyographic injections of Botulinum Toxin A into the lateral abdominal wall muscles. The surgical procedure lasted 450 min, during which there were no conversions or intraoperative complications. The robotic system was docked twice, once for each side, with a total docking time of thirty minutes. The patient\u2019s hospital stay extended to 4 days. In conclusion, our findings indicate that the combination of Botox A and robot-assisted transversus abdominis release utilising the Hugo RAS system is a safe and effective treatment option.<\/jats:p>","DOI":"10.1136\/bcr-2024-264022","type":"journal-article","created":{"date-parts":[[2025,6,3]],"date-time":"2025-06-03T04:15:18Z","timestamp":1748924118000},"page":"e264022","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":1,"title":["First experience in Spain of large ventral hernia treated with botulinum toxin combined with robot-assisted transversus abdominis release (R-TAR) using the Hugo RAS system"],"prefix":"10.1136","volume":"18","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-0953-2420","authenticated-orcid":false,"given":"Riccardo","family":"Caruso","sequence":"first","affiliation":[{"name":"General Surgery, HM Sanchinarro University Hospital, Madrid, Madrid, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yolanda","family":"Quijano","sequence":"additional","affiliation":[{"name":"Gneral Surgery, HM Sanchinarro University Hospital, Madrid, Madrid, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Camilla","family":"Far\u00e8","sequence":"additional","affiliation":[{"name":"Gneral Surgery, HM Sanchinarro University Hospital, Madrid, Madrid, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Valentina","family":"Ferri","sequence":"additional","affiliation":[{"name":"General Surgery, HM Sanchinarro University Hospital, Madrid, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"239","published-online":{"date-parts":[[2025,6,2]]},"reference":[{"key":"2025082801040776000_18.6.e264022.1","doi-asserted-by":"publisher","DOI":"10.1016\/j.suc.2013.06.010"},{"key":"2025082801040776000_18.6.e264022.2","doi-asserted-by":"crossref","first-page":"89","DOI":"10.1007\/s10029-014-1321-x","article-title":"A systematic review of the surgical treatment of large incisional hernia","volume":"19","author":"Deerenberg","year":"2015","journal-title":"Hernia"},{"key":"2025082801040776000_18.6.e264022.3","doi-asserted-by":"crossref","first-page":"375","DOI":"10.1007\/s10029-019-01911-1","article-title":"Robotic retromuscular ventral hernia repair and transversus abdominis release: short-term outcomes and risk factors associated with perioperative complications","volume":"23","author":"Gokcal","year":"2019","journal-title":"Hernia"},{"key":"2025082801040776000_18.6.e264022.4","doi-asserted-by":"crossref","DOI":"10.3390\/medicina57010014","article-title":"Low-Dose Pre-Operative Botulinum Toxin A Effectively Facilitates Complex Ventral Hernia Repair: A Case Report and Review of the Literature","volume":"57","author":"Mourad","year":"2020","journal-title":"Medicina (Kaunas)"},{"key":"2025082801040776000_18.6.e264022.5","doi-asserted-by":"publisher","DOI":"10.1007\/s00464-016-5030-7"},{"key":"2025082801040776000_18.6.e264022.6","doi-asserted-by":"crossref","first-page":"1121","DOI":"10.1111\/j.1526-4637.2011.01147.x","article-title":"Botox A injection for pain after laparoscopic ventral hernia: a case report","volume":"12","author":"Smoot","year":"2011","journal-title":"Pain Med"},{"key":"2025082801040776000_18.6.e264022.7","doi-asserted-by":"publisher","DOI":"10.1007\/s00268-009-0203-3"},{"key":"2025082801040776000_18.6.e264022.8","doi-asserted-by":"publisher","DOI":"10.1007\/s10029-014-1280-2"},{"key":"2025082801040776000_18.6.e264022.9","doi-asserted-by":"publisher","DOI":"10.1111\/ans.13258"},{"key":"2025082801040776000_18.6.e264022.10","doi-asserted-by":"publisher","DOI":"10.1007\/s00268-013-2211-6"},{"key":"2025082801040776000_18.6.e264022.11","doi-asserted-by":"crossref","first-page":"456","DOI":"10.1007\/s00464-020-07957-y","article-title":"The current state of robotic retromuscular repairs-a qualitative review of the literature","volume":"35","author":"Santos","year":"2021","journal-title":"Surg Endosc"},{"key":"2025082801040776000_18.6.e264022.12","doi-asserted-by":"crossref","first-page":"40","DOI":"10.1007\/s00104-021-01564-w","article-title":"Erratum to: Robotic hernia repair III. English version: Robotic incisional hernia repair with transversus abdominis release (r-TAR). Video report and results of a cohort study","volume":"92","author":"Dietz","year":"2021","journal-title":"Chirurg"},{"key":"2025082801040776000_18.6.e264022.13","doi-asserted-by":"publisher","DOI":"10.1007\/s00464-017-5729-0"},{"key":"2025082801040776000_18.6.e264022.14","doi-asserted-by":"crossref","DOI":"10.1136\/bcr-2023-256035","article-title":"New era of robotic surgery: first case in Spain of right hemicolectomy on Hugo RAS surgical platform","volume":"16","author":"Caruso","year":"2023","journal-title":"BMJ Case Rep"},{"key":"2025082801040776000_18.6.e264022.15","doi-asserted-by":"crossref","first-page":"2039","DOI":"10.1007\/s13304-023-01553-0","article-title":"Robot-assisted cholecystectomy with the new HUGO\u2122 robotic-assisted system: first worldwide report with system description, docking settings, and video","volume":"75","author":"Vicente","year":"2023","journal-title":"Updates Surg"},{"key":"2025082801040776000_18.6.e264022.16","doi-asserted-by":"crossref","DOI":"10.1016\/j.ijscr.2023.108178","article-title":"Robot-assisted Nissen fundoplication with the new HUGO\u2122 Robotic assisted system: First worldwide report with system description, docking settings and video","volume":"106","author":"Quijano","year":"2023","journal-title":"Int J Surg Case Rep"}],"container-title":["BMJ Case Reports"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/syndication.highwire.org\/content\/doi\/10.1136\/bcr-2024-264022","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,8,28]],"date-time":"2025-08-28T08:04:15Z","timestamp":1756368255000},"score":1,"resource":{"primary":{"URL":"https:\/\/casereports.bmj.com\/lookup\/doi\/10.1136\/bcr-2024-264022"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,6]]},"references-count":16,"journal-issue":{"issue":"6","published-online":{"date-parts":[[2025,6,2]]},"published-print":{"date-parts":[[2025,6]]}},"alternative-id":["10.1136\/bcr-2024-264022"],"URL":"https:\/\/doi.org\/10.1136\/bcr-2024-264022","relation":{},"ISSN":["1757-790X"],"issn-type":[{"value":"1757-790X","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,6]]}}}