Minimally invasive component separation

Innovative surgical techniques developed over the past 25 years enable abdominal wall reconstruction in patients with wide musculofascial defects, which often occur from loss of domain. Component separation allows for the medialization of rectus complexes by releasing the external oblique aponeurosis to restore the abdominal wall integrity. The original open component separation procedure, as described by Ramirez et al. [1], requires the division of rectus abdominis myocutaneous perforator vessels to the subcutaneous fat and skin during the exposure of the anterior rectus sheath. This procedure results in widely undermined skin flaps above a large subcutaneous dead space, with the potential for seroma formation and compromised vascularity to the overlying skin closure. Minimally invasive component separation, whether fully laparoscopic or through an open laparotomy with minimally invasive dissection, has helped address these potential pitfalls. In this chapter, we review minimally invasive techniques and their outcomes.