The other cannulas, one for the robotic optic and two for work arms, are located under direct view, preferably 20 cm away from the main adhesion point or center, calculating enough space for instruments to begin work (Fig. 2a, b). They could be in one lower quadrant, left or right with the camera in the middle or with the camera on the corner of the abdomen on the left lower quadrant between two robotic arms, one on the left flank and the other on hypogastrium, 2 cm above the pubic bone. At this position we can almost do any adhesiolysis with defect suturing. Docking for this rational is from the left shoulder or from the head. The initial steps of this dissection have the image pretty close to the camera. The adhesions are penetrated by the CO₂ and the limits from the bowel seromuscular layer and abdominal wall appear isolated for safe dissection. Electric cautery must be avoided. We used a bipolar fenestrated instrument on the left hand and a monopolar scissor on the right. The scope is 30° up view at this time.

During this total adhesiolysis an inadvertent or even strategic bowel opening must be immediately closed by suture (Fig. 3a–c). These lesions can become completely hidden afterwards if left to be treated at the end. All the instruments’ movements should point the anterior abdominal wall; it looks like a painter painting the ceiling lying on a flat scaffold. All the traction is over a slight angle, almost parallel to the inverted surface, to expose adhesions for the scissor lamina to work, blunt and sharp dissections. It is a step-by-step procedure when the adhesion is too firm (Fig. 4). The camera is very close at these moments (Fig. 5). The patient-side surgeon must help push the abdominal wall to produce a flat condition for dissection, sometimes bringing the hernia contents to the camera view or against the instruments’ tip reach (Fig. 6).