Diaphragmatic hernia (DH) represents a rare, potentially life-threatening condition, with traumatic diaphragmatic hernia (TDH) as a result of thoracoabdominal injury accounting for 10% to 30% of cases. 1 TDHs are more rarely localized to the right side because of the protective effect of the liver. 2 Further, patients may remain asymptomatic for a number of years and can present with nonspecific respiratory and gastrointestinal symptoms. 3 Once diagnosed, guidelines recommend surgical repair. 3 Laparoscopic, thoracoscopic, and combined approaches have all been described previously. 1 The abdominal approach provides access to the retrohepatic vena cava, whereas the thoracic approach allows better access to pleural adhesions for decortication. While minimally invasive approaches have emerged, reports of robotic DH repair remain limited, with few cases highlighting the robotic repair of congenital DH. 3 Two reports highlight the robotic repair of chronic TDH; however, one describes the transthoracic approach, whereas the other describes a transabdominal approach complicated by a gastrobronchial fistula as a result of technical error during TDH repair. 4, 5 We present details for the transabdominal robotic repair of chronic right-sided TDH with technical strategies used to avoid complications (Video 1). We planned a complete abdominal approach, but the right chest was exposed and accessible in case thoracoscopic access became necessary. During the case, we found no pleural adhesions requiring access from the chest. Institutional review board approval was not required; the patient provided informed written consent for the use and publication of deidentified information.

A 36-year-old male patient with a history of a motor vehicle accident at age 18 years presented to the emergency department with complaints of right-abdominal pain. A computed tomography scan demonstrated a large rightsided diaphragmatic hernia, with a significant portion of his liver, right colon, appendix, gallbladder, omentum, and associated mesentery in the chest without obstruction (Figure 1). The patient was referred to thoracic surgery. In the emergency department, the patient’s pain resolved, and he was scheduled for semielective robotic repair. In the operating room, the patient was placed in a right modified decubitus position with a bump under the right chest wall, ensuring access to the chest in case of an additional thoracoscopic approach.