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Laparoscopic TEP hernia repair for unilateral inguinal hernia in the canal of Nuck in a 7-year-old female patient
In this video, we present the case of a left-sided unilateral indirect inguinal hernia in the canal of Nuck in a 7-year-old female patient. Treatment was performed using the laparoscopic TEP inguinal hernia repair technique. The hernia sac was promptly identified and dissected without any concern to cord structures since the patient was a female. The herniotomy was performed with an Endoloop®. The only constraints of surgery were limited operating space and ergonomic handling of instruments. The patient was discharged in the evening of surgery and wounds healed within a week. Postoperative follow-up after 6 months revealed excellent cosmesis and a complete absence of hernia on the operated site. Mini laparoscopic instruments can also be used to improve surgical cosmesis and ensure same day discharge without any postoperative sequelae.
KB Kaundinya
Surgical intervention
5 months ago
1556 views
6 likes
0 comments
03:35
Laparoscopic TEP hernia repair for unilateral inguinal hernia in the canal of Nuck in a 7-year-old female patient
In this video, we present the case of a left-sided unilateral indirect inguinal hernia in the canal of Nuck in a 7-year-old female patient. Treatment was performed using the laparoscopic TEP inguinal hernia repair technique. The hernia sac was promptly identified and dissected without any concern to cord structures since the patient was a female. The herniotomy was performed with an Endoloop®. The only constraints of surgery were limited operating space and ergonomic handling of instruments. The patient was discharged in the evening of surgery and wounds healed within a week. Postoperative follow-up after 6 months revealed excellent cosmesis and a complete absence of hernia on the operated site. Mini laparoscopic instruments can also be used to improve surgical cosmesis and ensure same day discharge without any postoperative sequelae.
Laparoscopic TAPP approach to bilateral reducible inguinal hernia: live interactive procedure
We present the clinical case of a 57-year old male patient managed for a bilateral reducible inguinal hernia. The patient’s history included a right inguinal hernia repair in his childhood. A first port was inserted 1cm above the umbilicus and two 5mm ports were placed 7cm away from the umbilicus on the right and left side. Peritoneal dissection starts with a horizontal incision and parietalization is performed carefully to avoid injury to the vessels and deferent duct. After the myopectineal orifice has been sufficiently exposed, polypropylene meshes (Parietene™) trimmed to a 13 by 12cm size are inserted into the preperitoneal cavity and fixed using absorbable tacks. Finally, the meshes are fully covered using peritoneal flaps.
D Mutter, T Urade, J Marescaux
Surgical intervention
1 year ago
13758 views
86 likes
0 comments
46:18
Laparoscopic TAPP approach to bilateral reducible inguinal hernia: live interactive procedure
We present the clinical case of a 57-year old male patient managed for a bilateral reducible inguinal hernia. The patient’s history included a right inguinal hernia repair in his childhood. A first port was inserted 1cm above the umbilicus and two 5mm ports were placed 7cm away from the umbilicus on the right and left side. Peritoneal dissection starts with a horizontal incision and parietalization is performed carefully to avoid injury to the vessels and deferent duct. After the myopectineal orifice has been sufficiently exposed, polypropylene meshes (Parietene™) trimmed to a 13 by 12cm size are inserted into the preperitoneal cavity and fixed using absorbable tacks. Finally, the meshes are fully covered using peritoneal flaps.
Laparoscopic TEP unilateral inguinal hernia repair: a live interactive procedure
We present the clinical case of a 45-year old male patient managed for a right direct inguinal hernia. The patient’s history included a former approach for right inguinal hernia in his childhood and a laparoscopic left inguinal hernia repair. A first port was inserted below the umbilicus and access to the pubic bone was gained on the midline without using balloon. In this case, dissection of adhesions related to the previous operation was required. Attempts were made to identify anatomical landmarks after insertion of 5mm ports. The direct hernia content was dissected and reduced with blunt dissection. Once anatomical landmarks including pubic symphysis, Cooper’s ligament, epigastric vessels, spermatic cord, and psoas muscle were identified, a trimmed polypropylene mesh was inserted and the myopectineal orifice was sufficiently covered without fixation. Finally, the preperitoneal cavity was desufflated to complete the procedure.
B Dallemagne, T Urade, D Mutter, J Marescaux
Surgical intervention
1 year ago
3596 views
32 likes
2 comments
39:46
Laparoscopic TEP unilateral inguinal hernia repair: a live interactive procedure
We present the clinical case of a 45-year old male patient managed for a right direct inguinal hernia. The patient’s history included a former approach for right inguinal hernia in his childhood and a laparoscopic left inguinal hernia repair. A first port was inserted below the umbilicus and access to the pubic bone was gained on the midline without using balloon. In this case, dissection of adhesions related to the previous operation was required. Attempts were made to identify anatomical landmarks after insertion of 5mm ports. The direct hernia content was dissected and reduced with blunt dissection. Once anatomical landmarks including pubic symphysis, Cooper’s ligament, epigastric vessels, spermatic cord, and psoas muscle were identified, a trimmed polypropylene mesh was inserted and the myopectineal orifice was sufficiently covered without fixation. Finally, the preperitoneal cavity was desufflated to complete the procedure.
LIVE INTERACTIVE SURGERY: left direct inguinal hernia: laparoscopic TAPP approach
We present the clinical case of a 50-year-old patient managed for a left direct symptomatic reducible inguinal hernia, with a palpable impulse on examination. The patient’s history included a left indirect inguinal hernia repair in his childhood.

The procedure begins conventionally with an open laparoscopy with the introduction of a supra-umbilical port. The exploration confirms the presence of a left hernia and rules out the diagnosis of right hernia. Dissection starts with a horizontal peritoneal incision, which allows to progressively parietalize all elements of the cord, making sure to stay in contact with the peritoneum. Dissection of the previously operated hernia dating back to the patient’s childhood is slightly more painstaking and constraining due to the presence of adhesion-related scars. However, the parietalization of the peritoneum is carried on without any particular problem, and considering that it is a direct hernia, the deferent duct is very easily identified and parietalized. Reduction of the direct hernia is performed easily with the reintroduction of the transversalis fascia. Given the small size of the hernia, the fascia will not be exteriorized.

After complete lowering, a 15 X 15cm polypropylene mesh (Parietene™) is recut to a 13 X 12cm size with external trimming. The mesh is positioned in order to cover all direct and internal hernial orifices. It is only fixed to Cooper’s ligament, to the anterior superior iliac spine, and to the anterior abdominal wall so as to prevent any early mobilization postoperatively. Reperitonization is then performed with peritoneal fixation using absorbable staples (of the AbsorbaTack™ type). Exsufflation is achieved under visual guidance.

The entire procedure is performed as an outpatient surgery. The patient was admitted to our unit just before the intervention. He is discharged a few hours later.
D Mutter, J Marescaux
Surgical intervention
2 years ago
25334 views
1433 likes
1 comment
25:14
LIVE INTERACTIVE SURGERY: left direct inguinal hernia: laparoscopic TAPP approach
We present the clinical case of a 50-year-old patient managed for a left direct symptomatic reducible inguinal hernia, with a palpable impulse on examination. The patient’s history included a left indirect inguinal hernia repair in his childhood.

The procedure begins conventionally with an open laparoscopy with the introduction of a supra-umbilical port. The exploration confirms the presence of a left hernia and rules out the diagnosis of right hernia. Dissection starts with a horizontal peritoneal incision, which allows to progressively parietalize all elements of the cord, making sure to stay in contact with the peritoneum. Dissection of the previously operated hernia dating back to the patient’s childhood is slightly more painstaking and constraining due to the presence of adhesion-related scars. However, the parietalization of the peritoneum is carried on without any particular problem, and considering that it is a direct hernia, the deferent duct is very easily identified and parietalized. Reduction of the direct hernia is performed easily with the reintroduction of the transversalis fascia. Given the small size of the hernia, the fascia will not be exteriorized.

After complete lowering, a 15 X 15cm polypropylene mesh (Parietene™) is recut to a 13 X 12cm size with external trimming. The mesh is positioned in order to cover all direct and internal hernial orifices. It is only fixed to Cooper’s ligament, to the anterior superior iliac spine, and to the anterior abdominal wall so as to prevent any early mobilization postoperatively. Reperitonization is then performed with peritoneal fixation using absorbable staples (of the AbsorbaTack™ type). Exsufflation is achieved under visual guidance.

The entire procedure is performed as an outpatient surgery. The patient was admitted to our unit just before the intervention. He is discharged a few hours later.
Laparoscopic TAPP repair of strangulated Spigelian hernia
Among all abdominal wall hernias, Spigelian hernia (SH) or lateral ventral hernia represents a rare surgical condition accounting for about 0.1%. It occurs through slit-like defects in the transversus abdominis muscle aponeurosis in the so-called “semilunar or Spigelian fascia”, between the semilunar line and the rectus muscle, usually at the level where the lateral margin of the rectus muscle intersects the arcuate line of Douglas. It is clinically asymptomatic in almost 90% cases and has nonspecific clinical findings. However, it can sometimes be complicated by bowel content strangulation, requiring immediate surgical management. The laparoscopic repair has been well-described. Most authors use a transperitoneal approach either by placing the mesh in an intraperitoneal position or in the extraperitoneal space. In this video, we show the laparoscopic repair of a strangulated Spigelian hernia presented as intestinal obstruction using a transabdominal preperitoneal (TAPP) technique.
A Lapergola, A D'Attilio
Surgical intervention
2 months ago
11 views
0 likes
0 comments
07:12
Laparoscopic TAPP repair of strangulated Spigelian hernia
Among all abdominal wall hernias, Spigelian hernia (SH) or lateral ventral hernia represents a rare surgical condition accounting for about 0.1%. It occurs through slit-like defects in the transversus abdominis muscle aponeurosis in the so-called “semilunar or Spigelian fascia”, between the semilunar line and the rectus muscle, usually at the level where the lateral margin of the rectus muscle intersects the arcuate line of Douglas. It is clinically asymptomatic in almost 90% cases and has nonspecific clinical findings. However, it can sometimes be complicated by bowel content strangulation, requiring immediate surgical management. The laparoscopic repair has been well-described. Most authors use a transperitoneal approach either by placing the mesh in an intraperitoneal position or in the extraperitoneal space. In this video, we show the laparoscopic repair of a strangulated Spigelian hernia presented as intestinal obstruction using a transabdominal preperitoneal (TAPP) technique.
Laparoscopic Spigelian hernia repair
Spigelian hernia is a rare condition and it is difficult to diagnose it clinically. It has been estimated to account for 0.12% of abdominal wall hernias. The hernia ring is a well-defined defect in the transversus abdominis aponeurosis. The hernia sac, surrounded with extraperitoneal adipose tissue, often lies interparietally passing through the transversus abdominis and the internal oblique muscle aponeuroses and then spreading out beneath the intact aponeurosis of the external oblique muscle. The laparoscopic repair is well-established. Most authors use a transperitoneal approach either by placing the mesh in an intraperitoneal position or by raising the peritoneal flap and placing the mesh in the extraperitoneal space. In this video, we demonstrate the laparoscopic repair of a Spigelian hernia through the transabdominal preperitoneal (TAPP) placement of a composite mesh.
A D'Urso, D Mutter, J Marescaux
Surgical intervention
1 year ago
3850 views
16 likes
2 comments
08:23
Laparoscopic Spigelian hernia repair
Spigelian hernia is a rare condition and it is difficult to diagnose it clinically. It has been estimated to account for 0.12% of abdominal wall hernias. The hernia ring is a well-defined defect in the transversus abdominis aponeurosis. The hernia sac, surrounded with extraperitoneal adipose tissue, often lies interparietally passing through the transversus abdominis and the internal oblique muscle aponeuroses and then spreading out beneath the intact aponeurosis of the external oblique muscle. The laparoscopic repair is well-established. Most authors use a transperitoneal approach either by placing the mesh in an intraperitoneal position or by raising the peritoneal flap and placing the mesh in the extraperitoneal space. In this video, we demonstrate the laparoscopic repair of a Spigelian hernia through the transabdominal preperitoneal (TAPP) placement of a composite mesh.