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Single incision laparoscopic peritoneal hole repair during right TEP procedure
Background: Laparoscopic inguinal hernia repair offers various advantages both to the patient and the surgeon. Transabdominal preperitoneal (TAPP) and total extraperitoneal (TEP) repairs represent the two laparoscopic options. A personal technique of single incision laparoscopic TEP has already been published on WebSurg (Link: http://www.websurg.com/MEDIA/?noheader=1&doi=vd01en4054).
Video: This video demonstrates the single incision laparoscopic treatment of a peritoneal hole, which occurred accidentally during a right TEP procedure.
Results: The TEP procedure lasted 41 minutes and the peritoneal repair 8 minutes. The final umbilical scar length was 10mm and the patient was discharged within 24 hours.
Conclusions: Peroperative complications can occur during single incision laparoscopy, as well as during conventional laparoscopy and open surgery. The procedure can be performed without conversion or additional trocars, depending on the complications which occurred.
G Dapri
Surgical intervention
2 years ago
2221 views
148 likes
0 comments
04:03
Single incision laparoscopic peritoneal hole repair during right TEP procedure
Background: Laparoscopic inguinal hernia repair offers various advantages both to the patient and the surgeon. Transabdominal preperitoneal (TAPP) and total extraperitoneal (TEP) repairs represent the two laparoscopic options. A personal technique of single incision laparoscopic TEP has already been published on WebSurg (Link: http://www.websurg.com/MEDIA/?noheader=1&doi=vd01en4054).
Video: This video demonstrates the single incision laparoscopic treatment of a peritoneal hole, which occurred accidentally during a right TEP procedure.
Results: The TEP procedure lasted 41 minutes and the peritoneal repair 8 minutes. The final umbilical scar length was 10mm and the patient was discharged within 24 hours.
Conclusions: Peroperative complications can occur during single incision laparoscopy, as well as during conventional laparoscopy and open surgery. The procedure can be performed without conversion or additional trocars, depending on the complications which occurred.
Single incision transumbilical laparoscopic bilateral inguinal hernia repair (TEP)
Background: Laparoscopic repair of inguinal hernia by preperitoneal mesh placement (TEP) has been popularized. Recently, with the advent of single incision transumbilical laparoscopy, this procedure has to be considered because it allows to place a big mesh with a very small final scar, which is also cosmetically acceptable.

Video: A 48-year-old male was admitted to hospital for right direct and indirect and left direct inguinal hernia. A single-incision transumbilical bilateral TEP was proposed. The patient was placed in a supine position with his legs straight. The surgeon stood first on the patient’s left and on the patient’s right later on in the procedure. The natural umbilical scar was incised and the rectus fascia on the left side was opened. A purse-string suture using Vicryl 1 was placed starting at a 9 o’clock position. An 11mm reusable metallic trocar was introduced behind the left rectus muscle into the preperitoneal space. A 0-degree, normal length and rigid scope was advanced into the 11mm trocar and the preperitoneal space was insufflated. This space was dissected using the optical system, first on the right side, and then on the left side. At the time of hernia sac retraction, a monocurved reusable grasping forceps IV according to DAPRI (Karl Storz Endoskope, Tüttlingen, Germany) was introduced inside the purse-string suture, at a 9 o’clock position, parallel to the 11mm trocar. The bilateral hernia sac was reduced, the peritoneal sheet was retracted, and the spermatic elements skeletonized. Two 15cm (latero-lateral) by 10cm (medial cranio-caudal) by 8cm (lateral cranio-caudal) polypropylene meshes (Bard Davol Inc., Warwick RI, US) were introduced through the 11mm trocar. Both meshes were adequately positioned using the monocurved grasping forceps, placing the lateral corner anteriorly to the peritoneal sheet and the medial corner underneath the pubic bone. Meshes were not fixed and the space was desufflated under view.

Results: Operative time was 67 minutes and the final incision length was 12mm. Postoperative pain was controlled by paracetamol (4 g/day) and the patient was discharged after 24 hours.

Conclusions: Single incision transumbilical bilateral TEP makes sense because it allows to place two big meshes using a very small final scar. This treatment allows to increase abdominal trauma reduction, already obtained through conventional multitrocar laparoscopic TEP.
G Dapri, L Gerard, V Zulian, M Bortes, J Bruyns, GB Cadière
Surgical intervention
5 years ago
4169 views
77 likes
0 comments
07:50
Single incision transumbilical laparoscopic bilateral inguinal hernia repair (TEP)
Background: Laparoscopic repair of inguinal hernia by preperitoneal mesh placement (TEP) has been popularized. Recently, with the advent of single incision transumbilical laparoscopy, this procedure has to be considered because it allows to place a big mesh with a very small final scar, which is also cosmetically acceptable.

Video: A 48-year-old male was admitted to hospital for right direct and indirect and left direct inguinal hernia. A single-incision transumbilical bilateral TEP was proposed. The patient was placed in a supine position with his legs straight. The surgeon stood first on the patient’s left and on the patient’s right later on in the procedure. The natural umbilical scar was incised and the rectus fascia on the left side was opened. A purse-string suture using Vicryl 1 was placed starting at a 9 o’clock position. An 11mm reusable metallic trocar was introduced behind the left rectus muscle into the preperitoneal space. A 0-degree, normal length and rigid scope was advanced into the 11mm trocar and the preperitoneal space was insufflated. This space was dissected using the optical system, first on the right side, and then on the left side. At the time of hernia sac retraction, a monocurved reusable grasping forceps IV according to DAPRI (Karl Storz Endoskope, Tüttlingen, Germany) was introduced inside the purse-string suture, at a 9 o’clock position, parallel to the 11mm trocar. The bilateral hernia sac was reduced, the peritoneal sheet was retracted, and the spermatic elements skeletonized. Two 15cm (latero-lateral) by 10cm (medial cranio-caudal) by 8cm (lateral cranio-caudal) polypropylene meshes (Bard Davol Inc., Warwick RI, US) were introduced through the 11mm trocar. Both meshes were adequately positioned using the monocurved grasping forceps, placing the lateral corner anteriorly to the peritoneal sheet and the medial corner underneath the pubic bone. Meshes were not fixed and the space was desufflated under view.

Results: Operative time was 67 minutes and the final incision length was 12mm. Postoperative pain was controlled by paracetamol (4 g/day) and the patient was discharged after 24 hours.

Conclusions: Single incision transumbilical bilateral TEP makes sense because it allows to place two big meshes using a very small final scar. This treatment allows to increase abdominal trauma reduction, already obtained through conventional multitrocar laparoscopic TEP.
TEP repair of a recurrent right inguinal hernia following failed TAPP repair: world’s first report
A 10mm paraumbilical balloon-tipped port was inserted into the preperitoneal space under direct vision and CO2 was insufflated.
Blunt dissection of the preperitoneal space to the pubis inferiorly and towards the left hernial orifices was performed using the 10mm laparoscope.
A further 10mm port was introduced into the pre-peritoneal space midway between the pubic symphysis and umbilicus. An atraumatic grasper was used to aid with further pre-peritoneal dissection. An indirect sac was identified on the left, freed from the adherent cord and then reduced. After excluding a direct hernia on the ipsilateral side and ensuring adequate clearance for mesh placement, a third 5mm port was introduced. This was inserted 1cm above and medial to the left anterior superior iliac spine
Dissection of the right pre-peritoneal space was performed using a combination of atraumatic graspers, scissors and diathermy. The mesh from the previous repair was identified and noted to be very adherent to the anterior abdominal wall. Careful and patient mobilisation revealed that this mesh had curled up and formed part of the contents of a direct inguinal hernia on the right. After meticulous dissection, the mesh was entirely freed from the anterior abdominal wall and direct space and reduced inferiorly remaining adherent to the underlying peritoneum. The inferior epigastric vessels were then identified. Preperitoneal dissection had resulted in distortion of their position such that they had been pulled down away from the anterior abdominal wall. Care was required not to injure these vessels as they were mobilised and lifted up to their normal anatomical position. The cord on this side was examined and after confirming the absence of an indirect sac, further preperitoneal dissection was performed to ensure adequate space for mesh placement.
Bilateral Bard™ 3D meshes were inserted ensuring adequate cover of all hernial orifices with overlapping of meshes in the midline. The left indirect sac and right direct hernia contents, consisting mainly of old mesh, were well clear of the new meshes. No tackers were used. CO2 insufflation was stopped and the preperitoneal space was allowed to close under vision ensuring no mesh displacement. Ports were closed via a standard technique.
MH Mobasheri, A Wan, G Vasilikostas , KM Reddy
Surgical intervention
8 years ago
5468 views
42 likes
0 comments
10:26
TEP repair of a recurrent right inguinal hernia following failed TAPP repair: world’s first report
A 10mm paraumbilical balloon-tipped port was inserted into the preperitoneal space under direct vision and CO2 was insufflated.
Blunt dissection of the preperitoneal space to the pubis inferiorly and towards the left hernial orifices was performed using the 10mm laparoscope.
A further 10mm port was introduced into the pre-peritoneal space midway between the pubic symphysis and umbilicus. An atraumatic grasper was used to aid with further pre-peritoneal dissection. An indirect sac was identified on the left, freed from the adherent cord and then reduced. After excluding a direct hernia on the ipsilateral side and ensuring adequate clearance for mesh placement, a third 5mm port was introduced. This was inserted 1cm above and medial to the left anterior superior iliac spine
Dissection of the right pre-peritoneal space was performed using a combination of atraumatic graspers, scissors and diathermy. The mesh from the previous repair was identified and noted to be very adherent to the anterior abdominal wall. Careful and patient mobilisation revealed that this mesh had curled up and formed part of the contents of a direct inguinal hernia on the right. After meticulous dissection, the mesh was entirely freed from the anterior abdominal wall and direct space and reduced inferiorly remaining adherent to the underlying peritoneum. The inferior epigastric vessels were then identified. Preperitoneal dissection had resulted in distortion of their position such that they had been pulled down away from the anterior abdominal wall. Care was required not to injure these vessels as they were mobilised and lifted up to their normal anatomical position. The cord on this side was examined and after confirming the absence of an indirect sac, further preperitoneal dissection was performed to ensure adequate space for mesh placement.
Bilateral Bard™ 3D meshes were inserted ensuring adequate cover of all hernial orifices with overlapping of meshes in the midline. The left indirect sac and right direct hernia contents, consisting mainly of old mesh, were well clear of the new meshes. No tackers were used. CO2 insufflation was stopped and the preperitoneal space was allowed to close under vision ensuring no mesh displacement. Ports were closed via a standard technique.
Removal of mesh plug and TEP repair of a recurrent left inguinal hernia in a 72-year-old man
This video demonstrates in great detail the laparoscopic TEP approach to recurrent hernia. The previously placed mesh plug is carefully dissected and removed. The preperitoneal space is thus created in order to place a mesh in the correct position. This video is suitable for experienced laparoscopic hernia surgeons.
The author begins the dissection lateral to the inferior epigastric vessels, then uses sharp dissection to take down the adhesions. This step requires caution because of the proximity of major vessels. The author then continues with sharp and blunt dissection to further develop the lateral peritoneal space. A few clean sweeps of the scissors or blunt forceps downward make adequate space lateral to the inferior epigastric vessels for mesh placement.
P Arora
Surgical intervention
12 years ago
889 views
35 likes
0 comments
11:28
Removal of mesh plug and TEP repair of a recurrent left inguinal hernia in a 72-year-old man
This video demonstrates in great detail the laparoscopic TEP approach to recurrent hernia. The previously placed mesh plug is carefully dissected and removed. The preperitoneal space is thus created in order to place a mesh in the correct position. This video is suitable for experienced laparoscopic hernia surgeons.
The author begins the dissection lateral to the inferior epigastric vessels, then uses sharp dissection to take down the adhesions. This step requires caution because of the proximity of major vessels. The author then continues with sharp and blunt dissection to further develop the lateral peritoneal space. A few clean sweeps of the scissors or blunt forceps downward make adequate space lateral to the inferior epigastric vessels for mesh placement.
Right inguinal hernia and intrafascial psoas hernia: TEP repair
This is a video demonstrating the laparoscopic preperitoneal approach to repair a right inguinal hernia. The Veress needle is used directly at the beginning of the procedure to create the preperitoneal space. Interestingly, a psoas herniation is also discovered during the dissection. This video is suitable for general surgeons with an interesting laparoscopic hernia surgery.
The authors gain view of the pubic bone, following it to the Cooper’s ligament. Their goal is to create space with blunt dissection and gentle traction only. They proceed with caution to avoid the epigastric vessels. The hernia comes into view, but the authors remain close to the hernia sac to avoid the epigastric vessels until they discern the exact anatomy. This guides the operators to the hernia, and they then continue to develop additional lateral space.
B Dallemagne, S Perretta, J Marescaux
Surgical intervention
12 years ago
1871 views
53 likes
0 comments
13:39
Right inguinal hernia and intrafascial psoas hernia: TEP repair
This is a video demonstrating the laparoscopic preperitoneal approach to repair a right inguinal hernia. The Veress needle is used directly at the beginning of the procedure to create the preperitoneal space. Interestingly, a psoas herniation is also discovered during the dissection. This video is suitable for general surgeons with an interesting laparoscopic hernia surgery.
The authors gain view of the pubic bone, following it to the Cooper’s ligament. Their goal is to create space with blunt dissection and gentle traction only. They proceed with caution to avoid the epigastric vessels. The hernia comes into view, but the authors remain close to the hernia sac to avoid the epigastric vessels until they discern the exact anatomy. This guides the operators to the hernia, and they then continue to develop additional lateral space.