Laparoendoscopic single-site surgery (LESS) for laparoscopic inguinal hernia repair (IHR) offers the potential for excellent cosmetic outcomes and maximization of the inherent advantages of minimally invasive surgery. LESS IHR is associated with a steep learning curve, which is attributable to both the IHR technique itself and the single-site technique. The technical obstacles in the single-site technique may be mitigated by employing certain maneuvers and strategies that minimize clashing between instruments and improve freedom of movement. The current literature consistently points out the inherent challenges in LESS IHR, with its longer operative time compared to that of conventional laparoscopic IHR. LESS IHR performed by capable operators has comparable complication rates, duration of hospital stay, and incidence of recurrence as conventional laparoscopic IHR. LESS IHR is both feasible and safe. Given its excellent cosmetic outcome, it is likely to be sought by younger patients who are concerned with scar formation. The use of robotics may bypass the technical challenges in LESS, but cost considerations in their usage will likely persist.

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Crucial in any surgery, the performance and the outcome depend not only on the surgeon’s skills and patient preparation but also on the setup of the operating room (OR) and positioning of the patients. In endo-laparoscopic surgery, we work with technology like cameras, monitors, insufflators, energy devices, and more. They are connected and interconnected by several cables and tubings. It is vital for patient’s and OR Staff’s safety that they be easily accessible in a fast and timely manner in case of any emergency or unexpected event. Avoid entangling of cables, or interaction between tubing and cables will make your surgery safer, elegant, and less stressful.

Visualization is one of the fundamental pillars (including CO2 insufflation and instrumentation) critical to performing MIS. Initially evolved from direct view through the laparoscope to indirect view on the monitor projected from a camera system. Early advances were geared towards improving the image quality and reproduction of stereoscopic vision. Current advancements involve in part or in combination, the application of optical filters to manipulate specific light spectrums (narrow-band imaging) and the use of fluorescent dye (indocyanine green-fluorescent imaging) to see beyond what can be viewed with the naked eye, coupled with the advantage of real-time application. Narrow-band imaging is primarily used in gastrointestinal endoscopy to detect mucosal pathologies, while ICG aid in revealing specific structures beneath tissues and assess tissue perfusion; it is finding interest for application in various MIS procedures.