Application of a custom-made single-incision sealing device in laparoscopic surgery for totally extraperitoneal herniorrhaphy: initial experience

Abstract

Background: In this research, the safety and feasibility of single-incision laparoscopic surgery for total intraperitoneal herniorrhaphy (SILS-TEP) was clarified through a customized single-port device.Methods: A 2.5 cm curved incision was made along the lower umbilical margin. The subcutaneous fatty tissue was removed by electrotomy or blunt dissection to form a 5.0 cm preperitoneal space under the posterior sheath. The Iconport single-hole device silicone sealing sleeve was wedged under the posterior rectus sheath and inflated with CO 2 to dilate the anterior peritoneal space toward the lower abdomen.According to the standard method of laparoscopic total peritoneal hernia repair, conventional laparoscopic instruments were used to complete the operation.Results: Successful SILS-TEP hernia repair was performed in 63 patients. The mean operative times for unilateral indirect hernia were 65.5 [40-110] minutes. The mean operative times for unilateral direct hernia, and femoral were 51.3 [36-83] minutes, respectively. Six seroma cases were seen during the 1-to 32-month follow-up periods, and all patients recovered after conservative treatment. No other major complications were observed. The mean postoperative hospital stay was 3.3 days. Conclusions:With the assistance of a suitable single-port laparoscopic device, SILS-TEP umbilical incision under the posterior rectus sheath is a safe and feasible method.

Potential applications of single-incision laparoscopic totally preperitoneal hernioplasty

“…However, SIL-TEP has disadvantages that cannot be overcome by improving surgical skills. Since 2018, we have attempted to successfully perform single-incision inguinal hernia repair via the TPP approach[ 7 , 8 ]. In addition, comparison of SIL-TPP and SIL-TEP showed that SIL-TPP could overcome the disadvantages of SIL-TEP, such as a confined operation space and adverse factors resulting from peritoneum rupture[ 9 ].…”

“…201110229309.4) (Figures 1 and 2 ). The results suggested that SIL-TPP was a safe and feasible procedure[ 7 , 8 ]. In the initial stage of the study, peritoneal damage occurred in 3 patients at the beginning of the operation, and the author immediately converted to conventional TAPP surgery due to a lack of experience.…”

“…The primary anatomic landmarks, including the inferior epigastric vessels, pubic bone, anterior superior spine, corona mortis, and Cooper’s ligaments, were identified. Then, SIL-TPP was performed according to routine procedures[ 7 , 8 ] (Figure 2F ). In step 5, the mesh was placed.…”

“…However, evidence also suggests that SIL-TEP has inherent disadvantages, such as limited operation space, in-line positioning of the laparoscope, and instrument conflict, among others, which cannot be overcome through improved surgical skills[ 5 , 6 ]. Considering that the abdominal wall consists of nine layers, we previously introduced the totally preperitoneal (TPP) approach and succeeded in implementing SIL inguinal hernia repair in the PPS[ 7 , 8 ]. The procedure was named SIL totally extraperitoneal hernioplasty (SIL-TPP) to distinguish it from SIL-TEP[ 7 ].…”

A Technical Solution to Solve the Operation Difficulties of Single-Port Laparoscopic Surgical Instruments

“…US9,393,003B2) (Figure 1) to perform transumbilical single-port laparoscopic appendectomy, cholecystectomy, hernia repair and enterolysis. 6,7 By alternating between the different operation holes on the operation panel to eliminate interference, the target operation field has omni-directional exposure. The hard material operation panel supports the lens and equipment 8 so that one can expose the operation field from any angle.…”