Single-incision laparoscopic surgery (SILS) for totally extraperitoneal (TEP) inguinal hernia repair: first case

Abstract

To the Editors There has been an open debate in the most recent literature on possible progress in laparoscopic surgery, aiming mainly at benefits of minimization of surgical trauma and improvement of cosmesis. Natural-orifice transluminal endoscopic surgery (NOTES) and single-incision laparoscopic surgery (SILS) have emerged as approaches whose advantages and possible applications are being explored and tested currently.Operations eligible for NOTES approach are determined by the availability of entry point or hollow organ, availability of endoscopic instruments, and occasional necessity for hybrid or laparoscopic assistance. SILS on the other hand enables the application of a wide range of already existing instruments, implying less of a learning curve, lower costs, and lack of necessity for penetration through the hollow organ, which itself carries certain complications. The main point for reducing the number of incisions prevails: each incision risks morbidity of bleeding, incisional hernia, and organ damage, and decreases cosmesis.SILS was first described in 1998 in laparoscopic appendectomy [1] and cholecystectomy [2], but enthusiasm was limited until recently due to insufficient technical support. Revival was initiated by Hirano et al. in 2005 with its application in urology [3]. Return of SILS cholecystectomy and application in obesity surgery followed [4,5]. Technical approaches that enabled this revival were several adjacently placed trocars, special multilumen ports that allow simultaneous multiple instruments insertion [6], gelports [7], bent and articulating instruments, and adjustments in laparoscopes, which are all commercially available.Based on Cohrane 2005 systematic review [8] TAPP was associated with higher rates of port-site hernias and visceral injuries whilst there appear to be more conversions with TEP. Vascular injuries and deep/mesh infections were rare and there was no obvious difference between the groups. No studies reporting economic evidence were identified. Very limited data were available on learning effects, but these data suggest that operators become experienced at between 30 and 100 procedures. However, there were not enough data to support either one unanimously. Arguments discerning open and laparoscopic hernia repair are well known and we will not pursue them in this letter.We chose TEP, with the strongest argument of not entering the abdominal cavity and avoiding potential injury to intra-abdominal structures. Indications are bilateral and recurrent inguinal hernia and patient choice if dealing with primary hernia. We started performing TEP in 1996 and have so far performed more than 1,000 procedures without major complications. Until now we used three-port access as a standard approach and single or double mesh placement after adequate reposition and field preparation.In this technical modification-right primary indirect inguinal hernia TEP repair-we used a single vertical midline infraumbilical skin incision 2.5 cm long. Dissection of subcutaneous tissue to the anterior ...

The role of the laparoendoscopic single site totally extraperitoneal approach to inguinal hernia repairs: a review and meta-analysis of the literature

“…On further scrutiny, 16 articles 15,19,22,[35][36][37][38][39][40][41][42][43][44][45][46][47] were used in our literature review and 3 studies comparing LESS TEP with LAP TEP were found to have useful data for the summative outcome. One study commented on a previous report.…”

“…One study commented on a previous report. 37 Three studies 22,40,45 compared LESS TEP with LAP TEP and were combined to produce a summative outcome. A flow chart of the literature search according to PRISMA guidelines 48 is shown in Figure 1.…”

Single Incision Laparoscopic Splenectomy. Our First Experiences.

“…Many procedures such as (2,(10)(11)(12)(13)(14). The fi rst SILS practice in the world has been performed in our clinic (7).…”

Single-Incision Thoracoscopic Surgery for Spontaneous Pneumothorax Using Multi-Degrees of Freedom Forceps

“…Single-incision laparoscopic surgery (SILS) has now been adopted for appendectomy, cholecystectomy, and inguinal hernia repair. [6][7][8] Additionally, recent studies have demonstrated successful results of gastric or colorectal surgery using the SILS approach. 9,10) In contrast, only a few studies of single-incision thoracoscopic surgery (SITS) have been reported.…”