Single port left direct inguinal hernia repair

Minimally invasive techniques continue to evolve. This leads to an improvement of less invasive surgery over standard procedures. Single port TAPP inguinal hernia repair is technically feasible. This video shows a left direct inguinal hernia repair using the R port (namely the TriPort manufactured by Advanced surgical concepts).

Create account

Browse the WORLD

Virtual University

Google translate

Summary
Chapters
Your comments
Ask the Experts

You need to log in to watch this media!

Click here to log in.

Single port left direct inguinal hernia repair

Authors

Abstract

Minimally invasive techniques continue to evolve. This leads to an improvement of less invasive surgery over standard procedures. Single port TAPP inguinal hernia repair is technically feasible. This video shows a left direct inguinal hernia repair using the R port (namely the TriPort manufactured by Advanced surgical concepts).

Classification

new techniques, single port

Keywords

Single port left direct inguinal hernia repair

Media type

Surgical video

Duration

07'30''

Publication

2009-07

Popular

Favorites

Favorites Media

Audio

Subtitles

E-publication

WeBSurg.com, Jul 2009;9(07).
URL: http://www.websurg.com/doi-vd01en2694.htm

Single port left direct inguinal hernia repair

1. Clinical case presentation 00'12''

This is the case of a 65-year-old male patient with a history of reducible swelling in the left groin for 1 year. His past surgical history included an appendectomy operated on 10 years ago. His BMI is of 28 and he has no significant co-morbidities. On examination, a large reducible hernia is found on the left side. Preoperatively, we recommended a laparoscopic hernia repair using a single port. The patient was informed that this procedure is not carried out using this technique. He consented for the information and also consented for the procedure to be recorded. The patient undergoes a general anesthesia. No antibiotics are administered. The patient is positioned supine with head down. The surgeon stands on the left side of the patient. The assistant and the scrub nurse stand on the patient’s right side.

2. Presentation of instruments 01'00''

Instruments used are as follows: a R port (namely the TriPort manufactured by Advanced surgical concepts); roticulating mini-shears (manufactured by Covidien); a roticulating grasper (by Covidien); a re-usable straight grasper (by Karl Storz). The mesh used is an Ultrapro partially absorbable mesh manufactured by Ethicon. Its size is 6” by 6” (that is 15 cm x 15 cm). The tacking device used is the AbsorbaTackTM (by Ethicon). Vicryl 2/0 suture material is used to close the peritoneal and fascial defect after completion of the procedure. Monocryl 3/0 is applied to the skin.

3. R port introduction 01'37''

Now to the operative steps. An open cannulation is used. The R port is introduced as shown in the video. Two roticulating instruments (one grasper and one shears) as well as one straight grasper are used for the operation.

4. Peritoneal flap dissection 01'50''

The peritoneal flap is raised and dissection is carried out in the preperitoneal space.

5. Hernia reduction 02'16''

The hernia is reduced.

6. Mesh placement 04'29''

A 15 x 15cm mesh is placed and secured.

7. Peritoneal flap closure 05'29''

Absorbable tackers are used to close the peritoneal flap. The port is removed and the defect is closed with Vicryl 2/0 suture material. The skin is re-approximated with Monocryl 3/0. Total operating time is 50 minutes. The patient recovered uneventfully and was discharged within 3 hours. He was followed up 6 weeks afterwards and remains asymptomatic.