A Cheap Method of Single Incision Laparoscopic Surgery in Total Extraperitoneal Approach for Inguinal Hernia

Hayashi Nobuyasu, PhD, Ichihara Takao, PhD, Oka Yoshio, PhD, Sakon Masato, PhD. Nishinomiya Municipal Hospital

INTRODUCTION: With technical advancements and the increasing demand for more minimally invasive surgery, single incision laparoscopic surgery (SILS) has recently been deployed in certain surgical procedures including inguinal hernia surgery. Currently, SILS can usually be performed with the use of several novel multichannel single port devices. It is well known that these specialized ports and instruments are too expensive and ecologically wasteful. To our knowledge, no report in the literature has described SILS TEP for inguinal hernia using the glove port technique. We will demonstrate our initial experiences with SILS-TEP using a homemade single-port device with a surgical glove and cheap instruments, assessing the safety and feasibility of this technique.
MATERIAL and SURGICAL TECHNIQUE: From August to December 2011, a total of 10 indirect inguinal hernia cases under went SILS TEP performed by a single surgeon at our hospital with this technique. The single port was made with a sterile 6.0 inch surgical glove, three 5mm laparoscopic reusable standard trocars for reusable forceps and a laparoscopy. A Lap Protector for 2-4cm skin incision was installed in position through the incision with the bottom ring between the rectus muscle and the posterior layer of rectus sheath, followed by the placement of a single-port device using the surgical glove. No DPP balloon was used to dissect the peritoneum space. TEP procedure was almost the same as the conventional laparoscopic one, except for slight discomfort with visualization and retraction due to collision of the instruments.
RESULTS: We successfully performed SILS-TEP for 10 patients with unilateral inguinal hernia using this port. All procedures were completed without any intraoperative or postoperative complications without the need for any conversion to standard laparoscopic or open surgery. The mean operative time was 82.3 min (range, 65-120 min). No perioperative or postoperative complications or accidents were recorded in association with the use of a homemade single-port device during the surgery. All hospitalization duration was less than 24hr after each operation. Mean visual analogue pain scales on the operative day, 1hr, 3hr and 6hr after surgery and the first postoperative day were 6.3/10, 5.3/10, 5.1/10 and 2.1/10, respectively. These scores were comparatively lower than those obtained from conventional TEP or open methods, such as Mesh Plug procedures. Our port was more cost-effective than those commercial single port access systems, because our port consists of conventional reusable instruments. Another merit in our port system was its feasibility in the movement of forceps for SILS. We could preoperatively alter the choices of trocar placement in staggered position to prevent the interference. In addition, the surgical rubber glove was flexible enough to manipulate the forceps three dimensionally, minimizing the conflict. CONCLUSION: This homemade single port device reported in this study provides a simple, cost effective and flexible approach to carry out SILS-TEP. This port device might be an alternative for current commercial expensive port devices designed for SILS technique.

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