Manish Kumar Gupta, Associate Professor, Sarrah Idrees, Dr, Rathindra Sarangi, Dr. Sir Ganga Ram Hospital, New Delhi
Hasson trocar technique is the only technique known among laparoscopic surgeons to access the pre-peritoneal space (PPS) for TEP repair of inguinal hernia. The insertion of Hasson trocar in PPS is a relatively blind step and can accidently injure the peritoneum during insertion. This can result in difficult dissection and prolongation of operating time. The large cone of Hasson trocar needs to be fixed by anchoring sutures to the anterior rectus sheath (ARS). This fixation further tears the fibres of ARS & need repair at the end of surgery. Placement & fixation of Hasson trocar takes 7 to 10 minutes of operating time. Bigger wound causes more pain in comparison to 5 mm port wound. A 2.5-3 cm skin scar in the infra-umbilical region is also cosmetically less acceptable, especially to females.
We have innovated an optiview “555 Manish Technique” by which PPS is accessed by 5mm visiport under complete vision without any dependence on Hasson trocar and anchoring sutures for Mini TEP repair.
An indigenous inexpensive second generation “Manish Retractor” (Patent filed) is made which plays a key role in inserting 5mm visiport to access PPS under complete vision. We have also innovated a technique to introduce adequate size light weight polypropylene mesh through 5mm port which facilitates in completion of surgery by all three 5mm ports.
Results: We operated 160 male and 2 female patients. The average age of patients was 43.2 years. 160/162 cases were successfully completed by our technique. Two cases were converted to TAPP because of adhesions and difficult dissection. In 160 patients, 203 inguinal, 1 femoral & 1 obturator hernias were operated. The average duration of first 5mm port placement to access PPS was 2.1 minutes which is far less than the Hasson trocar technique. Pain was less due to all 5 mm ports. Smaller 5mm scars are cosmetically more acceptable to patients. We reported no recurrence or complications other than seroma on 6 months follow up.
Conclusion: “555 Manish Technique” is easy, less invasive, less morbid, time saving, cost effective & reproducible technique. There is no dependence on Hasson Trocar & it doesn’t compromise the principles of current surgical procedure.
Presented at the SAGES 2017 Annual Meeting in Houston, TX.
Abstract ID: 94758
Program Number: V342
Presentation Session: Video Loop Day 3
Presentation Type: VideoLoop