Many general surgeons initially perform single-incision laparoscopic surgery during cholecystectomy. The potential for bile duct injury makes single-incision cholecystectomy potentially dangerous while the surgeon is overcoming his learning curve. This describes one surgeon’s experience with single-incision totally extraperitoneal (TEP) inguinal hernia repair prior to performing more complex single-incision laparoscopic cases.
Methods: All patients who underwent TEP during September 2009 were retrospectively reviewed. The single-incision TEPs were performed through a periumbilical incision using a commercial port. A 5 mm standard laparoscope and standard laparoscopic instruments were used. A full dissection of the myopectineal orifice was performed and a 10 cm x 15 cm piece of polyester mesh was placed. Other single-incision operations during the same time period were also reviewed
Results: 12 patients underwent TEP during the study period. Two patients did not undergo attempted single-incision TEP:1 patient had a scrotal hernia and1 patient had a recurrent hernia. In 10 male patients, single-incision TEP was attempted.Nine patients had primary unilateral hernias and 1 patient had bilateral hernias. The average age was 48 years. The average BMI was 26. Eight of the 10 patients had complete single-incision TEP.Two patients required placement of additional laparoscopic trocars: in 1 patient the balloon dissection was inadequate, and in 1 patient bleeding in the obturator space required better visualization. The average operating time in the single-incision group was 49 minutes. Both cases requiring additional trocars lasted 90 minutes. There were no short-term complications in any of the 12 hernia patients.Two other patients had successful single-incision laparoscopic operations during the study period: a 37 year old woman had a resection of a 4 cm liver hemangioma ,and a 28 year old woman had an uncomplicated cholecystectomy.
Conclusions: Single-incision TEP was feasible and safe in this group of thin male patients with primary inguinal hernias. Performing single-incision TEP prior to more complex abdominal cases allowed this surgeon to gain facility with single-incision techniques with a diminished specter for serious complications. The more complex cases were facilitated by the prior experience with single-incision port placement, retraction, and dissection techniques. Single-incision TEP may be a useful entrée into the field of single-incision surgery for many general surgeons.
Program Number: P452