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Laparoscopic totally extraperitoneal (TEP) hernioplasty using two trocars: anatomical landmarks and surgical technique
BACKGROUND: Among endoscopic hernioplasties, totally extraperitoneal (TEP) and transabdominal preperitoneal (TAPP) approach are widely accepted alternatives to open surgery, both providing less postoperative pain, hospital length of stay and early return to work. Classical TEP technique requires thr...
Autores principales: | , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
Colégio Brasileiro de Cirurgia Digestiva
2015
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4737334/ https://www.ncbi.nlm.nih.gov/pubmed/26176249 http://dx.doi.org/10.1590/S0102-67202015000200009 |
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author | IUAMOTO, Leandro Ryuchi KATO, Juliana Mika MEYER, Alberto BLANC, Pierre |
author_facet | IUAMOTO, Leandro Ryuchi KATO, Juliana Mika MEYER, Alberto BLANC, Pierre |
author_sort | IUAMOTO, Leandro Ryuchi |
collection | PubMed |
description | BACKGROUND: Among endoscopic hernioplasties, totally extraperitoneal (TEP) and transabdominal preperitoneal (TAPP) approach are widely accepted alternatives to open surgery, both providing less postoperative pain, hospital length of stay and early return to work. Classical TEP technique requires three skin incisions for placement of three trocars in the midline or in triangulation. AIM: To describe a technique using only two trocars for laparoscopic total extraperitoneal for inguinal hernia repair. METHOD: Extraperitoneal access: place two regular trocars on the midline. The 10 mm is inserted into the subcutaneous in horizontal direction after a transverse infra-umbilical incision and then elevated at 60º angle. The 5 mm trocar is inserted at the same level of the pubis with direct vision. Preperitoneal space dissection: introduction 0º optical laparoscope through the infra-umbilical incision for visualization and preperitoneal dissection; insufflation pressure must be below 12 mmHg. Dissection of some anatomical landmarks: pubic bone, arcuate line and inferior epigastric vessels. Exposure of "triangle of pain" and "triangle of doom". Insertion through the 10 mm trocar polypropylene mesh of 10x15 cm to cover the hernia sites. Peritoneal sac and the dorsal edge of the mesh are repositioned in order to avoid bending or mesh displacement. It is also important to remember that the drainage is not necessary. RESULTS: The 2-port TEP required less financial costs than usual because it is not necessary an auxiliary surgeon to perform the technique. Trocars, suturing material and wound dressing were spared in comparison to the classical technique. Besides, there were only two incisions, which provides a better plastic result and less postoperative pain. CONCLUSION: The TEP technique using two trocars is an alternative technique which improves cosmetic and financial outcomes. |
format | Online Article Text |
id | pubmed-4737334 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2015 |
publisher | Colégio Brasileiro de Cirurgia Digestiva |
record_format | MEDLINE/PubMed |
spelling | pubmed-47373342016-02-24 Laparoscopic totally extraperitoneal (TEP) hernioplasty using two trocars: anatomical landmarks and surgical technique IUAMOTO, Leandro Ryuchi KATO, Juliana Mika MEYER, Alberto BLANC, Pierre Arq Bras Cir Dig Original Article BACKGROUND: Among endoscopic hernioplasties, totally extraperitoneal (TEP) and transabdominal preperitoneal (TAPP) approach are widely accepted alternatives to open surgery, both providing less postoperative pain, hospital length of stay and early return to work. Classical TEP technique requires three skin incisions for placement of three trocars in the midline or in triangulation. AIM: To describe a technique using only two trocars for laparoscopic total extraperitoneal for inguinal hernia repair. METHOD: Extraperitoneal access: place two regular trocars on the midline. The 10 mm is inserted into the subcutaneous in horizontal direction after a transverse infra-umbilical incision and then elevated at 60º angle. The 5 mm trocar is inserted at the same level of the pubis with direct vision. Preperitoneal space dissection: introduction 0º optical laparoscope through the infra-umbilical incision for visualization and preperitoneal dissection; insufflation pressure must be below 12 mmHg. Dissection of some anatomical landmarks: pubic bone, arcuate line and inferior epigastric vessels. Exposure of "triangle of pain" and "triangle of doom". Insertion through the 10 mm trocar polypropylene mesh of 10x15 cm to cover the hernia sites. Peritoneal sac and the dorsal edge of the mesh are repositioned in order to avoid bending or mesh displacement. It is also important to remember that the drainage is not necessary. RESULTS: The 2-port TEP required less financial costs than usual because it is not necessary an auxiliary surgeon to perform the technique. Trocars, suturing material and wound dressing were spared in comparison to the classical technique. Besides, there were only two incisions, which provides a better plastic result and less postoperative pain. CONCLUSION: The TEP technique using two trocars is an alternative technique which improves cosmetic and financial outcomes. Colégio Brasileiro de Cirurgia Digestiva 2015 /pmc/articles/PMC4737334/ /pubmed/26176249 http://dx.doi.org/10.1590/S0102-67202015000200009 Text en http://creativecommons.org/licenses/by-nc/4.0/ This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. |
spellingShingle | Original Article IUAMOTO, Leandro Ryuchi KATO, Juliana Mika MEYER, Alberto BLANC, Pierre Laparoscopic totally extraperitoneal (TEP) hernioplasty using two trocars: anatomical landmarks and surgical technique |
title | Laparoscopic totally extraperitoneal (TEP) hernioplasty using two
trocars: anatomical landmarks and surgical technique |
title_full | Laparoscopic totally extraperitoneal (TEP) hernioplasty using two
trocars: anatomical landmarks and surgical technique |
title_fullStr | Laparoscopic totally extraperitoneal (TEP) hernioplasty using two
trocars: anatomical landmarks and surgical technique |
title_full_unstemmed | Laparoscopic totally extraperitoneal (TEP) hernioplasty using two
trocars: anatomical landmarks and surgical technique |
title_short | Laparoscopic totally extraperitoneal (TEP) hernioplasty using two
trocars: anatomical landmarks and surgical technique |
title_sort | laparoscopic totally extraperitoneal (tep) hernioplasty using two
trocars: anatomical landmarks and surgical technique |
topic | Original Article |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4737334/ https://www.ncbi.nlm.nih.gov/pubmed/26176249 http://dx.doi.org/10.1590/S0102-67202015000200009 |
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