Application of a custom-made single-incision sealing device in laparoscopic surgery for totally extraperitoneal herniorrhaphy: initial experience

BACKGROUND: In this research, the safety and feasibility of single-incision laparoscopic surgery for total intraperitoneal herniorrhaphy (SILS-TEP) was clarified through a customized single-port device. METHODS: A 2.5 cm curved incision was made along the lower umbilical margin. The subcutaneous fatty tissue was removed by electrotomy or blunt dissection to form a 5.0 cm preperitoneal space under the posterior sheath. The Iconport single-hole device silicone sealing sleeve was wedged under the posterior rectus sheath and inflated with CO(2) to dilate the anterior peritoneal space toward the lower abdomen. According to the standard method of laparoscopic total peritoneal hernia repair, conventional laparoscopic instruments were used to complete the operation. RESULTS: Successful SILS-TEP hernia repair was performed in 63 patients. The mean operative times for unilateral indirect hernia were 65.5 [40–110] minutes. The mean operative times for unilateral direct hernia, and femoral were 51.3 [36–83] minutes, respectively. Six seroma cases were seen during the 1- to 32-month follow-up periods, and all patients recovered after conservative treatment. No other major complications were observed. The mean postoperative hospital stay was 3.3 days. CONCLUSIONS: With the assistance of a suitable single-port laparoscopic device, SILS-TEP umbilical incision under the posterior rectus sheath is a safe and feasible method.