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Inguinal Hernia Repair with Mini-laparoscopic Instruments

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Abstract

Surgical treatment of groin hernias has dramatically improved over the past century. Several contemporary tension-free techniques provide satisfactory results, including laparoscopic TAPP and TEP repairs. With the maturation of therapeutic laparoscopy has come an emphasis on making minimally invasive surgery even less invasive. “Reduced port surgery” (RPS) approaches emphasize fewer ports, smaller diameter trocars, and placement of incisions in occult locations. Mini-laparoscopy is one RPS option. The term “mini-laparoscopy” (Mini) is generally applied to laparoscopic instruments with reduced shaft diameters ranging from 1.9 to 3.5 mm. Newer generation Mini instruments have recently become available with improved effector tips, a choice of shaft diameters and lengths, better insulation and electrosurgery capability, improved strength and rotation, more ergonomic handles, low-friction trocar options, and improved instrument durability. Mini-laparoscopy is a natural evolution of conventional laparoscopy. Port placement, instrument triangulation, and procedure conduct are preserved. The optical shadow of Mini instruments is less, allowing the laparoscope to come closer to the surgical target. A surgeon proficient in conventional laparoscopy can transition to mini-laparoscopy with minimal learning curve. Mini-laparoscopy is intuitively cost-effective, with no expensive capital expenditures, maintenance contracts, or single-incision devices. With respect to inguinal hernia repair, almost all reports of Mini refer to TEP. Mini is especially helpful for TEP because TEP is executed in a constrained space. While the published experience regarding Mini for inguinal hernia repair is less mature than for cholecystectomy, the early findings appear similar—Mini has comparable safety, comparable effectiveness, and mildly improved post-op pain and cosmesis compared to conventional laparoscopy. The options for using Mini with TAPP, TEP, and combined approaches are presented here.

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Author information

Authors and Affiliations

  1. Department of Surgery—University of Pernambuco, Hospital Universitario Oswaldo Cruz, Recife, PE, Brazil

    Gustavo Carvalho

  2. Department of General Surgery, INC Curitiba Positivo University, Curitiba, Parana, Brazil

    Marcelo Loureiro

  3. Institute of Education and Research, Moinhos de Vento Hospital, Porto Alegre, Rio Grande do Sul, Brazil

    Miguel Nacul

  4. Department of Surgery, Montefiore Medical Center, Bronx, NY, USA

    Flavio Malcher

  5. Department of General and Laparoscopic Surgery, Hospital Centro Medico ABC Santa Fe, Mexico City, Mexico

    Eduardo Moreno Paquentin

  6. Department of Surgery, Duke University Medical Center, Durham, NC, USA

    Phillip Shadduck

Authors
  1. Gustavo Carvalho
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  2. Marcelo Loureiro
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  3. Miguel Nacul
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  4. Flavio Malcher
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  5. Eduardo Moreno Paquentin
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  6. Phillip Shadduck
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Editor information

Editors and Affiliations

  1. Emory University, Atlanta, GA, USA

    S. Scott Davis, Jr.

  2. Weill Med College At Cornell University, New York, NY, USA

    Gregory Dakin

  3. Stony Brook Surgical Associates, Centereach, NY, USA

    Andrew Bates

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© 2019 Society of American Gastrointestinal and Endoscopic Surgeons (SAGES)

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Carvalho, G., Loureiro, M., Nacul, M., Malcher, F., Paquentin, E.M., Shadduck, P. (2019). Inguinal Hernia Repair with Mini-laparoscopic Instruments. In: Davis, Jr., S., Dakin, G., Bates, A. (eds) The SAGES Manual of Hernia Surgery. Springer, Cham. https://doi.org/10.1007/978-3-319-78411-3_34

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  • DOI: https://doi.org/10.1007/978-3-319-78411-3_34

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  • Online ISBN: 978-3-319-78411-3

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