Skip to main content
Log in

Laparoendoscopic single-site versus conventional laparoscopic total extraperitoneal hernia repair: a prospective randomized clinical trial

  • Published:
Surgical Endoscopy Aims and scope Submit manuscript

Abstract

Background

This study aimed to compare laparoendoscopic single-site (LESS) total extraperitoneal (TEP) repair with conventional laparoscopic TEP repair for the treatment of inguinal hernias. To date, no other studies have compared the LESS and conventional laparoscopic TEP approaches for the treatment of inguinal hernia in a prospective randomized study setting.

Methods

For this study, 100 patients undergoing inguinal hernia repair were prospectively randomized into either the LESS TEP group or the conventional laparoscopic TEP group. Pre-, intra-, and postoperative factors were recorded. The primary end point was postoperative pain. The patients were interviewed at outpatient clinics at 1 week, 3 months, and 6 months postoperatively.

Results

The demographic data were comparable between the two groups. The median operative time was longer in the LESS TEP group (63.5 min) than in the conventional TEP group (50.5 min) (p = 0.001). No conversion was performed in either group. The mean pain score 2 h postoperatively during rest was significantly higher in the conventional TEP group than in the LESS TEP group (3.9 vs. 2.6; p = 0.02). The postoperative results were comparable between the groups in terms of analgesic requirements, systemic stress responses, complications, and postoperative convalescence.

Conclusions

The LESS TEP technique is associated with a longer operative time but offers the minor benefit of a reduction in immediate postoperative pain.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Subscribe and save

Springer+ Basic
EUR 32.99 /Month
  • Get 10 units per month
  • Download Article/Chapter or Ebook
  • 1 Unit = 1 Article or 1 Chapter
  • Cancel anytime
Subscribe now

Buy Now

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Fig. 1
Fig. 2

Similar content being viewed by others

References

  1. Memon MA, Cooper NJ, Memon B et al (2003) Meta-analysis of randomized clinical trials comparing open and laparoscopic inguinal hernia repair. Br J Surg 90:1479–1492

    Article  PubMed  CAS  Google Scholar 

  2. Tsai YC, Wu CC, Yang SS (2010) Open versus minilaparoscopic herniorrhaphy for children: a prospective comparative trial with midterm follow-up evaluation. Surg Endosc 24:21–24

    Article  PubMed  Google Scholar 

  3. Johansson B, Hallerback B, Glise H et al (1999) Laparoscopic mesh versus open preperitoneal mesh versus conventional technique for inguinal hernia repair: a randomized multicenter trial (SCUR Hernia Repair Study). Ann Surg 230:225–231

    Article  PubMed  CAS  Google Scholar 

  4. Kaouk JH, Autorino R, Kim FJ et al (2011) Laparoendoscopic single-site surgery in urology: worldwide multi-institutional analysis of 1,076 cases. Eur Urol 60:998–1005

    Article  PubMed  Google Scholar 

  5. Hernandez JM, Morton CA, Ross S et al (2009) Laparoendoscopic single-site cholecystectomy: the first 100 patients. Am Surg 75:681–685 discussion 685–686

    PubMed  Google Scholar 

  6. Ganpule AP, Dhawan DR, Kurien A et al (2009) Laparoendoscopic single-site donor nephrectomy: a single-center experience. Urology 74:1238–1240

    Article  PubMed  Google Scholar 

  7. Desai MM, Berger AK, Brandina R et al (2009) Laparoendoscopic single-site surgery: initial hundred patients. Urology 74:805–812

    Article  PubMed  Google Scholar 

  8. Aron M, Canes D, Desai MM et al (2009) Transumbilical single-port laparoscopic partial nephrectomy. BJU Int 103:516–521

    Article  PubMed  Google Scholar 

  9. Agrawal S, Shaw A, Soon Y (2010) Single-port laparoscopic totally extraperitoneal inguinal hernia repair with the TriPort system: initial experience. Surg Endosc 24:952–956

    Article  PubMed  CAS  Google Scholar 

  10. Tracy CR, Raman JD, Cadeddu JA, Rane A (2008) Laparoendoscopic single-site surgery in urology: where have we been and where are we heading? Nat Clin Pract Urol 5:561–568

    Article  PubMed  Google Scholar 

  11. Rane A, Rao P, Rao P (2008) Single-port-access nephrectomy and other laparoscopic urologic procedures using a novel laparoscopic port (R-port). Urology 72:260–263 discussion 263–264

    Article  PubMed  Google Scholar 

  12. Kaouk JH, Haber GP, Goel RK et al (2008) Single-port laparoscopic surgery in urology: initial experience. Urology 71:3–6

    Article  PubMed  Google Scholar 

  13. Tsai YC, Ho CH, Tai HC (2010) Laparoendoscopic single-site (LESS) retroperitoneal nephropexy with standard laparoscopic instruments. J Laparoendosc Adv Surg Tech A 20:257–260 discussion 260

    Article  PubMed  Google Scholar 

  14. Chung SD, Huang CY, Wang SM et al (2011) Laparoendoscopic single-site (LESS) retroperitoneal adrenalectomy using a homemade single-access platform and standard laparoscopic instruments. Surg Endosc 25:1251–1256

    Article  PubMed  Google Scholar 

  15. Chung SD, Huang CY, Wang SM et al (2010) Laparoendoscopic single-site (LESS) nephroureterectomy and en bloc resection of bladder cuff with a novel extravesical endoloop technique. Surg Innov 17:361–365

    Article  PubMed  Google Scholar 

  16. Filipovic-Cugura J, Kirac I, Kulis T et al (2009) Single-incision laparoscopic surgery (SILS) for totally extraperitoneal (TEP) inguinal hernia repair: first case. Surg Endosc 23:920–921

    Article  PubMed  Google Scholar 

  17. Tai HC, Lin CD, Wu CC et al (2010) Homemade transumbilical port: an alternative access for laparoendoscopic single-site surgery (LESS). Surg Endosc 24:705–708

    Article  PubMed  Google Scholar 

  18. Lau H (2005) Fibrin sealant versus mechanical stapling for mesh fixation during endoscopic extraperitoneal inguinal hernioplasty: a randomized prospective trial. Ann Surg 242:670–675

    Article  PubMed  Google Scholar 

  19. Tsai YC, Lin VC, Chung SD, et al (2012) Ergonomic and geometric tricks of laparoendoscopic single-site surgery (LESS) by using conventional laparoscopic instruments. Surg Endosc Epub 22 March

  20. Lin VC, Tsai YC, Chung SD et al (2012) A comparative study of multiport versus laparoendoscopic single-site adrenalectomy for benign adrenal tumors. Surg Endosc 26:1135–1139

    Article  PubMed  Google Scholar 

  21. Best SL, Donnally C, Mir SA et al (2011) Complications during the initial experience with laparoendoscopic single-site pyeloplasty. BJU Int 108:1326–1329

    Article  PubMed  Google Scholar 

  22. Graversen JA, Lusch A, Landman J (2012) Is LESS really more? Indian J Urol 28:82–88

    Article  PubMed  Google Scholar 

  23. Zheng M, Qin M, Zhao H (2012) Laparoendoscopic single-site cholecystectomy: a randomized controlled study. Minim Invasive Ther Allied Technol 21:113–117

    Article  PubMed  Google Scholar 

  24. Tugcu V, Ilbey YO, Mutlu B, Tasci AI (2010) Laparoendoscopic single-site surgery versus standard laparoscopic simple nephrectomy: a prospective randomized study. J Endourol 24:1315–1320

    Article  PubMed  Google Scholar 

  25. Lirici MM, Califano AD, Angelini P, Corcione F (2011) Laparoendoscopic single-site cholecystectomy versus standard laparoscopic cholecystectomy: results of a pilot randomized trial. Am J Surg 202:45–52

    Article  PubMed  Google Scholar 

  26. Lee SW, Lee JY, Kim KH, Ha US (2012) Laparoendoscopic single-site surgery versus conventional laparoscopic varicocele ligation in men with palpable varicocele: a randomized, clinical study. Surg Endosc 26:1056–1062

    Article  PubMed  Google Scholar 

  27. Kurien A, Rajapurkar S, Sinha L et al (2011) First prize: standard laparoscopic donor nephrectomy versus laparoendoscopic single-site donor nephrectomy: a randomized comparative study. J Endourol 25:365–370

    Article  PubMed  Google Scholar 

  28. Fagotti A, Bottoni C, Vizzielli G et al (2011) Postoperative pain after conventional laparoscopy and laparoendoscopic single-site surgery (LESS) for benign adnexal disease: a randomized trial. Fertil Steril 96:255e2–259e2

    Article  Google Scholar 

  29. Cho YJ, Kim ML, Lee SY et al (2012) Laparoendoscopic single-site surgery (LESS) versus conventional laparoscopic surgery for adnexal preservation: a randomized controlled study. Int J Womens Health 4:85–91

    Article  PubMed  Google Scholar 

  30. Bucher P, Pugin F, Buchs NC et al (2011) Randomized clinical trial of laparoendoscopic single-site versus conventional laparoscopic cholecystectomy. Br J Surg 98:1695–1702

    Article  PubMed  CAS  Google Scholar 

  31. Aprea G, Coppola Bottazzi E, Guida F et al (2011) Laparoendoscopic single site (LESS) versus classic video-laparoscopic cholecystectomy: a randomized prospective study. J Surg Res 166:e109–e112

    Article  PubMed  Google Scholar 

  32. Tai HC, Lin CD, Chung SD et al (2011) A comparative study of standard versus laparoendoscopic single-site surgery (LESS) totally extraperitoneal (TEP) inguinal hernia repair. Surg Endosc 25:2879–2883

    Article  PubMed  Google Scholar 

  33. Cugura JF, Kirac I, Kulis T et al (2012) Comparison of single-incision laparoscopic totally extraperitoneal and laparoscopic totally extraperitoneal inguinal hernia repair: initial experience. J Endourol 26:63–66

    Article  PubMed  Google Scholar 

  34. Chung SD, Huang CY, Wang SM et al (2011) Laparoendoscopic single-site totally extraperitoneal adult inguinal hernia repair: initial 100 patients. Surg Endosc 25:3579–3583

    Article  PubMed  Google Scholar 

  35. Chung SD, Huang CY, Chueh SC et al (2011) Feasibility and safety of total extraperitoneal inguinal hernia repair after previous lower abdominal surgery: a case-control study. Surg Endosc 25:3353–3356

    Article  PubMed  Google Scholar 

  36. AM C, WD F, HJ B,et al (1990) Response of serum interleukin-6 in patients undergoing elective surgery of varying severity. Clin Sci 79:161–165

  37. Suter M, Martinet O, Spertini F (2002) Reduced acute phase response after laparoscopic total extraperitoneal bilateral hernia repair compared to open repair with the Stoppa procedure. Surg Endosc 16:1214–1219

    Article  PubMed  CAS  Google Scholar 

  38. Grande M, Tucci GF, Adorisio O et al (2002) Systemic acute-phase response after laparoscopic and open cholecystectomy. Surg Endosc 16:313–316

    Article  PubMed  CAS  Google Scholar 

  39. Jess P, Schultz K, Bendtzen K, Nielsen OH (2000) Systemic inflammatory responses during laparoscopic and open inguinal hernia repair: a randomised prospective study. Eur J Surg 166:540–544

    Article  PubMed  CAS  Google Scholar 

  40. Chaudhary D, Verma GR, Gupta R et al (1999) Comparative evaluation of the inflammatory mediators in patients undergoing laparoscopic versus conventional cholecystectomy. Aust N Z J Surg 69:369–372

    Article  PubMed  CAS  Google Scholar 

  41. Karayiannakis AJ, Makri GG, Mantzioka A et al (1997) Systemic stress response after laparoscopic or open cholecystectomy: a randomized trial. Br J Surg 84:467–471

    Article  PubMed  CAS  Google Scholar 

  42. Greco F, Hoda MR, Mohammed N et al (2012) Laparoendoscopic single-site and conventional laparoscopic radical nephrectomy result in equivalent surgical trauma: preliminary results of a single-centre retrospective controlled study. Eur Urol 61:1048–1053

    Article  PubMed  Google Scholar 

  43. Park SK, Olweny EO, Best SL et al (2011) Patient-reported body image and cosmesis outcomes following kidney surgery: comparison of laparoendoscopic single-site, laparoscopic, and open surgery. Eur Urol 60:1097–1104

    Article  PubMed  Google Scholar 

Download references

Disclosures

Yao-Chou Tsai, Chen-Hsun Ho, Huai-Ching Tai, Shiu-Dong Chung, and Shih-Chieh Chueh have no conflicts of interest or financial ties to disclose.

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Yao-Chou Tsai.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Tsai, YC., Ho, CH., Tai, HC. et al. Laparoendoscopic single-site versus conventional laparoscopic total extraperitoneal hernia repair: a prospective randomized clinical trial. Surg Endosc 27, 4684–4692 (2013). https://doi.org/10.1007/s00464-013-3116-z

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00464-013-3116-z

Keywords

Navigation