MIS Techniques: Lap TAPP and rTAPP
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The transabdominal preperitoneal approach (TAPP) was described more than 25 years ago by several surgeons, and although the main principles are kept, there are several variations and details worth mentioning. Diverse technical details have emerged from formal research and surgical social media that are important for successful outcomes. While the TEP technique goes directly to the preperitoneal space, the TAPP technique reaches the same preperitoneal space after first entering the peritoneal cavity. Despite TAPP being considered as more invasive and taking longer to perform than TEP, it is surgically straightforward when it comes to understanding and learning the anatomy and the complexity of the repair; for this reason many surgeons see it as the first choice when learning MIS hernia repair.
Over the last three decades, the TAPP technique has evolved and has been refined, with successful innovations including central aspects like fixation and mesh types, but also creative and interesting (although never widely adopted) like combined approach, dissection aided by water, preperitoneal anesthetic injection to decrease pain, and self-expanding mesh. Therefore, we decided to include the more relevant steps proposed by many groups to reduce recurrences and minimize complications.
KeywordsLaparoscopic technique Laparoscopic hernia repair Robotic hernia repair rTAPP TAPP
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