Comparison of laparoendoscopic single-site versus conventional multiple-port laparoscopic herniorrhaphy: a systemic review and meta-analysis

Single-port versus traditional three-port laparoscopic total extraperitoneal inguinal hernia repair: A single-centre, prospective, randomised study

OBJECTIVE

To explore the efficacy and safety of single-incision laparoscopic (SIL) technique compared with the traditional three-port total extraperitoneal (TEP) technique for inguinal hernia repair.

METHODS

This prospective, randomised study involved patients who underwent surgery for inguinal hernia at our hospital from December 2021 to July 2023. Patients were randomly assigned to SIL-TEP or TEP groups based on a computer-generated random number table. Perioperative clinical indicators for the surgical approaches were evaluated.

RESULTS

Of the 127 patients eligible for study, 66 were randomised to the SIL-TEP group and 61 to the TEP group. The operation time for SIL-TEP was significantly longer than for TEP but the time to return to normal activities was significantly shorter and short-term pain score was significantly lower. There were no differences between groups in intraoperative blood loss, postoperative hospital stays, pain relief time, hospitalization costs or cosmetic satisfaction scores.

CONCLUSION

While SIL-TEP is more challenging than TEP for hernia repair, we found that at our centre it is comparable with regard to overall safety and feasibility. Further studies are needed to validate our findings.

Two-port (single incision plus one port) versus single-port laparoscopic totally extraperitoneal repair for inguinal hernia: a retrospective comparative study

The aim of this study is to compare the feasibility and efficacy of two-port (single incision plus one port) laparoscopic totally extraperitoneal repair (TEP) with single-port TEP for the treatment of inguinal hernia. We performed a retrospective comparative study from a prospectively maintained database. A cohort of 229 patients with inguinal hernia who underwent TEP were included. Of these patients, 124 underwent two-port TEP and 105 underwent single-port TEP. Differences in surgical outcomes were compared. The mean operative time was shorter in the two-port TEP group compared to the single-port TEP group (55.3 ± 13.1 vs. 65.1 ± 16.6 min, P < 0.001). There was no significant difference between the two groups in terms of other surgical outcomes including postoperative pain, postoperative hospital stay, time to resume daily activities, cosmetic satisfaction and complications. Two-port TEP is associated with a shorter operative time compared to single-port TEP, while the other outcomes evaluated in this study appear to be comparable.

Laparoendoscopic Single-Site Inguinal Herniorrhaphy: Experience of a Single Institute

Background: Minimally invasive techniques for inguinal herniorrhaphy have focused on developing the laparoendoscopic single-site (LESS) procedure to improve cosmesis. Outcomes of total extraperitoneal (TEP) herniorrhaphy vary considerably because of being performed by different surgeons. We aimed to evaluate the perioperative characteristics and outcomes of patients undergoing the LESS-TEP approach for inguinal herniorrhaphy and to determine its overall safety and effectiveness. Methods: Data of 233 patients who underwent 288 laparoendoscopic single-site total extraperitoneal approach (LESS-TEP) herniorrhaphies at Kaohsiung Chang Gung Memorial Hospital between January 2014 and July 2021 were reviewed retrospectively. We reviewed the experiences and results of LESS-TEP herniorrhaphy performed by a single surgeon (CHC) using homemade glove access and standard laparoscopic instruments with a 50 cm long 30° telescope. Results: Among 233 patients, 178 patients had unilateral hernias and 55 patients had bilateral hernias. About 32% (n = 57) of patients in the unilateral group and 29% (n = 16) of patients in the bilateral group were obese (body mass index ≥ 25). The mean operative time was 66 min for the unilateral group and 100 min for the bilateral group. Postoperative complications occurred in 27 (11%) cases, which were minor morbidities except for one mesh infection. Three (1.2%) cases were converted to open surgery. Comparison of the variables between obese and non-obese patients found no significant differences in operative times or postoperative complications. Conclusion: LESS-TEP herniorrhaphy is a safe and feasible operation with excellent cosmetic results and a low rate of complication, even in obese patients. Further large-scale prospective controlled studies and long-term analyses are needed to confirm these results.

An Alternative Technique for Transumbilical Single-Port Laparoscopic Percutaneous Precise Closure of the Inguinal Hernia Sac in Children: A 3-Year Single-Centre Study

Objective

To evaluate the safety and reliability of a novel technique of single-port laparoscopic-assisted percutaneous precise closure of the inguinal hernia sac in children.

Methods

From September 2016 through September 2019, children with inguinal hernia(s) treated with single-port laparoscopic-assisted percutaneous extraperitoneal closure using a guide wire were enrolled in this study. Operative time, surgical complications, recurrence rate, and cosmetic results were collected.

Results

A total of 917 cases with inguinal hernia(s) were collected. Among them, there were 886 (96.61%) boys and 31 girls. Their mean age was 5.2 ± 3.7 years. There were 693 (75.57%) cases with unilateral hernia. There were 224 cases with bilateral hernias or patent processus vaginalis, including 135 (14.72%) cases with an open contralateral ring which was confirmed intraoperatively. Twenty-three (2.51%) needed another port to complete the hernia sac separation. The operation time was 24.7 ± 5.2 min and 14.6 ± 3.8 min in bilateral and unilateral ones. Three cases complained of numbness in the thigh region or groin pain which subsided without medication in the 2^nd postoperative month. There was no recurrence, and the incision scars were nearly invisible.

Conclusion

Single-port laparoscopic-assisted percutaneous extraperitoneal closure using a guide wire is a safe, less cost, and reliable technique in the treatment of inguinal hernia in children.

Long-term outcomes of single-incision versus multiport laparoscopic colectomy for colon cancer: results of a propensity score-based analysis

BACKGROUND

Long-term outcomes of single-incision laparoscopic colectomy (SILC) for colon cancer (CC), as practiced in real-world settings, especially in relation to disease stage, have not been established. We examined, retrospectively, both short- and long-term outcomes of SILC versus those of multiport laparoscopic colectomy (MPLC) performed for CC in a propensity-score-matched cohort.

METHODS

The study involved 263 patient pairs matched 1:1 from among 691 patients who, between January 2008 and May 2014, underwent either SILC or MPLC for a primary solitary CC at our hospital. Short-term and long-term operative outcomes were compared between the two groups.

RESULTS

Operation time was the only surgical outcome that varied significantly between the two groups (p = 0.0004). Overall 5-year cancer-specific survival (CSS) in the SILC group was 93.7 (95% CI 89.6-96.2)%, and CSS per pathological stage (I, II and III) was 98.5 (90.0-99.8)%, 96.0 (88.2-98.7)%, and 88.3 (79.6-93.6)%, respectively, whereas overall 5-year CSS in the MPLC group was 93.3 (89.4-95.9)%, and CSS per pathological stage was 100%, 95.4 (88.3-98.3)%, and 84.1 (74.1-90.8)% (p = 0.5278, 0.2679, 0.7666, and 0.9073), respectively. Overall 3-year disease-free survival (DFS) in the SILC group was 94.0 (90.2-96.4)%, and 3-year DFS per pathological stage was 98.6 (90.4-99.8)%, 90.1 (81.4-95.0)%, and 79.0 (69.4-86.2)%, respectively, whereas overall 3-year DFS in the MPLC group was 93.2 (89.4-95.7)%, and 3-year DFS per pathological disease stage was 100%, 94.5 (87.4-97.7)% and 75.5 (64.7-83.8)% (p = 0.2829, 0.7401, 0.4335 and 0.8518), respectively. Thus, oncological outcomes did not differ significantly between groups. Incisional hernia occurred in 21 (8.0%) SILC group patients and 17 (6.5%) MPLC group patients, without a significant between-group difference (p = 0.6139).

CONCLUSION

Our data indicate that perioperative and oncological outcomes of SILC performed for CC are comparable to those of MPLC performed for CC.

Comparison of Single-Port Laparoscopic Totally Extraperitoneal Hernioplasty Versus Conventional Laparoscopic Totally Extraperitoneal Hernioplasty : A Single-Center Study

BACKGROUND

To evaluate the safety and outcomes of single-port laparoscopic totally extraperitoneal (SPLTEP) and conventional laparoscopic totally extraperitoneal (CLTEP) hernioplasty.

METHODS

Retrospectively, we collected patients who underwent a laparoscopic totally extraperitoneal approach. The inclusion criteria were as follows: (1) male patients aged >20 years, (2) untreated hernia, and (3) American Society of Anesthesiologists (ASA) score ≤3. The exclusion criteria included: (1) additional procedures received during surgery, (2) inguinoscrotal hernia, (3) ASA score >3, (4) previous lower abdominal surgery, (5) bleeding disorders, and (6) incarcerated, obstructed, strangulated, or recurrent inguinal hernias. Patients were classified into SPLTEP and CLTEP groups. The demographics, body mass index (BMI), ASA score, comorbidities, blood loss, operation time, postoperative length of stay (LOS)/complications, hernia recurrence, visual analog scale (VAS), and postoperative analgesic requirements were collected for analysis.

RESULTS

A total of 246 patients were enrolled. There were 103 patients in the SPLTEP group and 143 patients in the CLTEP group. The mean age was 56.1 ± 16.2 years versus 57.9 ± 15.1 years. There were no significances in demographics, BMI, ASA score, comorbidities, blood loss, operation time, postoperative LOS/complications, and hernia recurrence. The SPLTEP group had a shorter postoperative LOS, lower VAS at 18 hours postoperation, and a reduced amount of 24-hour postoperative analgesics.

CONCLUSION

SPLTEP hernioplasty is as safe as the CLTEP procedure. In addition, the SPLTEP group had a shorter LOS and a lower VAS score and required less postoperative analgesics. Further studies may focus on long-term complications, hernia recurrence, and chronic pain in these 2 groups.

A Modified Approach for Single-Port Laparoscopic Repair of Inguinal Hernias in Children

Background:

Although traditional open groin incision repair has been used routinely for decades, the benefit of the minimally invasive surgery has challenged the traditional open method. Nowadays, laparoscopic herniorraphy has evolved to making it more minimally invasive from 3 to 2 and now single port and from intracorporeal to extracorporeal knotting. This study aimed to evaluate a new modification of single port laparoscopic herniorraphy in children with congenital inguinal hernia.

Materials and Methods:

In this single-institution randomized case–control study 190 children who suffered from congenital inguinal hernia were divided into two groups randomly: Group 1 (N = 73) undergone a single-port modified extracorporeal purse-string sutures (laparoscopic surgery [LS]) and Group 2 (N = 117) undergone open surgery (OS).

Results:

The mean age of the patients at operation time was 28.79 ± 11.45 months. Overall, three patients (1.57%) had intraoperative retroperitoneal hemorrhage. The duration of anesthesia and operation for those undergoing bilateral operation were significantly shorter in LS group. There was no statistically significant difference in individual postoperative complication rates between the groups. The proportion of overall post-operative complications was 4 (5.4%) in LS and 13 (11.1%) in OS group (P = 0.18). Proportion of trapped cryptorchidism was significantly higher in the OS group.

Conclusion:

In conclusion for children with inguinal hernia, we had found the benefits of single-port modified extracorporeal purse-string for reduction the operative time, trapped testes and better cosmetics and parents' satisfaction.

Effect of bupivacaine versus lidocaine local anesthesia on postoperative pain reduction in single-port access laparoscopic adnexal surgery using propensity score matching

Objective

The umbilicus is a single, painful incisional site on the abdomen during trans-umbilical single-port access laparoscopic surgery. Previously, we found that periumbilical lidocaine could reduce postoperative pain. This study aimed to compare the efficacy of bupivacaine and lidocaine in reducing pain.

Methods

We performed a retrospective analysis in a study group (Bupivacaine group, 100 patients who received periumbilical infiltration of bupivacaine before their incisional site repair completion) and control group (Lidocaine group, 100 patients who received lidocaine at their incisional site repair completion). We compared postoperative pain based on the numerical rating scale (NRS) between propensity score-matched Bupivacaine-treated (n=50) and Lidocaine-treated (n=50) patients.

Results

The postoperative pain scores based on the NRS were not significantly different between the 2 groups until 12 hours post-operation. However, 24 hours post-operation, the Bupivacaine group showed significantly lower pain than the Lidocaine group (24 hours, 1.76±1.07 vs. 2.53±1.11 NRS, P<0.001; 48 hours, 0.84±0.85 vs. 2.16±0.85 NRS, P<0.001).

Conclusion

Periumbilical infiltration of bupivacaine has a longer acting efficacy on reducing postoperative surgical pain than that of lidocaine.

Role of single-incision laparoscopic surgery in the management of small bowel obstruction

BACKGROUND

Small bowel obstruction (SBO) arises on various backgrounds, and the surgical procedure is often modified intraoperatively as needed. Single-incision laparoscopic surgery (SILS) is less invasive than conventional multiport laparoscopic surgery (MPS) and reported to be equally safe and efficient. We have been applying SILS to SBO requiring surgical treatment, and we conducted a retrospective study to clarify the role of SILS in the management of SBO.

METHODS

Thirty-four consecutive patients were identified for inclusion in the study through a review of hospital records of patients having undergone surgery for SBO between May 2013 and June 2018. Patients with tumor- or hernia-related SBO were excluded. We also identified, for comparison, a group of patients who had undergone open surgery for SBO during the preceeding 5-year period. The primary study endpoint was the SILS completion rate, and analyses were performed to identify risk factors for conversion to open surgery and perioperative complications.

RESULTS

The SILS completion rate was 70.6% (24/34 patients), with conversion open surgery required for the remaining 10 (29.4%) patients. Conversion was necessitated by limited working space in 5 (50%) patients, discovery of massive necrosis in 3 (30%), and non-detection of the responsible lesion in 2 (20%). Univariable analysis showed an American Society of Anesthesiologists Physical Status score (p = 0.020) and severe intra-abdominal adhesions (p = 0.007) to be risk factors for conversion. Conversion to open surgery (vs complete SILS) was significantly associated with increased operation time (p = 0.018), blood loss (p = 0.021), postoperative stay (p = 0.010), and postoperative complications (p = 0.004). Open surgery was significantly associated with increased postoperative stay (p = 0.026) and postoperative complications (p = 0.011).

CONCLUSION

SILS appears to be a reasonable surgical treatment option for selected patients with SBO.

Patient-Reported Outcomes and Long-Term Results of a Randomized Controlled Trial Comparing Single-Port Versus Conventional Laparoscopic Inguinal Hernia Repair

BACKGROUND

Surgical techniques for inguinal hernia repair have evolved rapidly from open methods to conventional laparoscopic totally extra-peritoneal (CTEP) and recently single-port TEP (STEP). As there is currently no randomized controlled trial (RCT) reporting long-term patient-reported outcomes between CTEP and STEP, we reviewed patients who were randomized to CTEP or STEP 5 years after surgery.

METHODS

Telephone interviews were administered to patients with primary unilateral inguinal hernia recruited for the RCT comparing CTEP and STEP in 2011. The modified Body Image Questionnaire was used to measure long-term patient-reported outcomes.

RESULTS

Forty-two out of forty-nine of the STEP group and forty-one out of fifty of the CTEP group responded to phone interviews. Median follow-up time, demographic data and clinical outcomes were comparable between both groups. The Body Image Score (5-20: 5-least dissatisfied, 20-most dissatisfied; BIS score ± SD, STEP vs. CTEP, 5.33 ± 0.90 vs. 7.17 ± 1.87, p < 0.001) and Cosmetic Score (2-20: 2-least satisfied, 20-most satisfied; CS score ± SD, STEP vs. CTEP, 19.05 ± 1.31 vs. 15.87 ± 1.57, p < 0.001) were superior in the STEP group. Similarly, self-reported scar perception (1-cannot be seen, 2-can barely be seen, 3-visible; scar perception score ± SD, STEP vs. CTEP, 1.29 ± 0.51 vs. 2.55 ± 0.64, p < 0.001) and overall experience score (1-least satisfied, 10-most satisfied; overall satisfaction score ± SD, STEP vs. CTEP, 9.57 ± 0.67 vs. 8.22 ± 0.94, p < 0.001) were superior in the STEP group.

CONCLUSION

Patients who underwent STEP reported superior cosmetic and satisfaction scores and comparable surgical outcomes 5 years after surgery compared to the CTEP group. STEP should be strongly considered in patients who are concerned about long-term cosmetic outcomes and should be offered if surgical expertise is available. Trial registration NCT02302937.

A comparison of the oxidative stress response in single-incision laparoscopic versus multi-trocar laparoscopic totally extraperitoneal inguinal hernia repair

Introduction

Surgical treatment is always associated with tissue damage and the subsequent development of oxidative stress.

Aim

To compare the oxidative stress response in patients treated operatively for inguinal hernia with multi-trocar laparoscopic totally extraperitoneal technique (TEP) or single-incision laparoscopic totally extraperitoneal technique (TEP-SI).

Material and methods

A randomized group of 34 patients with one-sided inguinal hernia was enrolled in the study. Seventeen patients were treated with a standard TEP method (group 1) and the other 17 patients were treated with the TEP-SI technique (group 2). Thiobarbituric acid reactive substances (TBARS) and total antioxidant status (TAS) as the oxidative stress markers were measured before surgery (0), 1 day (1) and 4 days (2) after surgery.

Results

A decrease in TAS on the first day after surgery was observed in both groups. Sustained reduction on the fourth day after surgery was observed in group 1, whereas in group 2 an increase followed. A statistically significant difference was observed in TAS (2 : 0) ratio with a meaningful decrease in group 1. TBARS concentration was elevated 1 day after surgery in both groups. It remained at an elevated level on the fourth day after surgery in group 1, while it decreased in group 2. The duration of surgery was higher in group 2 (mean: 57.5 min) than in group 1 (mean: 50.0 min) (p = 0.0286).

Conclusions

Oxidative stress levels are lower in patients treated operatively by TEP-SI technique than by TEP. TEP-SI may be considered as a less invasive technique associated with less tissue injury.

Comparison between single-incision and multiple-incision laparoscopic surgery for totally extraperitoneal inguinal hernia repair

Introduction: We compared the clinical outcomes of single-incision laparoscopic surgery (SILS) and multiple-incision laparoscopic surgery for totally extraperitoneal (TEP) inguinal hernia repair.Material and methods: This retrospective study included 134 consecutive patients undergoing single-incision or multiple-incision laparoscopic surgery for inguinal hernia between January 2012 and December 2016 at our hospital.Results: In total, 62 patients undergoing SILS-TEP and 72 receiving multiple-incision laparoscopic surgery were included in this study. No significant differences in patients' characteristics between the two groups were noted. No patient required conversion to open surgery in either group. No significant differences were noted between the two groups in operative time, bleeding volume, post-operative hospital stay, and analgesics used. Postoperative complications were observed in 5.7% (4 of 62) of patients in the SILS group and 3.2% (2 of 72) of patients in the control group. Among the few patients who experienced complications, most had hematomas. No major complications or hernia recurrences were observed during the follow-up period in either group.Conclusions: SILS-TEP produced good cosmetic outcomes for patients regardless of previous surgery, and it could be safely performed with acceptable morbidity. It also does not increase the possibility of conversion to open surgery.

CTEP Versus LESS Totally Extraperitoneal Hernioplasty

Background and Objectives:

The authors sought to assess and compare the surgical outcomes of laparoendoscopic single-port surgery (LESS) for totally extraperitoneal (LESS-TEP) hernioplasty and conventional totally extraperitoneal (CTEP) hernioplasty.

Methods:

From March 2015 through May 2018, a retrospective analysis of postoperative outcomes was conducted that included 81 cases of LESS-TEP and 88 cases of CTEP hernioplasty patients. For postoperative indicator comparisons, a visual-analog pain scale and 5-level cosmesis evaluation sheet were applied. In addition, complications on postoperative outcomes following inguinal hernia repair surgery are discussed based on our analysis and surgical experience.

Results:

All operations were successfully performed at different hospitals. Compared with the CTEP group, the operative time in the LESS-TEP group increased significantly (P < .05). However, the cosmetic outcome in the LESS-TEP group was rated higher than that in the CTEP group (P < .05). There was no significant difference between the 2 groups in hospitalization time, the incidence of complications, postoperative pain levels, or medical costs (P > .05).

Conclusion:

LESS-TEP is as feasible and safe as CTEP. The use of LESS-TEP successfully improved the cosmetic outcomes of inguinal hernia repair surgery with smaller and fewer scars for patients. As a new surgical treatment approach for inguinal hernias, the LESS-TEP technique is still not a necessary or efficacious surgical alternative strategy for CTEP, especially for surgeons who are less experienced in the technique.

Current status of single-port versus multi-port approach in laparoscopic inguinal hernia mesh repair: an up-to-date systematic review and meta-analysis

A meta-analysis was conducted to provide an up-to-date comparison of single-port and multi-port approach, in laparoscopic inguinal hernia mesh repair. This meta-analysis was performed on the basis of the PRISMA guidelines and the Cochrane Handbook for Systematic Reviews of Interventions. The electronic databases (MEDLINE, Web of Science and Cochrane Central Register of Controlled Clinical Trials) were systematically screened. Fixed Effects or Random Effects model was used, according to the Cochran Q test. In total 16 eligible studies were found. There was no statistically significant difference, regarding unilateral operation duration, between the two approaches, in TEP (OR - 4.61; 95% CI - 9.70, 0.47, p = 0.08) or TAPP (OR - 1.96; 95% CI - 4.89, 0.97, p = 0.19) procedures. Similarly, in both operative modalities, no superiority of either approach was proven, in terms of conversion rate (TEP OR 0.69, p = 0.48; TAPP OR 5.46, p = 0.31), length of hospital stay (TEP WMD 0.00, p = 0.76; TAPP WMD - 0.11, p = 0.42) and overall complication rate (TEP OR 1.10, p = 0.51; TAPP OR 0.74, p = 0.43). Overall, single-port and the established multi-port approach in inguinal hernia mesh repair, are equivalent, regarding the postoperative outcomes. Given several limitations, further RCTs, of higher methodological and quality level are required.

Periumbilical infiltration of lidocaine with epinephrine for postoperative pain reduction in single-port laparoscopic adnexal surgery

An efficient and simple approach to control postoperative pain in transumbilical single-port laparoscopic surgery appears necessary. We conducted a retrospective analysis in a study group (80 patients who received periumbilical infiltration of lidocaine with epinephrine before their incisional site repair completion) and control group (80 patients who received no analgesic at their incisional site repair completion) matched for their age, body mass index and their frequency of previous abdominal surgery. The pain scores based on the numerical rating scale (NRS) and the analgesic use frequency during the postoperative period were evaluated. The postoperative pain scores based on the NRS were significantly lower in the study group than in the control group immediately after the operation and at postoperative 6 hours. The postoperative analgesic use frequency during the hospital stay and the pain scores at 24 and 48 hours were not significantly different between the two groups. Periumbilical infiltration of lidocaine with epinephrine can reduce surgical pain until 6 hours, postoperatively. Impact statement What is already known on this subject? No consensus on whether single port laparoscopic surgery significantly reduces postoperative pain, as compared to conventional laparoscopy exists, and the immediate postoperative pain seems to be severe even with the SPL surgery. What do the results of this study add? The periumbilical infiltration of lidocaine with epinephrine can alleviate surgical pain until 6 hours, postoperatively. What are the implications of these findings for clinical practice and/or further research? Our result may provide an efficient and simple approach to control postoperative pain in a single port laparoscopic surgery.

Single incision multiport versus conventional laparoscopic inguinal hernia repair: A matched comparison

Background:

The popularity of single-incision procedures is on the rise as wound cosmesis is increasingly being seen as an important body image-related outcome. In this study, we assess the potential benefits of single-incision multiport laparoscopic totally extra-peritoneal (S-TEP) without using specialised ports or instruments and compare the same with the conventional laparoscopic TEP (C-TEP) surgery in terms of operative time, post-operative pain, complications, cost and cosmesis.

Materials and Methods:

This is a prospective case-matched study of the patients undergoing S-TEP versus C-TEP from June 2014 to December 2015.

Results:

Each group had 36 patients. The two groups were comparable in the clinical characteristics. The mean duration of surgery for a unilateral hernia in C-TEP and S-TEP was 45.13 ± 10.58 min and 72.63 ± 15.23 min, respectively. The mean visual analogue scale (VAS) score for pain was significantly higher in S-TEP group at post-operative day (POD) 0 and 1. However, at POD 7, there was no significant difference between the groups. At 1^st and 6-week post-surgery, the cosmetic results were significantly better in S-TEP group as compared to C-TEP, however, at 6 months, the scar was highly acceptable in both treatment groups.

Conclusion:

S-TEP, using conventional laparoscopic instruments, is safe and feasible even in resource challenged setting. However, there is a need to review the indications and advantages of single-incision laparoscopic surgery, as no difference in cosmetic outcome by VAS score in S-TEP versus conventional laparoscopic arm seen by the end of 1 month.

Laparoendoscopic single-site surgery in inguinal hernia repair

Laparoendoscopic single-site surgery (LESS) for laparoscopic inguinal hernia repair (IHR) offers the potential for excellent cosmetic outcomes and maximization of the inherent advantages of minimally invasive surgery. LESS IHR is associated with a steep learning curve, which is attributable to both the IHR technique itself and the single-site technique. The technical obstacles in the single-site technique may be mitigated by employing certain maneuvers and strategies that minimize clashing between instruments and improve freedom of movement. The current literature consistently points out the inherent challenges in LESS IHR, with its longer operative time compared to that of conventional laparoscopic IHR. LESS IHR performed by capable operators has comparable complication rates, duration of hospital stay, and incidence of recurrence as conventional laparoscopic IHR. LESS IHR is both feasible and safe. Given its excellent cosmetic outcome, it is likely to be sought by younger patients who are concerned with scar formation. The use of robotics may bypass the technical challenges in LESS, but cost considerations in their usage will likely persist.

Kinematic and ergonomic assessment of laparoendoscopic single-site surgical instruments during simulator training tasks

While laparoendoscopic single-site surgery (LESS) appears to be feasible and safe, instrument triangulation, tissue handling, and other bimanual tasks are difficult even for experienced surgeons. Novel technologies emerged to overcome LESS' procedural and ergonomic difficulties of "tunnel vision" and "instrument clashing." Surgeon kinematics, self-reported workload and upper body discomfort were used to compare straight, bent and two articulating instruments while performing two basic surgical tasks in a LESS simulator. All instruments resulted in bilateral elevation and rotation of the shoulders, excessive forearm motion and flexion and ulnar deviation of wrists. Surgeons' adopted non-neutral upper extremity postures and performed excessive joint excursions to compensate for reduced freedom of movement at the single insertion site and to operate the instrument mechanisms. LESS' cosmetic benefits continue to impact laparoscopic surgery and by enabling performance through improved instruments, ergonomic improvement for LESS can reduce negative impact on surgeon well-being and patient safety.

[Single incision laparoscopy : Current status]

BACKGROUND

Since the introduction of single incision laparoscopy (SIL), there has been disagreement among professional societies regarding a general recommendation for the use of this minimally invasive method.

OBJECTIVES

Determination of evidence-based advantages of SIL compared to multiport laparoscopy (MPL).

MATERIALS AND METHODS

Description of recent technical developments and evaluation of prospective randomized clinical trials and valid meta-analyses with regard to organ-specific procedures. In addition, an expert opinion is provided based on 4209 SIL interventions.

RESULTS

SIL is nowadays applied in all fields of general and visceral surgery. Due to the initial enthusiasm, methodologically weak studies were often published in the literature. Any beneficial effect of SIL on reduced perioperative morbidity is not clearly confirmed, yet. A better cosmetic outcome is either obvious (in SIL liver resections) or nearly unverifiable (in SIL cholecystectomies).

CONCLUSION

SIL has proven feasible and safe after getting through the learning curve. Scientific evidence is currently insufficient to justify SIL without reservation in particular without the individual technical experience of the surgeon.

First 200 consecutive transumbilical single-incision laparoscopic TEPs

BACKGROUND

Endoscopic pre-peritoneal mesh repair (TEP) through single-incision laparoscopy (SIL) permits placement of a large mesh through a final millimetric umbilical scar. This prospective study evaluates the first 200 consecutive SILTEPs performed by a single surgeon.

PATIENTS AND METHODS

Between November 2011 and September 2015, 200 consecutive SILTEPs were performed in 161 patients. The mean age was 49.8 ± 16.3 years and the mean BMI was 24.5 ± 3.4 kg/m². The technique involved one 11-mm trocar, one 10-mm 0° scope and curved reusable instruments. A supplementary 1.8-mm straight trocarless grasping forceps was percutaneously inserted for perioperative complications or difficulties.

RESULTS

A unilateral hernia repair was performed in 122 patients, and a bilateral repair in 39 patients. The total operative time was 57.4 ± 22.3 min, and pure laparoscopic time was 46.6 ± 21.6 min. There was no need for insertion of a supplementary 5-mm trocar, and the need for insertion of 1.8-mm trocarless grasper was 32.9%. Perioperative complications occurred in 73 patients. The mean final scar length was 15.3 ± 2.6 mm. The mean hospital stay was 1.0 ± 0.3 days. Postoperative complications at the access site affected 15 patients and at the hernia site 31 patients. After a mean follow-up of 25.4 ± 12.3 months, there was one asymptomatic, small incisional hernia at the access site as well as one reoperation for recurrent inguinal hernia at 16 months. No other late complications were registered.

CONCLUSION

Transumbilical SILTEP permits placement of a large mesh through a final millimetric scar. Getting over the learning curve in conventional multitrocar TEP is mandatory. As per our institute's algorithm, the contraindications continue to be giant inguino-scrotal, incarcerated and recurrent inguinal hernias.