Technique for safe placement of reusable trocars during endoscopic extraperitoneal inguinal hernioplasty

Abstract

Endoscopic extraperitoneal inguinal hernioplasty has become an established technique for the repair of inguinal hernias. To reduce the cost of the procedure, reusable metallic trocars are substituted for disposable trocar ports. However, the use of metallic trocars is often associated with pericannula air leak and uncontrolled sliding movements. The insertion of the primary subumbilical trocar by open dissection technique has been widely accepted but percutaneous placement of secondary trocars with sharp obturators, even under direct endoscopic vision, is still potentially hazardous in the confined extraperitoneal space. We have, therefore, modified our method of placement of secondary trocars with finger dissection and railroad techniques. Making the trocar snug with a purse‐string suture over the fascial opening can substantially reduce peri‐cannula air leak, diminish the sliding movement of the cannula and facilitate closure of the wound. To avoid the risk of visceral and major vascular injuries, all endoscopic instruments are blunt‐tipped. Open dissection combined with finger dissection and railroad techniques enables the safe placement of trocars for endoscopic extraperitoneal inguinal hernioplasty. image image