V-038 INGUINAL TEP WITH ARTICULATED INSTRUMENTS: BEYOND CONVENTIONAL LAPAROSCOPY, CLOSER TO ROBOTIC SURGERY

Abstract

Abstract Introduction Is known that laparoscopic inguinal hernia repair is well recommended in the guidelines. Despite that, in most cases the surgeon needs to do with the instruments manoeuvres that are not ergonomics. Robotic surgery has eliminated these problems but unfortunately this platform is not within reach of all. Articulated instruments appear as a forward stepwise to avoid these difficulties and allowing a better performance of the technique. We present a video that shows a case of an inguinal total extraperitoneal (TEP) performance with these instruments. Material and methods A 45-year-old man with a bilateral inguinal hernia underwent an inguinal TEP using 2 articulated grasper and Maryland instruments (IMM-Tontarra). An expander balloon was used to open the Retzius space, then a Hasson umbilical trocar and 2 (5mm) infraumbilical and suprapubic trocars were placed. All surgery was performed with these 2 instruments an only straight graspers were used when placing the mesh. Results The patient was discharged the same day of surgery with no complications. Our group made different kind of surgery and we observed that the learning curve to obtain an optimal performance of this instruments is short, lesser than 10 patients. We did eTEP procedure for ventral/incisional hernias, Cholecystectomies and hemicolectomies demonstrating the usefulness of these tools. Conclusions Inguinal TEP technique repair using articulated instruments is a very good option for a better dissection of the tissues, better triangulation of the graspers and more ergonomic for the surgeon.