V545 SINGLE-TROCAR LAPAROSCOPIC HERNIORRHAPHY IN CHILDREN

Abstract

You have accessJournal of UrologyPediatrics1 Apr 2012V545 SINGLE-TROCAR LAPAROSCOPIC HERNIORRHAPHY IN CHILDREN Candace Granberg, Patricio Gargollo, Robert Minkes, Warren Snodgrass, and Micah Jacobs Candace GranbergCandace Granberg Dallas, TX More articles by this author , Patricio GargolloPatricio Gargollo Dallas, TX More articles by this author , Robert MinkesRobert Minkes Dallas, TX More articles by this author , Warren SnodgrassWarren Snodgrass Dallas, TX More articles by this author , and Micah JacobsMicah Jacobs Dallas, TX More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2012.02.619AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES The surgical approach to inguinal hernia repair in children is evolving from open to laparoscopic repair. In recent years, the laparoscopic approach has become even more minimally-invasive by eliminating working ports and performing the procedure using a single umbilical trocar. The objective of this video is to detail the technical steps of single-trocar inguinal herniorrhaphy. METHODS For this approach, a single 3mm trocar is placed at the umbilicus for the laparoscopic camera. Under laparoscopic guidance, a 25-gauge finder needle is used to localize the inguinal ring. A stab incision at the skin level of the inguinal ring facilitates placement of a needle to extracorporally close the hernia defect. The tip of the needle is advanced to the level of the peritoneum, at which time the wrist is rotated to advance the needle along the curve of the internal ring. The tip of the needle is used to gently dissect the vas and gonadal vessels off of the peritoneum. Once the lateral edge of the hernia is reached, the distal end of the needle is brought through the skin and the entire needle is brought above the fascia while keeping the proximal end of the needle below the skin level. The needle is then retracted in the subcutaneous space and brought back through the stab incision. With tension on the suture, the internal ring is observed to be closed. An extracorporeal knot is then placed, and skin adhesive is applied over the stab incision. RESULTS The procedure is safe and efficacious in children. The incision for the 3mm camera is hidden in the umbilicus, and the inguinal stab incision for the needle is tiny, thus offering fewer and smaller incisions as compared to a standard laparoscopic approach with working ports. CONCLUSIONS The single-trocar laparoscopic method allows for an increasingly minimally invasive approach to inguinal hernia repair. Moreover, the procedure is easy to learn, thus with minimal training it can be added to the pediatric urologist's armamentarium. © 2012 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 187Issue 4SApril 2012Page: e223 Advertisement Copyright & Permissions© 2012 by American Urological Association Education and Research, Inc.MetricsAuthor Information Candace Granberg Dallas, TX More articles by this author Patricio Gargollo Dallas, TX More articles by this author Robert Minkes Dallas, TX More articles by this author Warren Snodgrass Dallas, TX More articles by this author Micah Jacobs Dallas, TX More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...