Total Extraperitoneal Approach Research Articles

Evaluation of Surgical Results and Effectiveness of Laparoscopic Transabdominal Preperitoneal and Laparoscopic Totally Extraperitoneal Approaches in Bilateral Inguinal Hernia Repair: A Randomized Analysis.

Background: Laparoscopic surgery is recommended as the standard approach for bilateral inguinal hernia repair. There are few studies in the literature comparing laparoscopic transabdominal preperitoneal (TAPP) and laparoscopic total extraperitoneal (TEP) approaches for bilateral inguinal hernia repair. This study aimed to compare the surgical outcomes and effectiveness of laparoscopic TAPP and laparoscopic TEP methods applied in bilateral inguinal hernia repair. Methods: A total of 100 patients operated on for bilateral inguinal hernia by applying laparoscopic TAPP and laparoscopic TEP methods from January 2016 to March 2023 were included in the study. The patients were randomized equally in two groups. Postoperative follow-up results were statistically analyzed in terms of recurrence rate, swelling in the incisions, scrotal edema and swelling, suture dehiscence, and the average time to return to work. Results: In bilateral inguinal hernia patients operated with laparoscopic TAPP method compared with bilateral inguinal hernia patients operated with laparoscopic TEP method, postoperative recurrence rate was significantly lower (2% versus 16%), swelling in the incision sites was significantly less (4% versus 24%), and the average time to return to work was significantly shorter (3.6 ± 2.3 versus 6.3 ± 5.8) (P < .05). Scrotal edema and swelling and suture dehiscence results did not show significant differences between the two approaches (P > .05). Conclusions: Both methods are widely used in bilateral inguinal hernia repairs. Postoperative results revealed that the laparoscopic TAPP method with less postoperative recurrence rate and less swelling in the incision sites, and shorter average time of the patients to return to work appears to be superior to the laparoscopic TEP method.

Total extra-peritoneal approach to radical cystectomy with ureterostomy: A novel technique for the elderly and frail

ObjectivesRadical cystectomy with urinary diversion is the gold standard treatment for bladder cancer (high-risk/muscle invasive). The transperitoneal approach is associated with significant gastrointestinal complications like ileus. In the elderly and frail with a single functional kidney, we describe an extraperitoneal technique of radical cystectomy, with a ureterostomy, to be performed without general anesthesia. Materials and methodsThe elderly, frail, and high-risk candidates for general anesthesia, with a prior history of nephroureterectomy with a second primary muscle-invasive bladder cancer, were chosen. All patients underwent the described procedure under combined spinal and epidural anesthesia. The posterior dissection was retrograde, caudal to cranial, with the peritoneum being opened only for resection of the dome. A cutaneous ureterostomy was fashioned on the side of the functional kidney. Peri-operative parameters were assessed for early recovery in this high-risk group. ResultsThe mean age was 82 years (range: 73–91), with Charleson Comorbidity Index 5, and were all deemed unfit for neoadjuvant chemotherapy. With a median duration of 127.5 minutes, an average blood loss of 225ml, and no patient requiring general anesthesia; early ambulation, early return of bowel function, and a lesser hospital stay (7 days) with minimal morbidity were achieved. Negative surgical margins were achieved in all cases, with a mean harvest of 29 lymph nodes. Only 1 patient developed stomal stenosis. The cause-specific survival (CSS) is 100% at 2 years. ConclusionsThe highlighting features are the early return of bowel function (flatus passage on day 1) and the avoidance of the cardio-pulmonary complications of general anesthesia. The extraperitoneal cystectomy offers a promising alternative in this select group and warrants further studies to extrapolate this technique for bilateral urinary drainage.

A new approach to mesh fixation in laparoscopic transabdominal technique, "suture passer", superior or not?

Laparoscopic inguinal hernia surgery is a common procedure and pain is a common postoperative complication. Guidelines for mesh fixation vary, with no clear rule. Mesh fixation may not be necessary in total extraperitoneal approach (TEP), but more research is needed for transabdominal preperitoneal approach (TAPP). This study was conducted comparing mesh fixation methods using a suture passer and tacker, aiming to reduce pain and operation time. We used the FUÇA method for mesh fixation in TAPP. The patients were divided into two groups: Group I underwent classical tacker method while Group II used the FUÇA method. There were 52 patients in Group I and 51 patients in Group II. Polypropylene mesh was used in both groups. The surgeries were performed by four experienced surgeons. We analyzed retrospective data including age, gender, BMI, surgical approach, procedure duration, defect size, recurrence status, postoperative pain, hernia type, and complications. Pain was assessed using VAS score and McGill pain index. Recurrence was evaluated by a different surgeon. A total of 103 patients were included: 52 in Group I and 51 in Group II. Both groups had a similar median age (47years in Group I, 45years in Group II) and predominantly male participants (92.3% in Group I, 92.2% in Group II). Most patients had indirect inguinal hernia (77.7%) while the rest had direct inguinal hernia (22.3%). There were no significant differences in BMI or hernia type between the groups. The defect size measured by ultrasound was similar in both groups. Group I had higher VAS pain scores on postoperative day 1, at month 1, and at month 3 compared to Group II, but the difference vanished at the 12-month mark. The McGill Pain Index showed similar results. Recurrence was observed in one patient in each group. Complications occurred in 11 patients during the follow-up period, with similar rates between the groups. The mean surgical procedure time of Group 2 was significantly shorter than that of Group 1 (49.36m vs 43.43m, p = 0.009). FUÇA method is a technique that can be used safely in the TAPP procedure as it reduces postoperative pain and shortens the operation time.

Combining Innovative Techniques: Total Extraperitoneal Approach in Orthopedic Surgery (O-TEP) and Percutaneous Both Column Screw (BCS) Fixation Technique in a Geriatric Acetabular Fracture Case.

The concepts of both column fixation corridor (BCFC) and both column screws (BCS) along with the orthopedic total extraperitoneal approach (O-TEP) are highly innovative approaches in orthopedic surgery. However, the orthopedic literature lacks sufficient studies on these topics, indicating a significant gap. This case report aims to highlight how combining these innovative techniques can facilitate the use of BCFC and BCS in the treatment of acetabular fractures with O-TEP, thereby enhancing the feasibility of endoscopic techniques. Furthermore, we aim to discuss the potential advantages of BCFC and BCS concepts when used in O-TEP.For this purpose, we present a case of a 74-year-old geriatric patient with a transverse acetabular fracture involving the posterior column. The quadrilateral surface was exposed using the O-TEP approach, and the fracture was reduced using a fully endoscopic approach. The fixation was achieved using BCS and a Magic screw through percutaneous screw placement.The patient's clinical condition was followed for at least 13 months. The clinical outcomes demonstrated the effectiveness of combining these innovative techniques in the treatment of acetabular fractures, with satisfactory healing and functional recovery observed.This case report illustrates that combining BCFC and BCS with the O-TEP approach can facilitate the treatment of acetabular fractures with minimally invasive techniques and enhance the feasibility of endoscopic procedures. These findings suggest potential advantages of using BCFC and BCS concepts in O-TEP, warranting further investigation and study.

Totally extraperitoneal repair of groin hernia in liver transplant patients: a case series study (TOHER).

The present study aims to describe the feasibility and the postoperative results of groin hernia repair in liver transplant patients using a totally extra-peritoneal (TEP) repair approach. From May 2022 to March 2023, liver transplant patients with groin hernia underwent TEP groin hernia repair, by the single common senior experimented surgeon. Background information, intraoperative findings, postoperative complications, postoperative pain, health, and well-being were registered. Thirteen TEP approach groin hernioplasties were performed in 10 patients, completing the procedure in all cases without the need for conversion either to open or transabdominal preperitoneal approaches. 70% of surgical explorations revealed multiple hernia defects: lateral hernias in all patients, medial defects in 62%, and femoral defects in 30.8%. Median hospital stay was 1day [range (0.3)], with 30% treated as outpatients. Post-surgical complications occurred in 30% of cases: 1 hematoma and 2 seromas. Postoperative pain and physical functioning scored 100 (IQR 44) and 90 (IQR 15), respectively. TEP groin hernioplasty is safe and feasible for liver transplant patients, with low complication rates, short hospital stays, and a significant proportion treated as outpatients. The posterior approach allows comprehensive repair of myopectineal defects, crucial due to associated hernial defects.

An Observational Comparative Study of the Impact of Accidental Pneumoperitoneum in Understanding the Learning Curve for Totally Extraperitoneal and Extended Totally Extraperitoneal Inguinal Hernia Repair.

Abdominal wall hernia repair is among the fundamental procedures in general surgical practice. Subsequent to the advent of minimally invasive repair, there have been efforts to find the most reliable technique, with easily reproducible results that can be practiced by surgeons worldwide. From an analytical point of view, this study aimed to highlight the advantages and disadvantages of two techniques. A total of 60 participants were divided into two groups of 30 patients: the totally extraperitoneal (TEP) and the extended TEP (eTEP) hernia repair groups. Covariates and outcomes were analyzed using the chi-square and Mann-Whitney U tests. The study was carried out at a tertiary postgraduate teaching hospital in the western zone of Maharashtra, Pune, India, by a single surgeon. The operative procedures were as per standard surgical practice for both groups.The study was conducted to understand types of difficulties observed in the early implantation stages and the learning curve of these procedures. Ten percent of the procedures in the TEP group and 6.7% of procedures in the eTEP group required Veress needle use to manage accidental pneumoperitoneum (P=0.64). The mean operative time in the eTEP group was significantly shorter than that of the TEP group (P=0.031). Compared with the TEP approach, eTEP repair is associated with shorter operative times, owing to a shorter learning curve, a wider-angle view, a wider range of motion for instrument manipulation, and an ergonomically superior operative experience.

P-069 TOTAL EXTRAPERITONEAL (TEP) APPROACH FOR THE TREATMENT OF SPIGELIAN HERNIAS: SINGLE-CENTRE EXPERIENCE

Abstract Aim Spigelian hernias are rare. Surgical treatment is often recommended. Different minimally invasive techniques are available by means of intraperitoneal or extraperitoneal mesh placement, either by IPOM, transabdominal preperitoneal (TAPP) or total extraperitoneal (TEP) approach. TEP approach is seldom reported in the literature. We present a short series of TEP repair of Spigelian hernias. Materials and Methods Between February and October 2022, TEP repair was performed in two patients with unilateral Spigelian hernia, one case of bilateral hernia, and one combined unilateral Spigelian and inguinal hernia, ensuing the following technique. Preperitoneal access was achieved placing a contralateral 11mm trocar, a few centimetres above the umbilicus, posterior to the rectus muscle toward Retzius space. A 5mm trocar was placed suprapubic and another 11mm trocar at the flank. Working space is developed by blunt dissection. Spigelian hernia sac is dissected and reduced. At this point other inguinal or femoral hernias are explored, performing simultaneous repair if necessary. Sufficient preperitoneal space is ensured to allow correct overlap of a polypropylene self-gripping mesh, prior to closing the defect with barbed-polydioxanone suture. Results Median age was 72 years. Three cases were right hernias and two left, all diagnosed by imaging test due to symptoms. Latest discharge was 24 hours after surgery. No complications or recurrences were encountered at a median follow-up of 4 months. Conclusions Comparative studies between minimally invasive approaches of Spigelian hernias are scarce. In the presented experience, TEP approach proved to be an efficient and reproducible technique with favourable results.

OC-103 SYSTEMATISATION OF TEP IN 10 STEPS: THE WAY WE TEACH

Abstract Aim Laparoscopic total extraperitoneal approach (TEP) is a widely recognised treatment for hernia repair. As a reference group in minimally invasive hernia repair, with more than 1200 TEP cases performed in the last 5 years, and with more than 25 years of experience, we want to share our TEP systematisation in 10 steps, as we teach in our international courses. Material and Methods We describe the technique in 10 simple steps, attaching small video-clips to illustrate each one. Results Demostration of the 10 TEP steps: Conclusions Together with proctoring, this systematic way of teaching TEP technique allows a safer and shorter learning curve, by providing a series of simple steps to follow and repeat.

OC-107 IMPLEMENTATION OF LAPAROSCOPIC INGUINAL HERNIA REPAIR IN A LOCAL HOSPITAL. 2 YEARS’ EXPERIENCE AND CHALLENGES

Abstract Background More than 30 years have passed since the first laparoscopic inguinal hernioplasty but nowadays less than 5% of patients are currently operated by this technique as recent Spanish national data suggest. Objective To present our experience 2 years after implementation of laparoscopic inguinal hernioplasty in our local hospital and highlight the challenges we faced. Methods Our hospital deals with a high volume of abdominal wall surgery and has more than 20 years experience in ambulatory surgery. A multidisciplinary clinical pathway was implemented. Strict selection criteria were established and pelvitrainer sessions were done. Results From January 2021 until December 2022, 196 laparoscopic repairs were performed: 167 transabdominal preperitoneal (TAPP), 29 totally extraperitoneal (TEP). The main challenge was the learning curve. 5 surgeons with experience in laparoscopic surgery were trained. Until now 2 completed their learning curve for TAPP and began training in TEP approach while the others still need senior assistance. The duration of laparoscopic hernioplasty, the need for deep relaxation and the increased carbon dioxide absorption were the biggest concerns for the Anesthesia team. The cost of new materials could be afforded, even though different sutures and types of mesh fixation devices were used until getting the non-invasive one. Surgical outcomes were good, with few minor complications. Moreover the outpatient rate could be maintained but the average time in waiting list for laparoscopic approach was increased. Conclusion The implementation of a laparoscopic hernioplasty program is feasible and safe but faces many challenges, especially due to long learning curve.

Incidental Femoral Hernias Diagnosed by Laparoscopic Approach: Does Gender Really Matter?

Introduction: Laparoscopic approach in hernia repair enables to visualize all hernia orifices in the groin bilaterally and it may reveal a hernia in the groin region which had not been diagnosed with preoperative physical examination. Therefore, we aim to show incidence of incidental femoral hernias which are diagnosed during laparoscopic inguinal hernia repair. &#x0D; &#x0D; Material and Methods: In this retrospective study 865 cases of inguinal hernia that underwent laparoscopic approach for inguinal hernia repair at the xxx between September 2014 and August 2019 were included. The patients’ demographic data, operative and postoperative course were studied.&#x0D; &#x0D; Results: Between September 2014 and August 2019 865 cases of inguinal hernia underwent laparoscopic hernia repair in our institute. 822 of patients were male and 43 were female. 841 cases underwent totally extraperitoneal (TEP) and 24 cases had trans-abdominal preperitoneal (TAPP) repair. 3 of the operations had started with TEP approach, due to peritoneal injury finished with TAPP. Inferior epigastric artery injury occurred 6 of TEP and 1 of TAPP patients, there were managed by laparoscopic sealing of the damaged vessels. 58 (41 TEP and 17 TAPP) of patients were diagnosed femoral hernia incidentally thanks to posterior approach of laparoscopic hernia repair within 865 patients (6,7%). 3 of these patients was female and 55 were male. During the operation femoral hernia repair was also performed to them.&#x0D; &#x0D; Conclusion: In conclusion femoral hernias, which had not been diagnosed preoperatively, can be incidentally diagnosed intraoperatively due to dissection of preperitoneal inguinal canal and hernias can be repaired at the same operation. Although ratio of femoral hernia for female patients is higher than the male patients in the literature, in this report ratio of femoral hernias diagnosed incidentally is similar between females and males.

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.

Occult hernia: role of laparoscopy in detecting the unseen

Background: OH (occult hernias) refer to those hernias which are not evident on clinical examination, but which are noted either on surgical exploration or on good quality pre-operative imaging. Identifying them in day-to-day practice is of immense importance in view of unexplained and undiagnosed symptomatology, post-operative recurrences and cost effectiveness. The main objective of this paper is to study the incidence of occult hernias diagnosed intra-operatively during laparoscopic groin hernia surgery.Methods: In this retrospective study, we identified 723 patients who underwent laparoscopic repair of groin hernia in our institute by a single surgeon, from 2008 to 2021. OH were found in 120 patients, all during totally extraperitoneal approach (TEPA) and none during transabdominal pre-peritoneal approach (TAPP). The age range of these 120 patients was 22 to 83 years (mean: 60.7 years with SD: ±12.5 years). The patients were also analysed for sex, type of OH, side of OH and post-operative outcomes.Results: Incidence of OH in our study was 16.59% (120 out of 723 patients). OH were found in both male as well as female patients. These comprised of unilateral and bilateral OH. Patients with unilateral OH heavily outnumbered those with bilateral OH (n=117 vs. 3). There were 3 different types of OH in our study-inguinal, femoral and spigelian. The maximum number of cases were of inguinal OH (n=115). Among inguinal OH, patients with direct OH outnumbered those with indirect OH (n=73 vs. 40).Conclusions: Awareness about OH as an entity is important, as their identification and concurrent repair possibly spares the patient another surgical intervention at a later date.

V-001 ROBOTIC ETEP WITH TOP DOCK: STEP BY STEP FOR A SAFE PROCEDURE

Abstract Introduction Robotic surgery has evolved in the last few years. Extended total extraperitoneal approach (eTEP) has allowed a better location of the mesh avoiding contact with the bowel. The most important step for this technique is the trocars Positioning in the retrorrectal space. It will depend on the defect localization. Docking can be performed in 3 ways: Inferior (down), lateral and superior (top). The last one represents the most complex. We present a video that explains step by step how to do this technique. Material and methods We considered patients with M3–5W2 and W3 incisional/ventral hernias with a non-injured supraumbilical area. For the retrorrectal dissection, an optic trocar or an expander balloon were used in the left-up quadrant. Afterwards, a 12mm trocar was introduced and the pneumo initiated. At the left flank a 5mm trocar was placed to initiate the crossover with a hook. Subsequently, an 8mm trocar was place in the top midline and next the third robotic trocar at the right up quadrant. Finally, the docking was made. Results Twelve eTEP assisted with robot in a top dock have been performed in a safe way in patients with incisional/ventral hernias. Conclusions The eTEP technique assisted with robot in a top dock position allows a safe access following the steps that we learned in our experience.

053 Totally extraperitoneal approach (TEP) for gonadectomy for differences in sex development (DSD): Report of 2 cases

Introduction: 17-β-hydroxysteroid dehydrogenase type-3 deficiency (17βHSD-3) is a rare cause of 46XY DSD. Gonadectomy is often offered to prevent further virilization and to continue living in a female gender role [ [1] Chuang J. Vallerie A. Breech L. Saal H.M. Alam S. Crawford P. Rutter M.M. Complexities of gender assignment in 17β-hydroxysteroid dehydrogenase type 3 deficiency: is there a role for early orchiectomy?. Int J Pediatr Endocrinol. 2013; 12: 15 Crossref Google Scholar ]. Both laparotomic and laparoscopic approaches to gonadectomy had been described for DSDs [ [2] Dellaportas D. Chatzipapas I. Pandraklakis A. Michala L. Laparoscopic bilateral gonadectomy and inguinal hernia repair with mesh for complete androgen insensitivity syndrome: A case report. J Pediatr Adolesc Gynecol. 2019; 32 (Epub 2019 Feb 27): 443-445 Abstract Full Text Full Text PDF PubMed Scopus (1) Google Scholar ]. Retrieval and removal of testes located in the inguinal canal can be technically challenging and requires collaboration with surgical colleagues. Cases: We present 2 cases of DSD with 17βHSD-3. One of them is 16 years old, while the other one is 20 years old. Both cases presented with amenorrhea and clitoral enlargement, whereas the second case also had deepening of voice. Blood tests for both revealed elevated testosterone and androstenedione. MRI findings were similar showing bilateral gonads located in the inguinal canals. Genetic tests revealed 46 XY karyotype and HSD17B3 gene mutation. Both subjects opted to continue with a female gender role and opted for gonadectomy to prevent further virilization. Gonadectomy was performed with a totally extraperitoneal laparoscopic approach. An infraumbilical incision was made and care was taken to enter the potential space above the rectus sheath. Then a balloon was placed via the port to distend the extraperitoneal space and then the laparoscope was inserted. Secondary ports at the suprapubic region and the left lower quadrant were placed. The gonads were mobilized and gonadectomy performed. Gonadectomy was successfully performed for the first case, but for the second case, there was failure to mobilize the gonad and operation was completed with inguinal incisions. Conclusion: Totally extraperitoneal laparoscopic approach for hernia repair is a well-established technique familiar to surgeons [ [3] McKernan J.B. Laws H.L. Laparoscopic repair of inguinal hernias using a totally extraperitoneal prosthetic approach. Surg Endosc. 1993; 7: 26-28 Crossref PubMed Scopus (264) Google Scholar ]. This was the first time the TEP approach has been described for gonadectomy for DSD. By cooperating with surgeons who has abundant experience in operating in this region, one can allow utilization of techniques which were already commonly used. It raises the importance as gynecologists, we should be mindful of technological advances in other specialties as with other aspects of DSD, collaboration with other specialties may lead to advances in patient management.

Comparison of BMI on operative time and complications of robotic inguinal hernia repair at a VA medical center.

BMI is a risk factor for recurrence and post-operative complications in both open and laparoscopic totally extraperitoneal approach (TEP) repair. Robotic surgery using the transabdominal preperitoneal approach (TAPP) is a safe and viable option for inguinal hernia repair (IHR). The objective of this study is to determine how difference in BMI influences rate of operative time, complications, and rate of recurrence in a robotic TAPP IHR. We performed a retrospective review of patients who underwent robotic inguinal hernia repair between 2012 and 2019 at a Veterans Health Administration facility (N = 304). The operating time, outcomes, and overall morbidity and mortality for robotic IHR were compared between three different BMI Groups. These groups were divided into: "Underweight/Normal Weight" (BMI < 25) n = 102, "Pre-Obese" (BMI 25-29.9) n = 120, and "Obese" (BMI 30 +) n = 82. The average operating time of a bilateral IHR by BMI group was 83.5, 98.4, and 97.8min for BMIs < 25, 25-29.9, and 30 +, respectively. Operating time was lower in the Underweight/Normal BMI group compared to the Pre-Obese group (p = 0.006) as well as the Obese group (p = 0.001). For unilateral repair, the average operation length by group was 65.2, 70.9, and 85.6min for BMIs < 25, 25-29.9, and 30 +, respectively, demonstrating an increased time for Obese compared to Underweight/Normal BMI (p = 0.001) and for Obese compared to Pre-Obese (p = 0.01). Demographic/comorbidity variables were not significantly different, except for a higher percentage of white patients in the Underweight/Normal BMI group compared to the Pre-Obese and Obese groups (p = 0.02 and p = 0.0003). There was no significant difference in complications or recurrence. BMI has a significant impact on the operating time of both unilateral and bilateral robotic hernia repair. Despite this increased operative time, BMI group did not differ significantly in postoperative outcomes or in recurrence rates.

Laparoscopic radical cystectomy with pelvic lymph node dissection and ileal orthotopic neobladder by a total extraperitoneal approach: Our initial technique and short-term outcomes.

PurposeWith the increasing application of laparoscopic or robot-assisted radical cystectomy, a reliable and promising method is needed for reducing postoperative complications. We describe the short-term outcomes of totally extraperitoneal laparoscopic radical cystectomy (TELRC) with extraperitoneal pelvic lymph node dissection (EPLND) and extraperitoneal ileal orthotopic neobladder (EION) techniques.Materials and MethodsFrom January 2020 to December 2021, we performed TELRC and EPLND with EION in 72 patients in our center. The accompanying video highlights our novel techniques. The patients’ demographic data, intraoperative data, and perioperative complications were collected, and short-term oncological and functional results are reported.ResultsAll procedures were technically successful without conversion to open surgery. The patients’ mean body mass index was 26.22±5.71. Median age was 57.51±12.34 years. Average hospital stay was 13.78±4.62 days. Median intraoperative blood loss was 112.92±88.56 mL. No blood transfusion was needed during the operations and only one blood transfusion was performed during the perioperative period. Mean operating time was 259.44±49.84 minutes. Average cost was US$9,875.71±1,873.08. Postoperative short-term complications included short-term ileus (n=3), infection (n=13), leakage of urine (n=11), and lymph fistula (n=7). One late complication of unilateral vesicoureteral anastomotic stenosis occurred. The mean follow-up was 13.42±8.77 months, and no patient developed local or systemic recurrence. The short-term follow-up and small cohort of patients limited our evaluation of outcomes.ConclusionsTELRC with PLND and EION was technically feasible and clinically promising, with a reduced potential harm of postoperative complications. Long-term follow-up and a larger cohort of patients are needed for further study.

Minimally Invasive Total Extraperitoneal Varicocele Repair: First Description in Children.

Introduction: The aim of this study was to report the first pediatric case series treated with minimally invasive total extraperitoneal varicocele (MITEV) repair using the total extraperitoneal (TEP) approach. Materials and Methods: Five male adolescents (12-17 years) were included in this study, all with left-sided Grade III varicoceles. A 5 mm camera port was inserted just below the umbilicus and two 5 mm working ports were used, one above the symphysis in the midline and the other in the left lateral hemiabdomen just below the arcuate line. Results: Operation time ranged from 47 to 61 minutes (mean: 53 minutes). There were no intra- or postoperative complications. The peritoneum was not perforated, and the abdominal cavity was not entered. Two patients had resolution from varicoceles on follow-up clinical examination and ultrasonography was performed 6 months after surgery. In 3 patients, long-term follow-up was pending. Conclusion: MITEV repair reflects a new minimally invasive access to the retroperitoneum in children with varicocele.

The Enhanced-View Totally Extraperitoneal Approach: The True Epitome of Innovation of Modern Abdominal Wall Surgery

The Enhanced-View Totally Extraperitoneal Approach: The True Epitome of Innovation of Modern Abdominal Wall Surgery

Chirurgie endoscopique de l’acétabulum : vision ou illusion ?

Displaced acetabular fractures usually require open surgical approaches. Aim of this cadaver study was to evaluate a laparoscopic approach to prepare the anterior acetabular column and the quadrilateral plate in analogy to the laparoscopic pelvic lymphadenectomy. The laparoscopic preparation and anatomy is presented and illustrated step by step in a human cadaver followed by a modular plate osteosynthesis of the anterior column involving the quadrilateral plate is performed via a minimally invasive approach using standard laparoscopic instruments. In conclusion we could demonstrate that the laparoscopic preperitoneal preparation of the acetabulum according to the laparoscopic pelvic lymphadenectomy provides more free range for the surgical instruments compared to a previously described total extraperitoneal approach. The development of specific reduction tools and implants is under investigation. Until then, at least the laparoscopic preparation could be introduced in the clinical setting in the near future. Type of studyTechnical Note–Cadaver Study.

Study of Laparoscopic Inguinal Hernia Repair Using an Anatomically Contoured 3D Mesh

Background: Laparoscopic inguinal hernia surgery frequently is performed with mechanical fixation of polypropylene mesh. This mechanical fixation, though is necessary to prevent mesh migration, may be associated with pain syndromes and buckling. Recently an anatomically contoured 3D mesh (developed by Dr. Philippe Pajotin) has been introduced which is made up of monofilament polypropylene and resembles normal inguinal area curvature.&#x0D; Aims and Objective: This study was conducted to know whether elimination of tacking the 3D mesh during Total extraperitoneal approach (TEP) inguinal hernia repair results in decreased postoperative pain without increasing the incidence of hernia recurrence.&#x0D; Materials and Methods: This was a prospective interventional study in which 63 patients with clinical diagnosis of inguinal hernia were included on the basis of a predefined inclusion and exclusion criteria. All selected patients underwent laparoscopic TEP inguinal hernia repair using anatomically contoured 3D mesh. Patients were assessed for postoperative pain (using visual analogue scale) during their stay in the hospital as well as in the followup period.&#x0D; Results: In this study of Lap aroscopic inguinal hernia surgery using anatomically contoured 3D mesh of 63 male patients the most common affected age group was found to be 41-50 years (25.3%) with a mean age of 47.12 years +/- 13.01. Most common inguinal hernia was of indirect type (50.7%) and was seen on right side (52.3%). Mean operative time was 113.57+/- 29.04 minutes in unilateral and 170.6 ± 5.85 minutes in bilateralinguinal hernias. Postoperative mean VAS score (12 hrs) was found to be 3.46 ± 1.51. During follow up at 1 week, 1 month and 3 months mean VAS scores were found to be 0.46 ± 0.50, 0.14 ± 0.35 and 0.01 ± 0.12 respectively. Common complications included seroma (12.6%), pneumoscrotum (7.9%) and peritoneal breech (6.3%). None of the patients developed recurrence during follow up period.&#x0D; Conclusion: An anatomically contoured mesh for laparoscopic preperitoneal hernia repair usually requires no fixation and has minimal complications. It is associated with excellent recovery and marked reduction in pain.