Trocar Site Hernia Research Articles

725 - Trocar Site Hernia Repair following Robotic Tumor Debulking

725 - Trocar Site Hernia Repair following Robotic Tumor Debulking

Laparoscopic cholecystectomy with only two 5 mm trocars in a pregnant woman with biliary pancreatitis

Laparoscopic cholecystectomy (LC) during advanced pregnancy is challenging due to limited intraabdominal space. Patients may be at increased risk for a trocar site hernia. A 35-year-old female in her 22nd week of pregnancy was admitted with acute right upper quadrant pain. Amylase was elevated, LFTs were normal; ultrasound showed acute cholecystitis and no dilated biliary duct. Fetal ultrasound was normal. Antibiotics were started. Amylase peaked at >600 U/L before normalizing, indication for LC was made. MRCP and ERCP were not performed as the patient seemed to have passed a stone. Five mm trocars were placed in the left upper quadrant (LUQ) and umbilicus and a Teleflex minigrasper between the two. The uterus was at the umbilical level. The GB serosa was incised on both sides and a window was created behind the GB midportion and widened towards infundibulum and fundus. GB wall thickening and edema was noted. The critical view was obtained and cystic artery and duct were clipped and divided. The specimen was retrieved through the LUQ port site using a 5 mm endobag after dilatation to 12 mm due to the presence of two large stones. The port site fascia was closed using a suture passer. The postoperative course was uneventful and both mother and baby were well during follow up. In case of biliary pancreatitis during pregnancy, LC should be performed and if ultrasound shows a normal biliary system and amylase/lipase normalize, MRCP/ERCP and IOC may be avoidable. LC with two ports is feasible during pregnancy.

Robotic transabdominal retromuscular umbilical prosthetic hernia repair (TARUP): observational study on the operative time during the learning curve.

The use of extraperitoneal mesh in place of intra-peritoneal mesh is gaining popularity in laparoscopic ventral hernia repair. We have adopted a robotic assisted laparoscopic technique using a lateral single-dock robotic access with retromuscular mesh placement after opening the ipsilateral posterior rectus fascia. In this study, we wanted to evaluate the changes in operative times during the initial experience with this novel technique. The initial consecutive patients undergoing robotic assisted transabdominal retromuscular umbilical prosthetic repair (r-TARUP) using a 15 × 15cm self-fixating mesh were prospectively entered in the study and the operative times during the separate steps of the surgical procedure were recorded. Complications were reported up to 4 week post operatively and quality of life was assessed using the EuraHS-QoL score. Over a 5 month inclusion period, 41 patients with either a primary (n = 34) or a trocar site hernia (n = 7) at the umbilicus were identified. All hernias had a mean diameter of less than 4cm. The total OR time decreased significantly during the learning curve (tertile 1: 126min versus tertile 3: 102min; p = 0.002) due to a decrease in the skin-to-skin operating time (tertile 1: 81min versus tertile 3:61min; p = 0.002). The decrease in the retromuscular dissection time was the most significant of all the steps that comprised the console time (p = 0.004). The non-surgical time did not decrease (p = 0.15). The operation was performed on an outpatient basis in 68% of patients and with a one-night-stay in 29%. No complications related to the introduction of the robotic technique for this approach were observed and the early outcome is promising, with favorable quality-of-life evaluation at 4weeks. The decrease in operative time during the adoption of r-TARUP was mainly related to the improved efficiency in the dissection phase of the procedure. The technique is reproducible and safe and the operative time compares favorably to published operative times for laparoscopic and open retromuscular umbilical hernia repair.

Is the 8-mm robotic port safe? a case of trocar site hernia after robotic cholecystectomy using the da Vinci Xi system

Is the 8-mm robotic port safe? a case of trocar site hernia after robotic cholecystectomy using the da Vinci Xi system

The Role of the Composite and Biologic Meshes in the Trocar Site Hernia Repair Following Laparoscopic Surgery

The increasing proportion of laparoscopic interventions in the surgical centers has, also, determined an increased incidence of specific complications, such as trocar hernia. Nowadays, there is no unanimously agreed concensus regarding the optimal closure technique of the trocar incision, wether it should include the suture of the aponeurosis or not at the 10 mm ports. There is, also, no consensus regarding the proper surgical technique for the trocar hernia repair- alloplastic or tissue repair technique.The purpose of the study is to present our experience on the alloplastic repair of the trocar hernias. It is a retrospective study that analyzes the results obtained by our clinicalteam regarding the alloplastic repair of the trocar hernias, over a five-year period, between January 2011 and December 2015. The recurrence and the occurrence rates of different complications (seroma, neuroma with postoperative pain, parietal infiltration, infections and mesh rejection), depending on the type of mesh used for the surgical repair,are studied.

Early small bowel obstruction after laparoscopic gastric bypass: a surgical emergency

BackgroundEarly small bowel obstruction (ESBO; within 30 d of surgery) after laparoscopic gastric bypass (LRYGB) is reported in .5% to 5.2% of primary cases, but it is associated with significant morbidity, and the treatment is not standardized. ObjectivesTo review prevalence, causes, management, and outcomes of patients treated for ESBO after LRYGB. SettingTertiary academic medical center. MethodsRetrospective review to identify consecutive patients who underwent primary LRYGB and those who developed ESBO from January 2000 through June 2017. Data included demographic characteristics, co-morbidities, LRYGB technical details, and ESBO clinical presentation, location, causes, treatment, and outcomes. ResultsOne thousand seven hundred seventeen patients (84.2% females) had LRYGB. Mean age and body mass index was 42.4 ± 11.1 years and 48.2 ± 7.3 kg/m2, respectively. Twenty-nine patients (1.7%) had ESBO. All patients presented with symptoms, most commonly nausea and vomiting (n = 17), on average 4.1 ± 5.9 days postoperatively; most required reoperation (n = 23, 79.3%) and 5 required >1 reoperation. Location of the obstruction and treatment used were the following: (1) jejuno-jejunostomy (n = 17, 58.6%; narrowing or clot), treated with reoperation in 11; and (2) other than at the jejuno-jejunostomy (n = 12, 41.4%; trocar site, incisional or internal hernia, adhesions, mesenteric ischemia), treated with reoperation in all. All ESBO patients had additional complications, 6 (20.1%) developed an anastomotic leak, and 2 (6.9%) died. ConclusionESBO infrequently occurs after LRYGB; many causes are technique related and possibly preventable. However, it is associated with significant morbidity and mortality. A high index of clinical suspicion, rapid and appropriate imaging, and prompt operative intervention are recommended.

Efficacy and reliability of the use of a needle grasper to prevent trocar site hernia.

IntroductionPort site herniation is one of the serious complications of laparoscopic surgery, which decreases its benefits. Closure of a fascia defect at the port site is an important problem of laparoscopic surgery, especially in obese patients.AimTo evaluate needle grasper fascia closure.Material and methodsWe closed the port site fascia using a percutaneous organ-holding device (needle grasper) in laparoscopic cholecystectomy patients. This study included 334 patients who underwent laparoscopic cholecystectomy between January 2015 and January 2017 in our hospital. Patients were divided into 2 fascia closure groups: group 1 with a standard simple suturing technique and group 2 with a needle grasper to close the port site. Patient demographics, operative details, and postoperative outcomes were collected and evaluated.ResultsThere were 243 female and 91 male (total 334) patients with the mean age of 49.18 ±13.15 years. Only 1 patient in the BMI > 30 kg/m2 group of patients had port site hernia development with the needle grasper technique at the end of the 8-month follow-up period. The port site hernia incidence was higher in group 1 than group 2 (p < 0.001), but there was no significant difference in terms of operation duration between the two groups (p < 0.001, p = 0.709, respectively). In patients with a BMI > 30 kg/m2, both operation duration and port site hernia incidence were higher in simple suture closure than in the needle grasper technique (p < 0.001, p = 0.016, p = 0.005).ConclusionsThe needle grasper technique is easy, simple, safe, fast, and effective for fascia closure of port sites. This method can also be applied in obese patients easily, safely and in a short time.

Gynecologic Surgeons’ Perspectives on Risk Factors and Prophylaxis of Trocar Site Hernias: A National Survey [22Q

INTRODUCTION: Although trocar site hernias (TSH) occur in only 1.5-1.8% of all laparoscopic procedures, TSHs can represent serious postoperative complications. The purpose of this study was to survey gynecologic surgeons who are active members of the Society of Laparoendoscopic Surgeons (SLS) in order to elicit their experiences with TSHs, including fascial closure preferences. METHODS: After reviewing the clinical and epidemiological literature to compile relevant questions, an anonymous survey was designed using Qualtrics web-based survey software. The survey link was sent to all members of SLS via email. Descriptive analyses included frequencies, percentages, and chi-square tests or Fisher’s exact tests for measures of association. RESULTS: Respondents included 242 gynecologic surgeons, 54.2 % of whom reported at least one patient developing a TSH within the past 10 years. The likelihood of having ≥1 patient with TSH increased with higher monthly surgical volume; 39.5% for low-volume surgeons (≤10 procedures/month) compared to 71.4% of high-volume surgeons (≥20 procedures/month) (p&lt;0.01). Current use of fascial closure devices was more common among surgeons in an academic practice (60.3%) compared to those in private practice (39.6%, p &lt;0.01). Among all respondents, 87.6%, 16.1%, and 2.5% close 10-12mm, 8mm, and 5mm ports, respectively, without differences according to surgical volume or practice setting. Approximately 6% reported closing more than one port size. CONCLUSION: Increased surgical volume is directly proportional to TSH development. Port size remains one of the main risk factors for TSH development, with most respondents closing only 10-12 mm ports irrespective of surgical volume or practice setting.

Predisposing Factors, Prevention and Treatment of Trocar site Hernia

Predisposing Factors, Prevention and Treatment of Trocar site Hernia

Incisional Hernia Prevention and Use of Mesh. A Narrative Review

Incisional hernias are a very common problem, with an estimated incidence around 15%–20% of all laparotomies. Evisceration is another important problem, with a lower rate (2.5%–3%) but severe consequences for patients. Prevention of both complications is an essential objective of correct patient treatment due to the improved quality of life and cost savings.This narrative review intends to provide an update on incisional hernia and evisceration prevention. We analyze the current criteria for proper abdominal wall closure and the possibility to add prosthetic reinforcement in certain cases requiring it. Parastomal, trocar-site hernias and hernias developed after stoma closure are included in this review.

Profilaxis de la hernia incisional y utilización de mallas. Revisión narrativa

Incisional hernias are a very common problem, with an estimated incidence around 15-20% of all laparotomies. Evisceration is another important problem, with a lower rate (2.5-3%) but severe consequences for patients. Prevention of both complications is an essential objective of correct patient treatment due to the improved quality of life and cost savings.This narrative review intends to provide an update on incisional hernia and evisceration prevention. We analyze the current criteria for proper abdominal wall closure and the possibility to add prosthetic reinforcement in certain cases requiring it. Parastomal, trocar-site hernias and hernias developed after stoma closure are included in this review.

Trocar site hernia following laparoscopic cholecystectomy: a 10-year single center experience.

Laparoscopic cholecystectomy (LC) is the gold standard of treatment for patients with symptomatic cholelithiasis. Compared to open cholecystectomy, LC is associated with significantly lower postoperative complications. Trocar site hernia (TSH) is an uncommon, but potentially dangerous, complication of LC. The aim of this study was to evaluate the incidence of TSH following LC. The records of all patients who underwent elective LC between January 2004 and December 2013 were retrospectively reviewed. The open technique with a vertical incision infraumbilically was used to establish pneumoperitoneum. Two or three other skin incisions were made and trocars were inserted. In all cases, only the fascia at the site of infra-umbilical incision was closed. Following hospital discharge, all patients were regularly re-examined 1, 4 and 52weeks postoperatively and were contacted by phone during November-December 2015. Based on the findings from clinical and telephone follow-ups, the incidence of TSH was recorded. Using univariate/multivariate analysis, we investigated several variables to identify risk factors for TSH development. During the study period, 1172 patients were eligible and included in the final analysis. Seven patients (0.6%) presented TSH at 1-year follow-up. At the end of the study and with a mean follow-up of 65.86±25.19months, 11 patients (0.94%) presented TSH. Interestingly, all TSHs were developed at the infra-umbilical site. Multivariate analysis identified obesity as an independent risk factor for TSH. The incidence of TSH following LC is considerably low. Obesity is an independent risk factor for TSH development, while closure of fascial incision of 10mm below the xiphoid is not justified.

Small bowel obstruction in a lateral trocar site following laparoscopic bariatric surgery

One of the complications of laparoscopic surgery is incisional hernia at the port trocar site. It is a rare complication, with a reported incidence varying between 0.65% and 2.8%, and it is documented in both adults and children. An obese 62-year-old woman underwent a laparoscopic mini gastric bypass for body weight reduction at another hospital. On the third post-operative day, she developed abdominal pain with vomiting and was admitted to our hospital. Imaging studies confirmed a small bowel loop obstruction at the lateral 12mm trocar site and the patient was operated on immediately. The viability of the entrapped bowel was confirmed at the trocar site opening, the bowel loop was returned into the abdominal cavity and the defect was closed. Two days later, the patient was discharged in good condition. Trocar site or port site hernia is defined as an incisional hernia which occurs after minimal invasive surgery, at the trocar site incision. Following bariatric surgery its reported incidence is 1% - 1.6%. Its cause is multi-factorial, including obesity and old age, the size and site of the inserted trocar and the angle of insertion, and excessive manipulations. Although there is no clear consensus on closure at port sites, it is recommended that fascial defects of larger than 10mm in adults and 5mm in children should be closed. Trocar site hernia is a rare complication of laparoscopic procedures, and one that can be minimized. Viscus entrapment in a port site hernia should be suspected during the post-operative period whenever the patient presents with abdominal distension, pain and vomiting since, particularly in the case of bariatric surgery, the findings on physical examination may be inconclusive, due to obesity.

Trocar site hernia development in patients undergoing robotically assisted or standard laparoscopic staging surgery for endometrial cancer

To compare the incidence and potential risk factors of trocar site hernia formation in women undergoing robotically assisted versus standard laparoscopic staging (RBT vs. LSC, respectively) for endometrial cancer. We retrospectively identified all patients who underwent MIS staging for endometrial cancer at our institution from 01/09-12/12. Data collection involved the review of all operative notes, postoperative follow-up visit notes, and postoperative imaging reports. Appropriate statistical tests were used. We identified 760 eligible patients (LSC, 193; RBT, 567). The overall median age was 61years (range, 33-90). The median BMI was 28.5kg/m2 for LSC (range, 16.6-67.6) and 29.5kg/m2 for RBT (range, 17.9-66) patients (p=0.8). A trocar site hernia developed in 16 patients (2.1%)-5 (2.6%) of 193 LSC and 11 (1.9%) of 567 RBT patients (p=0.6). Median time to hernia diagnosis was 13months (range, 5-20.5) and 18months (range, 3-49), respectively (p=0.5). All hernias in the LSC cohort developed at the camera trocar site. In the RBT cohort, 10 developed at the camera trocar site and 1 at a lateral trocar site. Only BMI was associated with the development of hernias. A hernia was diagnosed in 7 (6.9%) of 101 patients with a BMI ≥40kg/m2 compared with 9 (1.4%) of 659 with a BMI <40kg/m2 (p=0.001). MIS for endometrial cancer is associated with a low rate of trocar site hernia formation, with similar rates associated with RBT and standard LSC. Higher BMI is associated with the development of postoperative trocar site hernias.

Evaluation of port site hernias, chronic pain and recurrence rates after laparoscopic ventral hernia repair: a monocentric long-term study

The aim of this study was to evaluate hernia appearance at the trocar site after laparoscopic treatment of primary or incisional ventral hernias using an intraperitoneal prosthetic mesh. Chronic pain at the trocar site and primary hernia recurrence were also evaluated. Two-hundred and twenty-six consecutive patients who underwent a standardized laparoscopic hernia repair for primary or incisional ventral hernia at our centre between January 2000 and December 2008 were included. All patients had clinical and radiological examinations. Primary end points were port site hernia and the occurrence of chronic trocar site pain. Secondary end point was primary hernia recurrence. Seventy-eight patients were excluded: 6 declined to participate, 48 were unreachable, and 24 did not meet the inclusion criteria (nine underwent a single site laparoscopic approach, ten died of unrelated disease, three were unable to visit the hospital and two had relocated). After exclusion, 148 remained in our study. Mean follow-up was 49±12.6months. Mean age at the time of surgery was 60years (range, 28-83) In total, 504 port sites were clinically and radiologically evaluated, and only one (0.02%) had secondary herniation. Three patients (2.0%) had a recurrent hernia, and 14 (9.5%) had developed chronic pain at time of assessment. Nine patients (6.1%) were re-operated for the recurrent hernia before the follow-up evaluation. The overall recurrence rate is, therefore, 8.1%. Only two minor complications and no major complications occurred after surgery. No mortality was observed. Laparoscopic repair for primary or incisional ventral hernias is a safe surgical approach, with low rates of hernia recurrence and a low morbidity rate. When fascial closure is maintained for 10mm port sites, the incidence of port site hernias is very low. Five millimetre ports do not require closure.

Single-incision surgery trocar-site hernia: an updated systematic review meta-analysis with trial sequential analysis by the Minimally Invasive Surgery Synthesis of Interventions Outcomes Network (MISSION).

Single-incision laparoscopic surgery (SILS) is a new technique that aims to minimize abdominal wall trauma and improve cosmesis. Concerns have been raised about the risk of trocar-site hernia following SILS. This study aims to assess the risk of trocar-site hernia following SILS compared to conventional laparoscopic surgery, and investigate whether current evidence is conclusive. We performed a systematic search of MEDLINE, AMED, CINAHL, CENTRAL, and OpenGrey. We considered randomized clinical trials comparing the risk of trocar-site hernia with SILS and conventional laparoscopic surgery. Pooled odds ratios with 95% confidence intervals(CI) were calculated using the Mantel-Haenszel method. Trial sequential analysis using the Land and DeMets method was performed to assess the possibility of type I error and compute the information size. Twenty-three articles reporting a total of 2471 patients were included. SILS was associated with higher odds of trocar-site hernia compared to conventional laparoscopic surgery (odds ratio 2.37, 95% CI 1.25-4.50, p=0.008). There was no evidence of between-study heterogeneity or small-study effects. The information size was calculated at 1687 patients and the Z-curve crossed the O'Brien-Fleming α-spending boundaries at 1137 patients, suggesting that the evidence of higher risk of trocar-site hernia with SILS compared to conventional laparoscopic surgery can be considered conclusive. Single-incision laparoscopic procedures through the umbilicus are associated with a higher risk of trocar-site hernia compared to conventional laparoscopic surgery.

Using Surgicel® Plug to Prevent Trocar Site Hernia after Laparo- scopic Surgery in Obese Patients

Background: Incisional hernia and wound dehiscence are common complications after abdominal surrgery. The development of minimally invasive surgical techniques has led to a dramatic decrease in these complications. Ten-millimeter and wider ports are often used in laparoscopic surgery. It could be difficult to close the ports sites, especially in obese patients, so, laparoscopic surgery may still be followed by trocar site herniation. Various methods have been advocated for its prevention. The aim of this study was to try a new method to prevent trocar site hernia in obese patients. Patientsand methods: This prospective interventional non-randomized non-controlled study was conducted in the Department of General Surgery at Ain Shams University hospitals in the period from November 2013 to November 2016 on 150 obese (Body mass index (BMI)>35 kg/m2) patients (50 males and 100 females) who underwent laparoscopic surgery (70 cholecystectomies, 25 gastric bypass surgeries, 35 sleeve gastrectomies and 20 appendectomies). In all patients, the fascial layer of trocar wounds was not closed. Instead, a Surgicel® plug was inserted into the muscle layer of trocar wounds. Informed consent was obtained from all patients included in the study. Results: One case, out of the included 150 obese patients, after laparoscopic gastric bypass developed port site hernia with an incidence of 0.67% (1/150). In both patients, hernia was uncomplicated. No patient in the other groups has been found to develop a hernia. Conclusion: Surgicel® plug is an easy technique with very low incidence of trocar site hernia after laparoscopic procedures in obese patients.

Trocar site hernia formation in patients undergoing robotically assisted and non-robotically assisted laparoscopic staging surgery for endometrial cancer

Trocar site hernia formation in patients undergoing robotically assisted and non-robotically assisted laparoscopic staging surgery for endometrial cancer

Long-Term Surgical Outcome of Trocar Site Hernia Repair

Port site hernias are emerging as a problematic complication of laparoscopic surgery. The aim of this study was to elucidate the characteristics of port site hernias and determine the long-term outcomes based on the interval between primary surgery and hernia occurrence. Twenty-four patients were surgically treated for trocar site hernia between 1997 and 2013. The patients were grouped into early-onset group (EOG; less than one month) and late-onset group (LOG; more than one month) based on the interval between laparoscopic surgery and hernia onset. A retrospective analysis was performed. There were seven patients in the EOG and 17 patients in the LOG. The body mass index was significantly higher (P = 0.033) in the LOG. In the EOG, primary closure was performed, and there were no recurrences. In the LOG, mesh reinforcement was applied in 58.8 per cent of patients, and 29.4 per cent of patients had recurrences. This recurrence rate was higher than the recurrence rate after primary repair of incisional hernia after open laparotomy (P = 0.088). In conclusion, In the EOG, small bowel resection was more frequent, but once repaired, there were no recurrences. Although mesh reinforcement was applied in the LOG, the recurrence rate was not less than the EOG.

Mini-Laparoscopy for Removal (Partial) of Adnexae at the Time of Hysterectomy

Study ObjectiveTo demonstrate our technique of mini-laparoscopic adnexectomy or salpingectomy at the time of total laparoscopic hysterectomy (TLH). DesignStep-by-step video demonstration of our technique. SettingThe advantages of laparoscopic surgery have been widely recognized, including improved visualization and exposure, reduced operative trauma owing to smaller incisions and gentler tissue handling, and faster postoperative recovery. Continuing technological developments have allowed the use of smaller-caliber instruments while maintaining a high standard of surgical performance. Mini-laparoscopy requires the use of 3-mm or smaller ports. The main advantage of mini-laparoscopy is the reduced incision size, which can translate into a lower incidence of incision-related complications such as postoperative pain, infection, and trocar site herniation, along with superior cosmetic results. Today, in younger patients, prophylactic salpingectomy can be considered instead of adnexectomy, taking into account the well-known benefits of ovarian conservation. Prophylactic salpingectomy involves Fallopian tube removal for primary prevention of epithelial carcinoma of the fallopian tubes, ovaries, and peritoneum in women undergoing pelvic surgery for another indication. Other advantages of this intervention are the avoidance of hydrosalpinx (which affects ∼30% women after hysterectomy), the 7.8% lifetime risk of revision surgery [1], tubal infection, and benign and malignant Fallopian tube tumors. Finally, salpingectomy has no known physiological side effects, is safe and feasible, does not worsen surgical outcomes, does not significantly increase the operative time, and is not related to increased rates of intraoperative and postoperative complications or readmission. InterventionsThe patient is a 44-year-old woman with a history of 2 previous cesarean sections with adenomyosis and endometriosis infiltration of the uterosacral ligaments. After discussion about the risks and benefits of ovarian conservation with prophylactic salpingectomy versus adnexectomy, the patient opted to preserve her ovaries. A TLH with partial removal of the uterosacral ligaments nodules and prophylactic bilateral salpingectomy was performed. To begin, the patient was placed in lithotomy position with Allen stirrups at an angle of approximately 100 degrees. Standard trocar placement was used. A 5- or 10-mm 0° scope was placed at the level of the umbilicus and three 3-mm skin incisions were made for accessory lower quadrant trocar placement: 2 lateral, approximately 3 cm medial to the anterior superior iliac spine, and 1 suprapubic, slightly higher than the line made by the lateral trocars, ensuring that the distance between this port and the camera trocar exceeded 8 cm. This triangulation of the accessory ports allowed for good ergonomics for the surgeon. The procedure continued with abdominopelvic cavity inspection and bilateral transperitoneal ureter identification and eventual adhesiolysis, and then the following steps:1.Coagulation and section of the round ligament bilaterally.2.Opening of the anterior leaf of the broad ligament.3.Fenestration of the posterior leaf of broad ligaments to displace the ureter laterally.4.Bilateral salpingectomy. The tuba-ovarian ligament was first divided at the fimbriae, and then the tube was completely removed from its fimbriated end up to the uterotubal junction, preserving the vascularization of the mesosalpinx as much as possible. The tubes were left attached to the uterus to allow en bloc removal.5.Coagulation and sectioning of the uteroovarian ligaments bilaterally.6.Vesicouterine and posterior dissection.7.Uterine vessel dissection, coagulation, and sectioning.8.Opening of the vagina.9.Uterus extraction by the vaginal route.10.Vaginal closure with laparoscopic figure-eight sutures.The instruments used were a 10-mm scope, a 3-mm bipolar forceps, 3-mm cold scissors, a 3-mm suction-irrigation device and 3-mm grasping forceps. ConclusionMini-laparoscopy is an alternative to classic laparoscopy associated with greater patient satisfaction. Prophylactic salpingectomy has proven to reduce the risk of ovary, peritoneal, and tubal epithelial carcinomas as well as benign tubal diseases, and does not significantly increase the operative time or the incidence of postoperative complications.