TAPP & TEP Combined Minilaparoscopic Inguinal Hernia Technique
5 years ago
TAPP & TEP Combined Minilaparoscopic Inguinal Hernia Technique. In this video we will demonstrate a step by step on how do we do the combined minilaparoscopic technique, that mixes the best of two worlds - the transabdominal and preperitoneal techniques. This technique was developed about 10 years ago and is based on the traditional TEP technique of Dr. Jean Duluq, published in 1991, that uses a heavyweight prolene mesh, without mesh fixation. Our tecnique has some very basic characteristics, that we must highlight: the simplicity, the ease of execution, reproducibility, low cost, low morbidity and great patient satisfaction, specially in the matters of pain and aesthetics. We can observe in detail in the following video bellow the 10 simple steps of the mini technique. 1) the creation of the open pneumoperitoneum with a 11mm reusable atraumatic trocar. 2) Under direct vision is created a pneumo-retroperitoneum without need of dissector balloon, being only used TWO 3mm low friction trocars. 3) after this pnumo creation a 20F Folley catheter is left in the peritoneal space and by a 4cm subcutaneous tunnel a piramidal tip trocar is blindly inserted in the preperitoneal space. 4) Preperitoneal space is enlarged, first with optics tip and also with the help with mini instruments. 5) proper dissection of the hernia sac is made and created sufficient space to acommodate a large mesh of approximately 15x13cm with rounded edges. 6) All anatomical repairs must be properly identified and dissected. 7) The mesh is introduced blindly by 11mm umbilical portal and accommodated in the retroperitoneum so as to cover the entire myopectineum orifice. 8) vaccum is created in preperitoneal space making impossible the mesh to move. 9) in the end mesh placement is checked by regular laparoscopy, after removing the Folley catheter. 10) ubilical access is carefully closed with Vycril 0.