The ability of a surgeon to maintain and update their skills is paramount to good patient care. In addition to increasing job satisfaction, mastering surgical skills is a lifelong process. Assuming that a newer procedure has a similar safety and efficacy profile to an existing procedure learning it can only increase the surgeons’ repertoire of skills which may become lifesaving in difficult cases.
Totally extraperitoneal hernia repair with single incision laparoscopic surgery (SILS) is a highly suitable alternative to conventional multiport surgery because the same infraumbilical incision can be made without additional risks of port-site hernias, and the potential damage caused by sharp trocars can be negated. The relative loss of triangulation with SILS can be easily overcome by modified dissection techniques, namely, by the use of such techniques as “chopsticks” and “in-line” dissection. With mastery of SILS and with telescopic extraperitoneal dissection, the costs of the disposables can be reduced so that SIL TEP repair becomes highly cost-effective, when compared to multiport with balloon dissection, with the potential to reduce post-op pain and analgesic intake, improved cosmesis, and early resumption of physical activities. While the potential benefits to an average patient may be minimal or modest at best, the combined effects of some 20 million patients worldwide who undergo inguinal hernia repair annually may be highly significant.
The principal author is a dedicated hernia specialist with experience of over 4000 cases of laparoscopic inguinal hernia repairs, over 16 years, with some 2000 being SIL TEP repairs undertaken since 2009. The authors have provided a step-by-step guide to SIL TEP repair with valuable tips and novel techniques to smooth out the transition from multiport to single-port surgery. Mastery of SIL TEP repair can then be applied to more difficult cases including inguino-scrotal hernias as well as ventral and incisional hernias.
Inguinal hernia Femoral hernia Single incision laparoscopic surgery Single port Totally extraperitoneal Laparoendoscopic single-site surgery
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