Single-Incision Lift Laparoscopic Trans-Abdominal Pre-Peritoneal Herniorrhaphy: A Low-Cost Technique for Rural Surgeons

METHODS AND DEVICES

An inguinal hernia is a common surgical problem with many possible methods of repair available. Kulacoglu found that mesh repairs are superior to "nonmesh" tissue-suture repairs, and he reviewed studies showing similar efficacy between Lichtenstein repair and endoscopic/laparoscopic methods. Polypropylene mesh is currently still preferred, while partially–absorbable, lightweight meshes may also have some benefits [1].

The reason for developing single-incision laparoscopic surgery (SILS) was to reduce the invasiveness of traditional laparoscopy. Laparoscopic transabdominal preperitoneal (TAPP) herniorrhaphy using the three-trocar technique is very common in treatment of recurrent inguinal hernia. Kucuk showed that the SILS approach is technically feasible and safe [2]. A Cochrane review comparing laparoscopic and open repairs revealed no apparent difference in recurrence, and found that laparoscopy seems to cause less persisting pain and numbness. The patient’s return to his or her usual activities is also faster [1, 3]. However, SILS hernioplasty is not common in rural areas because of the high cost and the steep learning curve. Single incision laparoscopic hernioplasty using the lift laparoscopy apparatus designed by Dr. Daniel Kruschinski [4], and a combination of open and laparoscopic surgical instruments offers a low-cost method, which is much easier for the surgeons working in rural areas to learn.
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6 Comments

  1. Girijadutt Sharma
    Posted Jun 2014 at 4:38 pm | Permalink

    Pl mention the type of Lift appartus , cost and source in india

    • Dr. J. Gnanaraj
      Posted Jun 2014 at 1:21 pm | Permalink

      Right now we are using the one developed by Dr. Daniel Kruschinski in Germany. It is expensive. The set costs almost 7200 euros. However we are developing a new set of instruments for single incision surgery and a low cost apparatus with Stann biomedicals in Coimbatore. It should be ready in a week’s time.

  2. OM PRAKASH
    Posted Jun 2014 at 5:44 pm | Permalink

    dear Sir. i am a rural surgeon, please inform when indian low cost appratus is ready

    • mdCurrent-India Editor
      Posted Jun 2014 at 5:57 pm | Permalink

      We will mention it in the mdCurrent-India newsletter when the new apparatus is available. This should be helpful to many surgeons!

  3. teja chandra gudivada
    Posted Jun 2014 at 2:21 am | Permalink

    it would be helpful if you post a video of that surgery

  4. Dr. J. Gnanaraj
    Posted Apr 2015 at 3:16 am | Permalink

    The low cost lift apparatus is available at STAAN bio-medicals at Coimbatore and the cost is about INR 1,00,000. E mail is staan3@hotmail.com

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