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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