Inguinal Hernia Repair with Mini-laparoscopic Instruments
Surgical treatment of groin hernias has dramatically improved over the past century. Several contemporary tension-free techniques provide satisfactory results, including laparoscopic TAPP and TEP repairs. With the maturation of therapeutic laparoscopy has come an emphasis on making minimally invasive surgery even less invasive. “Reduced port surgery” (RPS) approaches emphasize fewer ports, smaller diameter trocars, and placement of incisions in occult locations. Mini-laparoscopy is one RPS option. The term “mini-laparoscopy” (Mini) is generally applied to laparoscopic instruments with reduced shaft diameters ranging from 1.9 to 3.5 mm. Newer generation Mini instruments have recently become available with improved effector tips, a choice of shaft diameters and lengths, better insulation and electrosurgery capability, improved strength and rotation, more ergonomic handles, low-friction trocar options, and improved instrument durability. Mini-laparoscopy is a natural evolution of conventional laparoscopy. Port placement, instrument triangulation, and procedure conduct are preserved. The optical shadow of Mini instruments is less, allowing the laparoscope to come closer to the surgical target. A surgeon proficient in conventional laparoscopy can transition to mini-laparoscopy with minimal learning curve. Mini-laparoscopy is intuitively cost-effective, with no expensive capital expenditures, maintenance contracts, or single-incision devices. With respect to inguinal hernia repair, almost all reports of Mini refer to TEP. Mini is especially helpful for TEP because TEP is executed in a constrained space. While the published experience regarding Mini for inguinal hernia repair is less mature than for cholecystectomy, the early findings appear similar—Mini has comparable safety, comparable effectiveness, and mildly improved post-op pain and cosmesis compared to conventional laparoscopy. The options for using Mini with TAPP, TEP, and combined approaches are presented here.
