Laparoscopic totally extra-peritoneal (TEP) inguinal hernia repair with DynaMesh ENDOLAP 3D - general and visceral surgery

After infraumbilical transverse skin incision, expose the anterior rectus sheath with two Langenbeck retractors and incise it transversely with the scalpel. Retract the medial edge of the rectus muscle with the retractor and insert the dissecting balloon. Slides it on the posterior lamina of the rectus sheath to the pubic bone. Under direct vision with the 0° laparoscope, balloon dilation will bluntly dissect and thus help to clearly identify the guiding structures of the pubic bone, rectus muscle, and epigastric vessels. Remove the balloon and arm the incised anterior rectus sheath with braided size 0 absorbable sutures.

Now, insert a Hasson trocar is inserted and securely fixed with the preplaced sutures.  In most cases, a working pressure of 7 mmHg suffices to adequately unfold the preperitoneal space. Insert a 5 mm trocar at least 5 cm above the pubic bone in the midline.

Tip:
An insulated 5 mm trocar with short thread is recommended.

While expand the medial preperitoneal space with the Overholt and laparoscope, the midline will be crossed. From here, the dissection proceeds laterad, with a large medial hernia readily apparent. Continue the lateral dissection along the transversus abdominis muscle to the level of the umbilicus. At this level in the anterior axillary line, insert the third trocar, either as a 5 mm or, as in the video, as a 10 mm trocar.

Notes:

• This position of the second working trocar allows good triangulation.
• Particular attention must be paid to the course of the lateral femoral cutaneous nerve during lateral preparation, especially when electrocoagulation is used.