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Optimizing the Working Space for Single-Port Laparoscopic Totally Extraperitoneal Closure of Inguinal Hernia with TPV
Shaodong Gu1,2,3, Yingxun Wang1,2,3, Jian Bao4
1Department of Pediatric Surgery, The First People's Hospital of Lianyungang, Lianyungang, China.
Insights
The TPV protocol significantly improved single-port laparoscopic inguinal hernia repair in children, leading to higher success rates and shorter surgery times. This optimized approach also reduced postoperative complications, enhancing patient outcomes.
Area of Science:
- Pediatric Surgery
- Minimally Invasive Surgery
- Surgical Technique Optimization
Background:
- Inguinal hernias are common in infants and young children, requiring surgical intervention.
- Single-port laparoscopic surgery offers a minimally invasive approach for hernia repair.
- Optimizing the surgical workspace can potentially improve outcomes in laparoscopic procedures.
Purpose of the Study:
- To evaluate the efficacy of the TPV (tilt, pad, and void) protocol in optimizing the working space for single-port laparoscopic totally extraperitoneal (TEP) closure of inguinal hernias in pediatric patients.
- To compare surgical outcomes, including success rate, duration, and complications, between the TPV-optimized group and a conventionally treated group.
Main Methods:
- A prospective cohort study involving 400 pediatric patients undergoing single-port laparoscopic TEP inguinal hernia repair.
- Group A (n=200) received surgery optimized with the TPV protocol (30° head-down tilt, 4-5 cm hip padding, voided bladder).
- Group B (n=200) received conventional single-port laparoscopic TEP repair.
Main Results:
- The TPV protocol group (Group A) demonstrated a significantly higher surgical success rate (198/200) compared to the conventional group (182/200, P<.05).
- Surgery duration was significantly shorter in Group A for both unilateral (14.38±2.85 min vs. 21.17±4.47 min) and bilateral inguinal hernias (20.73±4.58 min vs. 28.99±4.12 min, P<.05).
- Postoperative complications were significantly lower in Group A (1/200) compared to Group B (8/200).
Conclusions:
- The TPV protocol effectively optimizes the working space for single-port laparoscopic TEP inguinal hernia closure in infants and young children.
- This optimized approach leads to improved surgical success rates, reduced operative times, and a lower incidence of postoperative complications.
- The TPV protocol represents a valuable advancement in minimally invasive pediatric inguinal hernia surgery.
Abstract:
To evaluate the outcomes of single-port laparoscopic internal ring closure of inguinal hernia, optimized according to TPV (tilt, pad, and void) protocol, in infants and young children. From August 2018 to March 2021, a prospective cohort study was conducted including 400 patients younger than 3 years with either left- or right-side inguinal hernia treated with single-port laparoscopic totally extraperitoneal (TEP) closure of the internal ring using a two-hooked core needle apparatus. Patients whose hospitalization ID ended with an odd number were included in group A (n = 200). They were surgically treated with single-port laparoscopy optimized according to TPV protocol, in which the operating table was placed at a 30° head-down tilt position (tilt), the hip was padded by 4-5 cm (pad), and the bladder was voided (void). The remaining patients in group B (n = 200) were conventionally treated with single-port laparoscopic TEP closure of the internal ring. Success rate of surgery, surgery duration, and postoperative complications of two groups were compared. A significantly higher success rate of surgery was detected in group A than in group B (198/200 versus 182/200, P < .05). Regardless of unilateral or bilateral inguinal hernia, surgery duration was significantly shorter in group A than in group B (unilateral inguinal hernia, 14.38 ± 2.85 minutes versus 21.17 ± 4.47 minutes; bilateral inguinal hernia, 20.73 ± 4.58 minutes versus 28.99 ± 4.12 minutes, both P < .05). In addition, the incidence of postoperative complications was significantly lower in group A (1/200 versus 8/200). TPV protocol to optimize working space for single-port laparoscopic TEP closure of inguinal hernia can increase the success rate, shorten surgery duration, and decrease the incidence of postoperative complications.
