Energy profile of laparoscopic TEP bilateral inguinal hernia repairs

Laparoscopic totally extraperitoneal (TEP) inguinal hernia repair is effective but technically demanding, with a long learning curve conventionally characterized using operative time. Electrosurgical generator data is a routinely produced yet underexploited signal that may yield an objective, phase-specific descriptor of intraoperative performance. We aimed to characterize the intraoperative electrosurgical energy profile of bilateral TEP repairs performed by an experienced surgeon and to assess its consistency across cases, as a feasible preliminary step towards future objective referencing of energy profile usage in hernia surgery.

Eight adult patients undergoing elective bilateral TEP repair for primary, non-complex inguinal hernia between July 2023 and March 2024 were included in this prospective single-center observational study. Intraoperative electrosurgical data were captured by a data logger connected to the electrosurgical unit and synchronized with laparoscopic video. All procedures were performed by an experienced and specialized surgeon. The procedure was divided into nine phases; energy emitted per minute and the duty cycle per phase were analyzed, and inter-case consistency of the duty-cycle profile was quantified using Pearson correlation.

A case-specific digital energy profile combining monopolar and bipolar use was mapped for each patient. Intervention duration ranged from 41 to 85 min (median 56.5), total activation duration from 2.09 to 5.45 min (median 3.77), and total emitted energy from 1670 to 7224 J (median 5043.5). Energy use was comparable between hernias of maximum EHS grade 1 and 2, whereas hernias of maximum EHS grade 3 showed more than 50% higher energy use. The duty cycle was highest during the main dissection phases and decreased toward parietalisation and this was consistent across the cases analysed. No postoperative complications occurred, and all patients were discharged the same day.

The intraoperative electrosurgical energy profile of bilateral TEP repairs by an experienced surgeon is reproducible across cases and resolves into a phase-specific pattern that mirrors the underlying surgical anatomy. This exploratory analysis provides a foundation for subsequent comparative studies in which trainees could objectively compare their electrosurgical behavior against an experienced reference, complementing existing learning aids in TEP and other phase-structured procedures.