World Journal of Laparoscopic Surgery

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VOLUME 15 , ISSUE 3 ( September-December, 2022 ) > List of Articles

Original Article

Extracorporeal Abdominal Transillumination in Laparoscopic Ventral Hernia Repair: A Tool to Achieve More Confidence and Safety

Maged Rihan

Keywords : Laparoscopy, Parallel-design study, Transillumination, Two-port technique, Ventral hernia

Citation Information : Rihan M. Extracorporeal Abdominal Transillumination in Laparoscopic Ventral Hernia Repair: A Tool to Achieve More Confidence and Safety. World J Lap Surg 2022; 15 (3):207-210.

DOI: 10.5005/jp-journals-10033-1536

License: CC BY-NC 4.0

Published Online: 08-12-2022

Copyright Statement:  Copyright © 2022; Jaypee Brothers Medical Publishers (P) Ltd.


Background: Two-port laparoscopic ventral hernia repair is currently practiced with preferable results. This study was conducted aiming to add to the general safety of trocar placement, and trying to solve the problems of the blind insertion of the primary trocar. This can be achieved by extracorporeal transillumination of the anterior abdominal wall before insertion of the primary trocar; thus, delineating whether the abdominal wall harbors any underlying tissues, and accordingly trying to visualize what is being performed rather than doing it blindly. Materials and methods: This is a single-center study. Patients’ enrollment was carried out between March 2018 and June 2019. They were randomized into two groups: Laparoscopic repair using transillumination before inserting the primary (camera) trocar (group I) and laparoscopic repair only (group II). The primary endpoint was the length of the direct distance between the primary port and the left midaxillary line. This distance is inversely proportional to the distance that will exist between the camera port and the hernial defect. Secondary outcomes involved the duration of the operation and adverse events. Results: The analysis included 46 patients, of whom 23 were randomized to group I and 23 to group II. No significant differences were present regarding patient characteristics or operation times. The direct distances between the primary trocar and the left midaxillary line were significantly less in group I, a median of 35 mm (15–65 mm) than in group II, a median of 75 mm (45–85 mm) (p = 0.013). Conclusion: Extracorporeal abdominal wall transillumination is a promising approach for achieving more safety and confidence in the two-port laparoscopic ventral hernia repair and represents an auxiliary tool for surgeons as a trial to visualize if there are structures adherent to the inner aspect of the anterior abdominal wall to improve abdominal entry safety.

  1. Pham CT, Perera CL, Watkin DS, et al. Laparoscopic ventral hernia repair: A systematic review. Surg Endosc 2009;23(1):4–15. DOI: 10.1007/s00464-008-0182-8.
  2. Muysoms FE, Miserez M, Berrevoet F, et al. Classification of primary and incisional abdominal wall hernias. Hernia 2009;13(4):407–414. DOI: 10.1007/s10029-009-0518-x.
  3. Berrevoet F, Doerhoff C, Muysoms F, et al. A multicenter prospective study of patients undergoing open ventral hernia repair with intraperitoneal positioning using the monofilament polyester composite ventral patch: Interim results of the PANACEA study. Med Devices (Auckl) 2017;10:81–88. DOI: 10.2147/MDER.S132755.
  4. Christoffersen MMW. Clinical outcomes after elective repair for small umbilical and epigastric hernias. Dan Med J 2015;62(11):B5161. PMID: 26522486.
  5. Bittner R, Bingener–Casey J, Dietz U, et al. Guidelines for laparoscopic treatment of ventral and incisional abdominal wall hernias [International Endohernia Society (IEHS)] – Part 2. Surg Endosc 2014;28(1):2–29. DOI: 10.1007/s00464-013-3170-6.
  6. Liberman MA, Rosenthal RJ, Phillips EH. Laparoscopic ventral and incisional hernia repair: A simplified method of mesh placement. J Am Coll Surg 2002;194(1):93–95. DOI: 10.1016/s1072-7515(01)01135-8.
  7. Heniford BT, Park A, Ramshaw BJ, et al. Laparoscopic ventral and incisional hernia repair in 407 patients. J Am Coll Surg 2000;190(6):645–650. DOI: 10.1016/s1072-7515(00)00280-5.
  8. Abir F, Eisenberg D, Bell R. Laparoscopic ventral hernia repair using a two (5-mm) port technique. JSLS 2005;9(1):94–96. PMID: 15791980.
  9. Mehrotra PK, Ramachandran CS, Arora V. Two port laparoscopic ventral hernia mesh repair: An innovative technical advancement. Int J Surg 2011;9(1):79–82. DOI: 10.1016/j.ijsu.2010.08.010.
  10. Jansen FW, Kapiteyn K, Trimbos–Kemper T, et al. Complications of laparoscopy: A prospective multicentre observational study. Br J Obstet Gynaecol 1997;104(5):595–600. DOI: 10.1111/j.1471-0528.1997.tb11539.x.
  11. Jansen FW, Kolkman W, Bakkum EA, et al. Complications of laparoscopy: An inquiry about closed- versus open-entry technique. Am J Obstet Gynecol 2004;190(3):634–638. DOI: 10.1016/j.ajog.2003.09.035.
  12. Mann CD, Luther A, Hart C, et al. Laparoscopic incisional and ventral hernia repair in a district general hospital. Ann R Coll Surg Engl 2015;97(1):22–26. DOI: 10.1308/003588414X14055925058913.
  13. Supe AN, Kulkarni GV, Supe PA. Ergonomics in laparoscopic surgery. J Minim Access Surg 2010;6(2):31–36. DOI: 10.4103/0972-9941.65161.
  14. Trejo A, Jung MC, Oleynikov D, et al. Effect of handle design and target location on insertion and aim with a laparoscopic surgical tool. Appl Ergon 2007;38(6):745–753. DOI: 10.1016/j.apergo.2006.12.004.
  15. Wyman ML, Kuhns LR. Pneumoperitoneum demonstrated by transillumination. Am J Dis Child 1976;130(11):1237–1238. PMID: 984006.
  16. Almaimani G, Oyais A. Laparoscopic umbilical hernia repair using a “two-port” technique: A single-center experience. J Curr Surg 2017;7(3):39–41. DOI: 10.14740/jcs329w.
  17. Abhishek V, Mallikarjuna MN, Shivaswamy BS. Laparoscopic umbilical hernia repair: Technique paper. ISRN Minimally Invasive Surg 2012:2012(1):906405. DOI: 10.5402/2012/906405.
  18. Theodoropoulou K, Lethaby D, Hill J, et al. Laparoscopic hernia repair: A two-port technique. JSLS 2010;14(1):103–105. DOI: 10.4293/108680810X12674612014860.
  19. Wedge JJ, Grosfeld JL, Smith JP. Abdominal masses in the newborn: 63 cases. J Urol 1971;106(5):770–775. DOI: 10.1016/s0022-5347(17)61394-6.
  20. Sharma A, Mehrotra M, Khullar R, et al. Laparoscopic ventral/incisional hernia repair: A single-centre experience of 1,242 patients over a period of 13 years. Hernia 2011;15(2):131–139. DOI: 10.1007/s10029-010-0747-z.
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