Page 21 - World Journal of Laparoscopic Surgery

ORIGINAL ARTICLE
Extracorporeal Abdominal Transillumination in Laparoscopic

Ventral Hernia Repair: A Tool to Achieve More Confidence

and Safety

Maged Rihan
Received on: 10 February 2022; Accepted on: 14 September 2022; Published on: 07 December 2022

AbstrAct
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.
Keywords: Laparoscopy, Parallel-design study, Transillumination, Two-port technique, Ventral hernia.
World Journal of Laparoscopic Surgery (2022): 10.5005/jp-journals-10033-1536

IntroductIon Department of General Surgery, Faculty of Medicine, Kasr Al-Ainy,
Ventral hernia in adults is the second most common hernia after Cairo University, Cairo, Egypt
1,2
inguinal hernia, it includes primary and incisional hernias, Corresponding Author: Maged Rihan, Department of General Surgery,
Laparoscopic approach for ventral hernia repair is associated Faculty of Medicine, Kasr Al-Ainy, Cairo University, Cairo, Egypt, Phone:
with low postoperative complications, hospital stay, and recovery +00966596519744, e-mail: magedrihan@hotmail.com
time. 3–5 How to cite this article: Rihan M. Extracorporeal Abdominal Tran-
Although it is classically done by three or four ports in the sillumination in Laparoscopic Ventral Hernia Repair: A Tool to
6,7
abdominal wall, the newly described “two-port technique” is Achieve More Confidence and Safety. World J Lap Surg 2022;15(3):
considered to be the least invasive. 8,9 207–210.
Access to the abdominal cavity through small incisions is a Source of support: Nil
challenge for the laparoscopic surgeon. At least 50% of associated Conflict of interest: None
gastrointestinal and major blood vessels injuries occur during entry
to the abdominal cavity before the beginning of the intended
surgery, 10,11 and there are many concerns related to bowel injury, the defect is large, a big mesh is required for repair, and therefore,
especially in patients with intraabdominal adhesions like those who the lateral border of the mesh will be too close to the optical port,
have incisional hernias, 12 which may cause some technical difficulties during fixation. Hence,
There is no certain consensus concerning the technique the optical port should be as far away as possible from the hernia.
of port placement and laparoscopic entry, It is dictated by the Transillumination has been used by pediatric surgeons as a
13
surgeons’ predilection based on personal experiences. To fast and simple technique for diagnosing pneumoperitoneum and
facilitate convenient instrumental manipulations with appropriate other abdominal diseases to obviates the necessity of frequent
15
visualization during laparoscopy, the operation target site should radiographs. Here we document our experience in using
be 15–20 cm away from the optical port, and the remaining trocars transillumination of the abdomen prior to insertion of the first trocar
are placed at 5–7 cm on either side of the optical trocar. 14 in two-port laparoscopic ventral hernia repair.
It is important to keep the primary port as far away from the This study was conducted aiming to improve the outcome,
targeted operation site as possible. This point is of great importance add to the general safety of trocars placement, and try to solve
in laparoscopic ventral hernia repair, because in some cases where the problems of the blind insertion of the primary trocar and the

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