Page 24 - World Journal of Laparoscopic Surgery

Transillumination in Laparoscopic Hernia Repair
the primary trocar insertion. It highlights the abdominal wall areas 2. Muysoms FE, Miserez M, Berrevoet F, et al. Classification of primary
which are free of tissues attachments where safe trocar insertion and incisional abdominal wall hernias. Hernia 2009;13(4):407–414.
could be achieved. Generally, our results are comparable with DOI: 10.1007/s10029-009-0518-x.
previous two-port laparoscopic hernia repair studies regarding 3. Berrevoet F, Doerhoff C, Muysoms F, et al. A multicenter prospective
operating time and defect sizes. 9,17 study of patients undergoing open ventral hernia repair with
intraperitoneal positioning using the monofilament polyester
Transillumination of the abdomen had been used by pediatric composite ventral patch: Interim results of the PANACEA study. Med
surgeons as a helpful part of the physical examination of infants. Devices (Auckl) 2017;10:81–88. DOI: 10.2147/MDER.S132755.
Several studies have been reported demonstrating its helpfulness in 4. Christoffersen MMW. Clinical outcomes after elective repair for small
detection of pneumoperitoneum, ascitic fluid and in differentiation umbilical and epigastric hernias. Dan Med J 2015;62(11):B5161. PMID:
19
between cystic and solid masses. To our knowledge, there 26522486.
are no previous reports in the English literature describing 5. Bittner R, Bingener–Casey J, Dietz U, et al. Guidelines for laparoscopic
transillumination in laparoscopic ventral hernia repair. treatment of ventral and incisional abdominal wall hernias
Our technique does not significantly vary from other two- [International Endohernia Society (IEHS)] – Part 2. Surg Endosc
2014;28(1):2–29. DOI: 10.1007/s00464-013-3170-6.
port described techniques but this study focuses attention on the 6. Liberman MA, Rosenthal RJ, Phillips EH. Laparoscopic ventral and
benefits of using abdominal transillumination before insertion incisional hernia repair: A simplified method of mesh placement. J Am
of the first trocar to obtain optimal results. Authors stated that Coll Surg 2002;194(1):93–95. DOI: 10.1016/s1072-7515(01)01135-8.
the ports in laparoscopic ventral hernia repair should be placed 7. Heniford BT, Park A, Ramshaw BJ, et al. Laparoscopic ventral
as laterally as possible opposite the hernia, preferably in the left and incisional hernia repair in 407 patients. J Am Coll Surg
side. 18,20 2000;190(6):645–650. DOI: 10.1016/s1072-7515(00)00280-5.
The farther away the camera port is from the hernial defect 8. Abir F, Eisenberg D, Bell R. Laparoscopic ventral hernia repair using
location, the wider the field of view and the easier it is to handle a two (5-mm) port technique. JSLS 2005;9(1):94–96. PMID: 15791980.
the mesh. And this is precisely the goal of transillumination as 9. Mehrotra PK, Ramachandran CS, Arora V. Two port laparoscopic
ventral hernia mesh repair: An innovative technical advancement.
it guarantees to a big extent the identification of the farthest Int J Surg 2011;9(1):79–82. DOI: 10.1016/j.ijsu.2010.08.010.
most secure point for placing the trocar without the possibility of 10. Jansen FW, Kapiteyn K, Trimbos–Kemper T, et al. Complications of
inducing any intraabdominal injuries. It gives more confidence to laparoscopy: A prospective multicentre observational study. Br J
the surgeon to insert the primary trocar as lateral as it could be. Obstet Gynaecol 1997;104(5):595–600. DOI: 10.1111/j.1471-0528.1997.
The main limitations of this study were the small sample size tb11539.x.
with BMI limited cases, and the single-center design. In addition, 11. Jansen FW, Kolkman W, Bakkum EA, et al. Complications of
there was a level of intersurgeon variability. 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.
conclusIon 12. Mann CD, Luther A, Hart C, et al. Laparoscopic incisional and ventral
Extracorporeal abdominal wall transillumination is a promising hernia repair in a district general hospital. Ann R Coll Surg Engl
2015;97(1):22–26. DOI: 10.1308/003588414X14055925058913.
approach for achieving more safety and confidence in the two-port 13. Supe AN, Kulkarni GV, Supe PA. Ergonomics in laparoscopic surgery.
laparoscopic ventral hernia repair and represents an auxiliary tool J Minim Access Surg 2010;6(2):31–36. DOI: 10.4103/0972-9941.65161.
for surgeons as a trial to visualize if there are structures adherent 14. Trejo A, Jung MC, Oleynikov D, et al. Effect of handle design and target
to the inner aspect of the anterior abdominal wall to improve location on insertion and aim with a laparoscopic surgical tool. Appl
abdominal entry safety. However, it does not substitute the essential Ergon 2007;38(6):745–753. DOI: 10.1016/j.apergo.2006.12.004.
safety principles for laparoscopy in general. The potential benefits 15. Wyman ML, Kuhns LR. Pneumoperitoneum demonstrated by
of this technique are its reproducibility and practicality; also, it transillumination. Am J Dis Child 1976;130(11):1237–1238. PMID:
could be tried with alternative tools rather than the scope as a light 984006.
source. More studies in various centers are required to optimize and 16. Almaimani G, Oyais A. Laparoscopic umbilical hernia repair using
a “two-port” technique: A single-center experience. J Curr Surg
validate this technique. 2017;7(3):39–41. DOI: 10.14740/jcs329w.
No financial support was received from any organization for 17. Abhishek V, Mallikarjuna MN, Shivaswamy BS. Laparoscopic umbilical
the submitted work. hernia repair: Technique paper. ISRN Minimally Invasive Surg
Disclosure: The authors declare no conflict of interest. 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: 10.4293/108680
orcId 810X12674612014860.
Maged Rihan https://orcid.org/0000-0001-9323-9405 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.
references 20. Sharma A, Mehrotra M, Khullar R, et al. Laparoscopic ventral/incisional
1. Pham CT, Perera CL, Watkin DS, et al. Laparoscopic ventral hernia hernia repair: A single-centre experience of 1,242 patients over a
repair: A systematic review. Surg Endosc 2009;23(1):4–15. DOI: period of 13 years. Hernia 2011;15(2):131–139. DOI: 10.1007/s10029-
10.1007/s00464-008-0182-8. 010-0747-z.

210 World Journal of Laparoscopic Surgery, Volume 15 Issue 3 (September–December 2022)