The conventional totally extra-peritoneal approach for inguinal hernia repair is technically demanding and difficult to master. Here, we discuss the enhanced-view totally extra-peritoneal (eTEP) approach, which can be mastered rapidly, regardless of previous experience; it can be mastered by self-educated surgeons. Thus far, we have used eTEP in daily clinical practice for more than 1200 cases. This chapter aims to guide surgeons in the selection of an ideal strategy for mastering and teaching eTEP. We discuss using social media to communicate with other surgeons involved in hernia repair, along with involvement in various courses and software programs. We also describe our progressive eTEP course, which permitted rapid progression of eTEP competency. Our course consisted of a preparatory stage (basic laparoscopic lectures, simulation, and observation during laparoscopic procedures) and a principal stage (abdominal wall and groin surgery lectures, eTEP operative technique lectures, and participation in eTEP procedures). Upon course completion, surgeons could independently complete eTEP procedures. Based on our experience with this course, we provide three examples of adapted trocar arrangements; three additional anatomical landmarks with tentative names for safer and faster dissection, as well as more efficient mesh positioning (“Brick artery,” “Hooked Ridge,” and “Four Corners”); and ten practical tips designed for surgeons engaged in self-education, which can guide implementation of eTEP.

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Adopting Laparoscopic eTEP Inguinal Hernia Repair

  • Youri Mnouskin,
  • Shlomi Rayman,
  • Jorge Daes

摘要

The conventional totally extra-peritoneal approach for inguinal hernia repair is technically demanding and difficult to master. Here, we discuss the enhanced-view totally extra-peritoneal (eTEP) approach, which can be mastered rapidly, regardless of previous experience; it can be mastered by self-educated surgeons. Thus far, we have used eTEP in daily clinical practice for more than 1200 cases. This chapter aims to guide surgeons in the selection of an ideal strategy for mastering and teaching eTEP. We discuss using social media to communicate with other surgeons involved in hernia repair, along with involvement in various courses and software programs. We also describe our progressive eTEP course, which permitted rapid progression of eTEP competency. Our course consisted of a preparatory stage (basic laparoscopic lectures, simulation, and observation during laparoscopic procedures) and a principal stage (abdominal wall and groin surgery lectures, eTEP operative technique lectures, and participation in eTEP procedures). Upon course completion, surgeons could independently complete eTEP procedures. Based on our experience with this course, we provide three examples of adapted trocar arrangements; three additional anatomical landmarks with tentative names for safer and faster dissection, as well as more efficient mesh positioning (“Brick artery,” “Hooked Ridge,” and “Four Corners”); and ten practical tips designed for surgeons engaged in self-education, which can guide implementation of eTEP.