Single incision laparoscopic surgery (SILS) is a novel approach to laparoscopic surgery, and can be performed with multiple trocars or a single access port (SAP). While SILS has been demonstrated in a variety of procedures, its use for inguinal hernias is just emerging. This video demonstrates the feasibility of a SILS total extraperitoneal (TEP) inguinal hernia repair using a SAP and summarizes our initial experience.

Demonstrated is a 79 year old female with a right inguinal hernia. An infraumbilical incision (27mm) is made and the anterior fascia overlying the left rectus is incised. After using a balloon dissector, a SAP is inserted accomodating three trocars. The dissection of the right groin, reduction of a direct and femoral hernia, and insertion of hernia mesh is demonstrated using standard laparoscopic instruments.

We have performed complete SILS TEP inguinal hernia repairs using a SAP on three patients thus far. Findings include two bilateral indirect hernias in men and a right direct and femoral hernia in a woman. All patients did well having no immediate complications. At the first post-operative visit there were no recurrences, seromas, or wound complications. Complaints of postoperative incisional pain were present.

To our knowledge, these are the first reported cases of SILS TEP using a SAP. Using a single skin incision, the actual operative steps and instruments used are completely unchanged from traditional laparoscopy. Advantages and disadvantages remain to be proven. Further evaluation is certainly required.