1 Dr. Anil Sharma MS (Bom), FICS, FRCS (Edin), FRCS (Eng). Max Institute of Minimal Access, Metabolic & Bariatric Surgery Max Superspeciality Hospital 2 Press Enclave Road, Saket, New Delhi – , INDIA Endoscopic TEP groin hernia repair Our Technique

1. The preperitoneal space is created using an indigenous balloon made from two finger stalls of size 8 surgical glove. Click here to view video 1

Endoscopic TEP groin hernia repair Our Technique 2. The access port is sub umbilical, 1.2 cm long, starting at midline. Two other ports (5 mm) are sited in the midline, the lower port 1 cm above pubic bone and the other mid way between these two ports. Click here to view video 2

Endoscopic TEP groin hernia repair Our Technique 3. Access is gained to the preperitoneal space by open access (Hasson technique). Click here to view video 3

Endoscopic TEP groin hernia repair Our Technique 4. The preperitoneal space is developed and accessed by a process of cleavage to identify anatomical landmarks. Click here to view video 4

Endoscopic TEP groin hernia repair Our Technique 5. A direct hernial sac is reduced after separating it from the stretched out transversalis fascia. Click here to view video 5

Endoscopic TEP groin hernia repair Our Technique 6. An indirect hernial sac is dissected, separated from cord structures, ligated and divided. Click here to view video 6

Endoscopic TEP groin hernia repair Our Technique 7. Parietalization of the spermatic cord is performed by reflecting the peritoneal fold proximally upto the point where the vas deferens turns medially. Click here to view video 7

Endoscopic TEP groin hernia repair Our Technique 8. A polypropylene mesh trimmed to size 15 x 13 cm is rolled to 2/3 rd of its length and the roll is kept in place with sutures placed 5 cm from the margins. Click here to view video 8

Endoscopic TEP groin hernia repair Our Technique 9. The prepared mesh is completely rolled and inserted through the 10 / 12 mm Hasson trocar. The mesh is positioned such that the medial corner of the mesh is 2 cm below pubic bone and 2 cm beyond the midline. The mesh is unrolled on to the floor of the preperitoneal space. Click here to view video 9