創新技術：應用捲動方式於腹腔鏡全復膜前疝氣修補術放置網膜
傅士彰1、張孟霖2
衛生福利部桃園醫院 泌尿科
ROLLING Method for mesh placement of laparoscopic total extra-peritoneal hernioplasty: a Novel technique
Shih-Chang Fuh1, Meng-Lin Chang2
Department of Urology, Taoyuan General Hospital, Taoyuan, Taiwan1
Department of Urology, Keelung General Hospital, Keelung, Taiwan2
Background: Inguinal hernias account for 75% of all abdominal wall hernias and repair of these hernias is one of the most commonly performed surgical procedures in the world. Minimal invasive surgery is the trend for modern operation. Laparoscopic herniorrhaphy has some advantages such as reduce post-operative pain and decrease requirement for narcotics. However, the skill of mesh placement is difficult, especially for beginners. We present a technique with rolling method, which makes mesh placement easier and less time consuming.
Method: After pre-peritoneal dissection, which ensures that adequate space available for placement of large mesh prosthesis was done. The procedure of mesh placement could be started.
Then we have to make some “handicraft arts”. First, use 3.0 vicryl stat suture over one side of the mesh (Fig. 1). Then roll the mesh into a rod and tie both end with silk (Fig. 2). After all handicraft procedure, put this rod into pre-peritoneal space. Then fixed one end of the rod near pubic tubercle (with forceps or tack), the other end over lateral side of abdominal wall (Fig. 3). Cut the silk suture and then pull the stat suture of 3.0 vicryl – the mesh placement was done amazingly.
Result: By using this technique, time for mesh placement is lessened thus operative time is also reduced. The mesh could be placed more flat and neat than before.
Discussion: Laparoscopic total extra-peritoneal repair (TEP) is more comfortable for the patient than traditional open method. However, TEP might have some disadvantages, such as increased cost, lengthier operation, steeper learning curve, and most importantly, results in higher recurrence and complication rates early in a surgeon’s experience.
While using this rolling method, mesh placement could be easier and more efficient than traditional method. It is easy learning and may shorten the learning curve of mesh placement. Since our procedure was easily performed, we believe it is worth imitating for urologists who just begin to learn the skill of TEP.