Single Access Laparoscopic Hernia Repairs

Single Access Laparoscopic Hernia Repairs

Laura Dacks

Shawn Tsuda


In the last decade, surgery has quickly evolved toward less invasive methods. Laparoscopic surgery has continued to be on the forefront for many general surgical procedures due to shorter hospital stay, less pain, and reduced complications. The development and mastery of minimally invasive methods has piqued interest among surgeons and industry toward innovative methods beyond traditional laparoscopy.

Laparoscopic surgery through a single access site is a minimally invasive surgical technique either through a single incision with multiple instruments inserted into the abdomen via separate trocars or through a multi-channel access port (Fig. 37.1). The procedure is then performed with the same steps as the conventional laparoscopic method. Inherent challenges through this technique would include decreased triangulation, instrument crowding or “sword fighting,” and poorer visualization. Several articles have been published recently focusing on trials and outcomes of laparoscopic single incision surgery for ventral, incisional, and inguinal hernia repairs (Table 37.1). The focus of this chapter is to familiarize surgeons with the most updated techniques of single access laparoscopic surgery (SALS) hernia repairs.


Indications and contraindications are essentially identical to those of the standard laparoscopic approaches.

SALS Totally Extraperitoneal (TEP) Inguinal Hernia Repair


  • Bilateral hernias

  • Recurrent hernias

  • Unilateral hernias in young, active patients

Figure 37.1 Single port versus single ncision technique.

Table 37.1 Compilation of Single-Site Laparoscopic Hernia Repair Research

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Jun 13, 2016 | Posted by in GASTROENTEROLOGY | Comments Off on Single Access Laparoscopic Hernia Repairs

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Author Type of Study Patients (n) Type of Surgery Single Incision or Single Port Conversion Comments
Chung et al. (2011) Prospective 100 TEP Single incision 2 Converted to single site TAPP. One patient had recurrence.
Kucuk (2011) Prospective 15 TAPP Single port No All were recurrent hernias, 13 were open and 2 were previous TEP repairs.
Bucher et al. (2011) Prospective 52 VH/IH/UM/IN Single port No 6/52 previous surgeries were port-site incisional hernias. Used working channel endoscope.
Bower & Love (2011) Prospective 14 VH/IH Both No None
Barbaros et al. (2011) Case report 3 IH Single port No Giant hernias (15–18 cm) requiring 30 × 20 cm mesh. Transfascial sutures were not used on last two cases.
Tai et al. (2010) Prospective/retrospective 54 TEP Single incision No Prospective for LESS TEP, retrospective for conventional TEP
Sherwinter (2010) Retrospective 52 TEP Both No Based on availability of products.
He et al. (2010) Case report 3 TEP Single port No None
Surgit (2010) Prospective 23 TEP Single port 1 Converted to standard laparoscopic TEP
Agrawal et al. (2010) Prospective 19 TEP Single port No None
Roy & De (2010) Prospective 15 TAPP Single incision No Intracorporeal suturing of the peritoneum was abandoned after two cases due to being technically difficult.
Podolsky et al. (2009) Retrospective 30 VH/IH Single incision No None
Rahman & John (2009) Case report 1 TAPP Single incision No None
Bucher et al. (2009) Case report 4 TEP Single port 1 Additional port placed due to bleeding. Used working channel endoscope.
Jacob et al. (2009) Case report 3 TEP Single port No None