Park Jung Hyun, Kim Dong Jin
Department of Surgery, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea.
Front Surg. 2024 Jan 4;10:1305320. doi: 10.3389/fsurg.2023.1305320. eCollection 2023.
Ipsilateral left-sided-approach laparoscopic transabdominal preperitoneal herniorrhaphy (LA-TAPP) is a procedure used for inguinal hernia. However, conventional laparoscopic instruments may limit the operator's ability to approach certain areas during the procedure. This study aims to assess the feasibility of using an articulating bipolar grasper (ArtiSential®).
Between January 2017 and May 2022, 184 patients with inguinal hernia underwent LA-TAPP and were divided into an articulating group (AG) and a conventional group (CG). The two groups were compared for clinical characteristics, surgical outcomes, and recurrence rates. Learning curve analysis was also performed using the CUSUM score.
The AG and CG included 72 and 112 patients, respectively. Both groups had similar age, sex, BMI, hernia location, and hernia type. The AG had a significantly shorter operation time (59.2 ± 29.4 vs. 77.8 ± 22.4 min, < 0.001) than the CG. The duration of hospitalization was slightly shorter in the AG (2.2 ± 0.5 vs. 2.5 ± 1.4 days, = 0.056). Postoperative complications were lower in the AG (5.6%) than in the CG (9.8%). Scrotal neuralgic pain was observed in 1.4% of patients in the AG and 3.6% of patients in the CG. Learning curve analysis revealed that 24 cases were needed to overcome the learning curve for using an articulating device.
IP-TAPP with an articulating instrument is a safe and efficient procedure. The operation time can be reduced by improving the surgeon's procedural autonomy and reducing collisions between the instruments and the patient's ribs.
同侧左侧入路腹腔镜经腹腹膜前疝修补术（LA-TAPP）是一种用于腹股沟疝的手术。然而，传统的腹腔镜器械可能会限制术者在手术过程中接近某些区域的能力。本研究旨在评估使用可弯曲双极抓钳（ArtiSential®）的可行性。
2017年1月至2022年5月期间，184例腹股沟疝患者接受了LA-TAPP手术，并分为可弯曲组（AG）和传统组（CG）。比较两组的临床特征、手术结果和复发率。还使用累积和（CUSUM）评分进行学习曲线分析。
AG组和CG组分别包括72例和112例患者。两组在年龄、性别、体重指数、疝位置和疝类型方面相似。AG组的手术时间明显短于CG组（59.2±29.4 vs. 77.8±22.4分钟，<0.001）。AG组的住院时间略短（2.2±0.5 vs. 2.5±1.4天，=0.056）。AG组的术后并发症低于CG组（5.6% vs. 9.8%）。AG组1.4%的患者和CG组3.6%的患者出现阴囊神经痛。学习曲线分析显示，使用可弯曲器械需要24例才能克服学习曲线。
使用可弯曲器械的IP-TAPP是一种安全有效的手术。通过提高术者的操作自主性和减少器械与患者肋骨之间的碰撞，可以缩短手术时间。
