A Novel Method of Endoscopic Access to Establish Preperitoneal Space for Ventral Hernia with Optical Gasless Trocar

Extended view totally extraperitoneal (e-TEP) and totally visceral sac separation (TVS) techniques are used increasingly in ventral hernias. Perhaps the most fundamental difficulty of these methods is how to establish preperitoneal space. It restricts the promotion of these surgical procedures. We explored a reliable way of using an optical gasless trocar to establish the preperitoneal space and evaluated its reproducibility, efficiency, and safety. Patients who had ventral hernia surgery using with e-TEP/TVS approach between January 2022 and December 2023 were retrospectively analyzed. A total of 70 patients were included with 47 patients undergoing e-TEP repair and 23 patients undergoing the TVS approach. Patient’s data were obtained from the hospital’s electronic database and patient files. To detect any incision complications, an outpatient examination and telephone interviews were used as follow-up in 3 months after surgery. The median patient age was 58 years. The mean operative time to establish the preperitoneal space was 2.7 min, and the median postoperative pain score in the first 24 h was 3. There was no conversion to another surgical technique. The mean postoperative length of stay was 4.9 days. There were no incision-related complications. According to our experience, the technique of endoscopic access with an optical gasless trocar to establish preperitoneal space for ventral hernia can be safely performed in both the e-TEP/TVS approaches, as it offers a visual view during the puncture process. It also allows patients with ventral hernia receiving e-TEP or TVS repair to benefit from this technique.