Innovative articulating instruments in single incision laparoscopic totally extraperitoneal hernioplasty (SILTEP): Evaluating feasibility, safety, and learning curve

Abstract

Background Laparoscopic surgery for adult inguinal hernia reduces postoperative pain and speeds recovery compared to open surgery. The totally extraperitoneal (TEP) approach, particularly the single incision surgery (SILTEP), presents challenges due to limited range of motion and workspace. ArtiSential®, the laparoscopic articulating instrument, offers improved dexterity and ergonomics but lacks evaluation in hernia repair.

Methods This retrospective study at a single center analyzed 42 patients who underwent SILTEP with ArtiSential® by a single surgeon between April 2023 and March 2024. Data on demographics, surgical techniques, intra- and postoperative outcomes were collected and learning curves with dissection time (DT) was analyzed.

Results Of 42 patients, 7 (16.7 %) experienced intraoperative complications. The postoperative complication rate was 9.8 %, with surgical site infections (5.0 %), seroma (2.4 %), and urinary retention (2.4 %). The median DT significantly decreased from 42 min in the initial phase (first 9 cases) to 26 min in the later phase (p = 0.007). The median postoperative pain scores were 4.5 on day 0 and 1.0 on day 1. The majority of patients (88.1 %) were discharged on the first postoperative day.

Conclusions The study demonstrated that ArtiSential® laparoscopic articulating instruments enhance the efficiency and ergonomics of SILTEP, significantly reducing DT with favorable postoperative outcomes. While the learning curve was accelerated, prior experience with conventional SILTEP likely influenced these results. The promising initial findings suggest that ArtiSential® can effectively address challenges in single-port laparoscopic surgery, though further research with larger sample sizes and longer follow-up is needed to confirm long-term benefits and broader applicability.