細径デバイスを用いたtotal extraperitoneal inguinal hernia repair（TEP）

Laparoscopic total extraperitoneal inguinal hernia repair with needlescopic instruments

◆要旨：［目的］細径デバイスによるtotal extraperitoneal repair（TEP）法の手術手技・成績を報告する．［方法］トロッカーは12mm-3mm-3mmとし，エネルギーデバイスは3mmモノポーラー剪刃のみ使用した．従来式TEP法群23例，細径式TEP法導入後の前期群26例と手技の安定した後期群24例の手術成績を検討した．［結果］手術時間中央値は後期群で片側67.5分，両側101分であり，従来式群と有意差はなかった．修復を要した腹膜損傷は細径式群全体の5.0％（3/60）であった．各群とも再発は認めていない．［結論］本法は細径化と手術クオリティの保持を両立しうる有用な術式である．

［PURPOSE］ Although needlescopic surgery in minimally invasive surgery is becoming more common, there have been no reports of needlescopic total extraperitoneal inguinal hernia repair（TEP） in Japan. In this report, we describe our operative technique and evaluate the feasibility of the needlescopic TEP. ［METHODS］ We performed needlescopic TEP using one 12-mm and two 3-mm trocars in 26 patients between September 2014 and December 2014（early period）, and in 24 patients between January 2015 and April 2015（later period）. The results including demographic features and operative outcomes were compared with 23 patients who underwent conventional TEP from April 2014 to August 2014. ［RESULTS］ The median operative time in the later period of needlescopic TEPs was 67.5 minutes for unilateral repairs and 101 minutes for bilateral repairs. There was no significant difference compared to the conventional TEPs. In our series of 60 patients who underwent needlescopic TEP, the peritoneal injury occurred in 22（36.7％） patients, but only 3（5％） patients required the peritoneal repair. There has been no postoperative recurrence to date. ［CONCLUSION］ Needlescopic TEP seems to be a feasible procedure as a minimally invasive surgery while maintaining the operation quality when performed by experienced surgeons.