Bilateral Laparoscopic Inguinal Hernia Repair with Mesh Using the Totally Extraperitoneal (TEP) Technique

1. Introduction

2. Preparation

1. Position the Patient
2. Surgical Site and Scrotum Prep
3. Draping and Setup

3. Infraumbilical Incision

4. Access to the Preperitoneal Space and Placement of Ports

5. Visualization of the Public Tubercle

6. Following Cooper's Ligament Laterally Towards Hesselbach's Triangle

7. Direct Space Examination and Reduction of any Hernia

8. Femoral Space Examination and Reduction of any Hernia or Fat

9. Identification and Elevation of Epigastric Vessels and Dissection Laterally to the ASIS

10. Lateral-to-Medial Indirect Space Dissection and Reduction of any Hernia or Preperitoneal Fat

11. Repeat on the Right Side

1. Follow Cooper's Ligament Laterally Towards Hesselbach's Triangle
2. Examine the Direct Space and Reduce any Hernia
3. Examine the Femoral Space and Reduce any Hernia or Fat
4. Identification and Elevation of Epigastric Vessels and Dissection Laterally to the ASIS
5. Lateral-to-Medial Indirect Space Dissection and Reduction of any Hernia or Preperitoneal Fat
6. Clearing the Cord and Vas Deferens of any Peritoneum

12. Preparation of the Myopectineal Orifice for Flat Mesh Placement

1. Clearing the Left Cord and Vas Deferens of any Peritoneum

13. Changing Gloves

14. Placement of the Mesh

1. Fixate with Tacks
2. Desufflation Under Direct Visualization

15. Closure

16. Post-op Remarks