Inguinal Hernia

Question 1

Patient Position

Answer 1

Supine
Tuck arms and pad pressure points
trend

Question 2

Port Placement

Answer 2

Endo @ belly button
L & R hand 8cm lateral
Assist port - trainglualted behind or continue lateral
Stow arm 1 or 4

Question 3

Deploy for docking

Answer 3

Pelvic and patient side approach

Question 4

Typical instruments

Answer 4

1 - stowed
2 - Cadiere or Pro grasp or Fenestrated bipolar
3 - Endo 30 or 0
4 - MCS - Mega suture cut

Question 5

Procedure steps - TAPP

Answer 5

1. Lysis of adhesions
2. creation of peritoneal flap
3. Mesh fixation
4. Close peritoneum

Question 6

Creating peritoneal flap - steps

Answer 6

Mark spot 4-5cm above hernia
Open laterally and drop flap
stay between peritoneum and transversalis fascia.

Question 7

Mesh fixation - where do you place the mesh

Answer 7

Coopers ligament
superior and medial aspect of the mesh
superior and lateral - avoid the nerves

Question 8

Types of mesh

Answer 8

Pro - grip - Dr. Wright uses this
3D Max - most use this in my accounts (well for Macks)

Question 9

Closing the peritoneum - what type of suture

Answer 9

Using a running stitch - Vloc or Stratafix - try to pull in the direction of the barbs

Question 10

Difference between Vloc & stratafix

Answer 10

Stratafix is more spikey - straight angle
Vloc is more blunted - vloc has a dual angle

Question 11

Which direction to suture when closing the flap

Answer 11

suture from dominant hand towards non-dominant hand.