title: Mini Totally Extra-Peritoneal Repair of Inguinal Hernia with All 5 mm Ports: An Innovative "555 Technique".
abstract: BACKGROUND
  Totally extra-peritoneal (TEP) repair of inguinal hernia is now a standard surgical technique. A 12 mm incision in infra-umbilical region for Hasson trocar is must for TEP repair of inguinal hernia. This is the only technique known to laparoscopic surgeons. We have innovated a "555 Technique" for completing Mini TEP repair of inguinal hernia by using all three 5 mm ports.
  
  
  METHODS
  Sixty-one consecutive patients were subjected for TEP repair of inguinal hernia by our innovative "555 Technique" since October 2014. A simple "Manish Retractor" is devised to make extra-peritoneal space with 5 mm trocar. Fifty-nine cases were men and 2 cases were women. The mean age of patients was 44.6 years (range 23-82 years).
  
  
  RESULTS
  Out of 61 cases, 27 were indirect inguinal hernia (23 unilateral, 4 bilateral), 32 direct inguinal hernia (21 unilateral, 11 bilateral), 1 femoral hernia, and 1 obturator hernia. One patient of indirect inguinal hernia had sliding hernia with sigmoid colon. Sixty cases were successfully operated by "555 Technique." There was conversion to trans-abdominal pre-peritoneal repair (TAPP) in 1 case. The average time for insertion of 5 mm trocar in preperitoneal space by our technique was 150 seconds. No complications were noted on 6 months follow-up. Small infra-umbilical scar was cosmetically more acceptable to patients.
  
  
  CONCLUSIONS
  "555 Technique" is a feasible option without compromising the principles of TEP repair for inguinal hernia. Innovation of simple "Manish Retractor" is the key in completing Mini TEP repair. This technique is simple, less invasive, less morbid, and cost effective as it avoids dependence over costly Hasson trocar with better cosmetic results.
authors.affiliation: Department of General and Laparoscopic Surgery, Sir Ganga Ram Hospital , Delhi, India .
authors.forename: Manish K
authors.initials: MK
authors.lastname: Gupta
authors.affiliation: Department of General and Laparoscopic Surgery, Sir Ganga Ram Hospital , Delhi, India .
authors.forename: Kiran Kumar
authors.initials: KK
authors.lastname: Muley
authors.affiliation: Department of General and Laparoscopic Surgery, Sir Ganga Ram Hospital , Delhi, India .
authors.forename: Murali Krishna
authors.initials: MK
authors.lastname: Bethanbhatla
authors.affiliation: Department of General and Laparoscopic Surgery, Sir Ganga Ram Hospital , Delhi, India .
authors.forename: Juhil D
authors.initials: JD
authors.lastname: Nanavati
authors.affiliation: Department of General and Laparoscopic Surgery, Sir Ganga Ram Hospital , Delhi, India .
authors.forename: Kumar
authors.initials: K
authors.lastname: Manish
authors.affiliation: Department of General and Laparoscopic Surgery, Sir Ganga Ram Hospital , Delhi, India .
authors.forename: Rathindra
authors.initials: R
authors.lastname: Sarangi
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D005500:Follow-Up Studies; D006552:Hernia, Inguinal / Q000601:surgery*; D059685:Herniorrhaphy / Q000295:instrumentation / Q000379:methods*; D006801:Humans; D010535:Laparoscopy / Q000295:instrumentation / Q000379:methods*; D008297:Male; D008875:Middle Aged; D010537:Peritoneum / Q000601:surgery*; D016896:Treatment Outcome
keywords: 555 Technique; 555 Technique of inguinal hernia repair; Manish Retractor; TEP repair without Hasson trocar; extra peritoneal repair without Hasson trocar; mini TEP repair of inguinal hernia