Fig 1.
(a) The incision length should be limited to 1-1.5 cm, extending no further than the umbilicus. (b) The umbilicus is completely inverted, and a longitudinal incision is made along the midline.
Fig 2.
Creating the surgical glove port.
(a) After dissecting the subcutaneous tissue and exposing the anterior rectus sheath on the side of the hernia. (b) This was followed by the separation of the rectus muscle from the posterior rectus sheath. (c) An Alexis of XXS size was inserted in front of the posterior rectus sheath. (d) A non-powdered surgical glove (5.5 inches) was put on the wound retractor air-tightly, through which three 5-mm trocars were inserted via the fingertips.
Fig 3.
Two procedures were standardized: dissection of the spermatic ducts and dissection of the vas deferens.
(a) The precise positioning of these devices creates ample working space for the laparoscopic camera and forceps within the lumen of the Alexis due to the horizontal cross configuration. (b) The spermatic cord is visible from the medial side, and the forceps can be observed emerging from the hernia side of the screen. (c) The precise positioning of these devices creates ample working space for the laparoscopic camera and forceps within the lumen of the Alexis due to the vertical cross configuration. Additionally, the forceps handles are inverted to ensure smooth vertical manipulation and ample operating space. The hands of the surgeon and the scopist are vertically aligned, ensuring that an adequate distance is maintained. (d) A flexible-tip laparoscopic camera is then inserted into the ventral direction, and the tip of the laparoscopic camera looks down on the spermatic cord.
Fig 4.
To safely insert the mesh, forceps were used to grasp the inner portion of the mesh and a surgical glove was covered.
Table 1.
Patients’ characteristics.
Table 2.
Preoperative data.
Fig 5.
Learning curve of STEP as performed by the early career surgeon.
The operating time decreased gradually after 20 cases and stabilized after 40 cases. STEP: single-port totally extraperitoneal.
Fig 6.
Postoperative umbilical region.
Although it is still highly cosmetic, for better cosmetic results, it would be desirable to have an incision only within the umbilicus, not extending beyond the umbilicus so that the scar is barely noticeable.