What are the beneficial outcomes for patients
undergoing an inguinal hernia repair through the
TEP approach?
"After a few years of experience with the TEP repair, especially
after becoming more efficient in the approach, I noticed the
patients were doing so much better as far as the recovery
and the pain, that I thought that I should offer the TEP
approach to unilateral hernia patients as well. There's no pain
in the groin after doing a TEP repair. The pain comes from
where you put your incisions."
How did the Kii Dissecting Balloon help you with
this approach?
"I like the fact that once I found the [preperitoneal] space, the
balloon almost does the whole dissection for me. When we
inflated that balloon and took it out, we probably had 75% of
the dissection already accomplished from the balloon before
we even had to go in and clean up loose ends."
Dissecting balloons play an important role in TEP repair. Availability of these devices over the past decade has
been limited and increasingly costly.
In order to provide choice to surgeons performing TEP repair, Applied Medical introduced the Kii® Dissecting
Balloon access system in November 2018. John Steers, MD, a general surgeon at Carroll Hospital (Westminster,
MD), shares his experience with the TEP approach for inguinal hernia repair and how dissecting balloon
technology has benefited his practice and his patients' recovery.
With the benefits of using a dissection balloon
for the TEP approach, why do you think some
surgeons still continue to perform the procedure
without it?
"Cost. I can't speak for all surgeons, some may prefer
a blunt method, but for a lot of surgeons, I believe
the cost is the biggest issue."
What is your opinion on the learning curve for
surgeons adopting the TEP approach?
"I think learning to get into the preperitoneal
space efficiently and making sure you can do it
reproducibly, such that it is not a unique experience
each time, is the key to the approach. Once you
learn the technique of how to get into the space and
get the exposure that you need, then everything
else sort of falls into line, because then it is no
different than a TAPP approach. Once you've done
the exposure, the anatomy is the same."
For full interview Q&A responses
with Dr. Steers, please visit
www.appliedmedical.com/kiidissecting
Surgeons who perform minimally invasive techniques for inguinal hernia
repair surgery understand the importance of safe dissection methods for
the totally extraperitoneal (TEP) laparoscopic technique.
"I noticed the patients were
doing so much better as far as
the recovery and the pain."
"I like that once I've found the space,
the balloon does the majority of
the dissection. To me it saves time
and it is safe."
Do you find the safety and efficiency of the TEP approach
is enhanced with dissecting balloon technology?
"I think for some people that's personal preference... I like
the fact that once I've found the space, the balloon does the
majority of the dissection. To me it saves time and the nice
soft balloon makes it safe. Also, if you run into some bleeding,
the fact that the balloon is inflated and you see bleeding
through the balloon, you can just keep the balloon inflated
for three minutes and it will tamponade the bleeder. In a case
where you are just using a scope, you'd need to go in with an
energy device or a clip to stop the bleeding, and sometimes
the visualization will require you to have a suction irrigator
as well."
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APPLIED MEDICAL DOES NOT PROVIDE MEDICAL ADVICE. Each healthcare
professional must rely on his or her own professional judgment when
deciding whether and how to use a particular procedure or product with a
particular patient.
