TAPP Inguinal hernia repair

ANATOMY
Watch for iliac vein, bladder, vas, inferior epigastrics, testicular vessels
PROCEDURE
Hasson/Trendelenburg
2 flank 5mm ports well lateral and just inferior to umbilicus
Reduce hernia
Look for ‘casper’ sign, which is transversalis fascia tenting back in. This is the limit of the hernial content and where to transect.
Incise peritoneum with diathermy/scissors. Cut high as it is easier to dissect down than up
Dissect well medial towards rectus
10x15cm mesh, round off corners (No smaller than this as mesh shrinks.
Roll into cigar. Roll up/down (ie horizontally) so it’s easier to unfurl. Unfurl from bottom up. Make sure mesh is down low enough as most recurrences will be low down
Once in position close mesh with 3-0 vicryl. To do this cut a length of suture to about mayo scissor length. Tie a loop in the end and pass into peritoneum.
Start at one end, lock suture through loop and close peritoneum in 2 layers.
Not sure how to knot off...
To remove suture from 5mm port, bend back straight and grasp at blunt end.
Tissue glue for skin.