Abdominal wall nerve blocks support multimodal analgesia, but percutaneous ultrasound-guided blocks can be technically difficult in reduced port surgery (RPS) and may carry a risk of inadvertent visceral injury when puncture angles are constrained. Our group previously demonstrated that a transperitoneal abdominal wall block can be performed with simultaneous extracorporeal ultrasound confirmation of injectate spread. Here, we report a purpose-designed laparoscopic injection needle to standardize this internal approach in RPS. The single-use device has an 800 mm flexible shaft, a 25-gauge needle, and an adjustable tip protrusion (2-7 mm), enabling insertion through 3 or 5 mm ports while maintaining pneumoperitoneum. The target layer is identified from the peritoneal side; correct plane entry is confirmed by visual "tenting" and controlled hydrodissection; and local anesthetic is delivered while observing real-time tissue distension. The technique was integrated into reduced-port transabdominal preperitoneal (TAPP) inguinal hernia repair without workflow interruption. CONCLUSIONS: This device provides a practical method to perform abdominal wall nerve block under direct visualization in RPS, with depth control tailored to abdominal wall thickness. Future comparative studies versus ultrasound-guided techniques are warranted.
Nagata et al. (Thu,) studied this question.