TAPP5: Technical Modification of Transabdominal Preperitoneal (TAPP) Inguinal Hernia Repair Using Three 5-mm Ports

The laparoscopic transabdominal preperitoneal (TAPP) technique is an established method for inguinal hernia repair, conventionally performed using one 10-mm and two 5-mm ports.We describe TAPP5, a threeport technique using 5-mm ports throughout, including a method for introducing appropriately sized mesh through a 5-mm incision.The procedure follows the standard principles of TAPP repair, including development of the preperitoneal space, identification of the relevant anatomical landmarks, reduction of the hernia sac, and placement of the mesh over the myopectineal orifice.The mesh is introduced through a lateral 5-mm operating port after being rolled into a narrow cylindrical configuration, grasped with a laparoscopic rat-tooth grasper, lubricated, and advanced through the port incision using gentle traction and rotational movement.The port is then reinserted and the mesh positioned using standard laparoscopic instruments.TAPP5 allows inguinal hernia repair to be performed using three 5-mm ports while permitting introduction of standard medium-and large-sized meshes.The technique maintains the established principles of TAPP repair and may provide an alternative port configuration for laparoscopic inguinal hernia repair.Further studies are required to evaluate operative and clinical outcomes and to compare this approach directly with conventional TAPP repair.