Single-port laparoscopic hernia needle therapy: New hope for the treatment of inguinal hernia in children

Abstract

The single-port laparoscopic hernia needle technique is gaining attention in the treatment of pediatric inguinal hernias due to its unique advantages. This editorial highlights the superiority and challenges of single-port laparoscopic hernia needles in the treatment of inguinal hernias in children. We hope that the study by Wang et al and this editorial will draw the attention of more physicians to the single-port laparoscopic hernia needle technique and promote its widespread use in the treatment of pediatric inguinal hernias.

Key Words: Single-incision laparoscopic herniorrhaphy needle; Pediatric inguinal hernia; Precise and minimally invasive; Aesthetically; Strengths and challenges

Core Tip: A study by Wang et al confirmed that the single-incision laparoscopic hernia pin technique for the treatment of pediatric inguinal hernias is associated with significantly less intraoperative bleeding, minimal trauma, and aesthetic outcomes compared to traditional approaches. By highlighting its multiple core values of trauma control and aesthetic design, this editorial makes it clear that despite the challenges of clinical dissemination, this technique will remain a state-of-the-art option for pediatric hernia repair.

INTRODUCTION

The single-incision laparoscopic herniorrhaphy needle technique has revolutionized the treatment of pediatric inguinal hernias in a minimally invasive manner. Recently, the World Journal of Gastrointestinal Surgery published a clinical study entitled "Single-incision laparoscopic herniorrhaphy needle treatment for pediatric inguinal hernia: Surgical outcome, postoperative complications, and serum inflammation effects"[1]. The study by Wang et al[1] demonstrated the advantages of the single-incision laparoscopic herniorrhaphy needle technique over traditional techniques for the treatment of pediatric inguinal hernia in terms of intraoperative and postoperative parameters, thus proving that the technique combines both therapeutic efficacy and aesthetics, and provides a better solution for the treatment of pediatric hernias worthy of clinical dissemination.

STRENGTHS AND CHALLENGES

In the field of minimally invasive surgery, single-port laparoscopic technology is revolutionizing the future of pediatric hernia repair after nearly two decades of research and development. Using a tiny 0.5-1 cm incision at the umbilicus as its core, this technology leaps from "minimally invasive" to "ultra-minimally invasive" through the precise manipulation of hernia needles and other specialized instruments. The clinical report of almost no intraoperative bleeding[2] and a surgical time of only 10-15 minutes[3] together illustrate the efficiency revolution of modern surgery.

By cleverly using the natural folds of the umbilicus to perfectly hide the surgical scars, this "invisible surgery" concept not only avoids the potential impact of traditional surgical scars on the child's psyche but also highlights the excellent advantages of the precise ligation of the internal loop port technology with an ultra-low recurrence rate of 0.28%[3] and 0% complications[4]. Under the magnified vision of laparoscopy, the surgeon can simultaneously examine and treat the hidden hernia on the opposite side, truly achieving "one operation, both sides free from worry", avoiding the risk of missing a hidden hernia in traditional surgery[5].

Adopting a complete extraperitoneal operation path minimizes the damage to the spermatic cord, blood vessels, and other important tissues[6], and with the promotion of day surgery mode, the efficient recovery process of discharge within 24 hours is reshaping the efficient rhythm of medical services[7,8]. With the iteration of instruments and technological refinement, single-port laparoscopic technology is redefining the gold standard of pediatric hernia treatment with the triple breakthrough of "less trauma, faster recovery, and better aesthetics".

Although the single-port laparoscopic hernia needle technique for pediatric inguinal hernia repair has the advantage of being minimally invasive and scarless, its clinical application still faces multidimensional challenges.

First, the "chopstick effect" occurs when instruments are operated through a single orifice, and parallel access leads to limited operative space and frequent collisions between instruments, placing high demands on the laparoscopic proficiency of the operator[9]. Anesthesia management requires a precise balance between pneumoperitoneum pressure and the limits of respiratory cycle compensation in children, especially in the younger age group with a potential risk of pneumothorax and hypercapnia[10,11].

Second, the complexity of the anatomy makes it difficult to standardize the operation. The anatomical features of the inguinal region in children show dynamic changes with age - the internal ring opening is wide and the peritoneum is delicate in infancy, making it easy for the hernia needle to penetrate the peritoneum; the accumulation of fat in the extraperitoneal space during the preschool period increases the resistance to the operation; and during puberty, the vasculature of the spermatic cord becomes thickened and fixed, making it easy to injure the reproductive function during the operation[12].

Third, the effectiveness of the single-port laparoscopic hernia needle technique in the treatment of inguinal hernia in children shows significant heterogeneity. This heterogeneity is mainly due to the diversity of surgical practices, instrument selection, and surgical techniques used in different healthcare institutions[13-16]. For example, some hospitals use homemade hernia needles, while others use commercially available ones that vary widely in material, size, and shape, which may lead to inconsistent surgical outcomes[16,17]. There is a lack of standardized criteria for the treatment of the internal ring opening, as well as the angle and depth of the needle puncture entry, which further impacts the standardization and reproducibility of the surgical procedure[18,19]. In addition, most of the available study data are limited to 1-3 years of follow-up, and there is a lack of evaluation of long-term efficacy beyond five years and its impact on the genitourinary system[20]. This lack of standardized protocols for the technique and insufficient data on long-term efficacy have, to some extent, limited the clinical promotion and application of the technique.

Last but not least, the high cost of developing specialized curved instruments and the 3-5 times longer training time for skilled operators compared to conventional surgery have driven up the cost of the procedure.

Faced with these challenges, the medical team must not only be able to perform the procedure with a wide range of skills, such as luminal techniques, anesthesia management, and complication management but also recommends that both the patient and the surgeon should evaluate the indications for the procedure and the risk-benefit ratio before surgery.

CONCLUSION

In conclusion, the single-port laparoscopic hernia needle for the treatment of inguinal hernia in children not only integrates trauma control and aesthetic design but also improves efficacy and significantly reduces the risk of surgery. We firmly believe that with the improvement of instruments and the maturation of technology, this innovative procedure, which combines minimally invasive concepts and aesthetic design, will become a cutting-edge choice in the field of pediatric hernia treatment and bring good news to more children.

ACKNOWLEDGEMENTS

Many thanks to Mr. Han Bo-Ning for providing the audio for the core tip of this manuscript.