Description

This comprehensive surgical video presents a detailed, step-by-step explanation of the enhanced-view totally extraperitoneal (eTEP) approach for inguinal hernia repair, demonstrated by Dr. R.K. Mishra at World Laparoscopy Hospital. The eTEP technique expands the conventional extraperitoneal working space, providing improved visualization, greater instrument mobility, and better ergonomic access to the myopectineal orifice without routinely entering the peritoneal cavity. The procedure begins with appropriate patient positioning, operative-site preparation, safe extraperitoneal access, and controlled development of the retromuscular and preperitoneal planes. Dr. Mishra explains trocar placement, identification of the rectus muscle and posterior rectus sheath, crossover technique, preservation of the peritoneum, and systematic creation of adequate working space. Important anatomical landmarks—including the pubic symphysis, Cooper’s ligament, inferior epigastric vessels, direct and indirect hernia spaces, femoral canal, vas deferens, gonadal vessels, and iliopubic tract—are demonstrated clearly. The video also explains careful reduction of direct, indirect, femoral, and cord lipoma components while protecting the bladder, peritoneum, nerves, vessels, and spermatic cord structures. Special attention is given to complete parietalization of the cord elements, identification of the critical view of the myopectineal orifice, and adequate dissection to accommodate a sufficiently large prosthetic mesh. Proper mesh orientation and coverage of all potential hernia sites are emphasized to reduce the risk of recurrence, folding, migration, and postoperative discomfort. The demonstration discusses operative ergonomics, atraumatic tissue handling, hemostasis, peritoneal tear management, prevention of pneumoperitoneum-related loss of working space, and appropriate conversion strategies when anatomical planes cannot be developed safely. Practical measures for reducing complications such as vascular injury, nerve injury, seroma, urinary retention, chronic groin pain, mesh infection, and recurrence are also reviewed. This educational presentation is particularly valuable for general surgeons, laparoscopic surgeons, surgical residents, fellows, and clinicians seeking a structured understanding of advanced extraperitoneal inguinal hernia surgery. It highlights the importance of sound anatomical knowledge, standardized dissection, careful patient selection, and supervised hands-on training before independent clinical application. The procedure was demonstrated at World Laparoscopy Hospital, an international training centre for laparoscopic and robotic surgery, under the guidance of Dr. R.K. Mishra. The content is intended exclusively for surgical education and should not replace formal training, institutional protocols, or supervised operative experience.