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The extended-view totally extraperitoneal (eTEP) technique is designed to overcome the limited working space and fixed port constraints of conventional totally extraperitoneal (TEP) hernia repair. This study aimed to provide a direct, randomised comparison of early outcomes between the eTEP approach and the transabdominal pre-peritoneal (TAPP) technique for groin hernias. A prospective, randomised, single-blind, parallel-group trial was conducted at a tertiary care centre. Seventy patients were allocated to either eTEP or TAPP repair (35 per group). Early post-operative complications - defined as post-operative pain, seroma and scrotal hematoma - were assessed as the primary composite endpoint. Key secondary endpoints included operative time, intraoperative complications, blood loss, hospital stay and early recurrence. Demographic and hernia characteristics were comparable at baseline. While Visual Analogue Scale pain scores decreased significantly over time in both groups ( P < 0.001), there was no statistically significant difference between the groups at any assessed interval. Seroma was clinically detected in three patients (8.6%) in the eTEP group at 1 week, all of which resolved spontaneously; no seromas occurred in the TAPP group ( P = 0.239). The median operative time was significantly shorter for eTEP (85 min, interquartile range [IQR]: 76-103) compared to TAPP (94 min, IQR: 87-110; P = 0.011). Rates of intraoperative complications, blood loss and mean hospital stay were similar between groups. Both eTEP and TAPP are safe and effective for groin hernia repair, demonstrating comparable early post-operative pain and morbidity. The eTEP technique was associated with a statistically significant reduction in operative time, positioning it as a valuable surgical alternative to TAPP. Clinical Trials Registry-India (CTRI/2023/09/057520).

Laparoscopic repair is recommended for inguinal hernia because it is associated with reduced postoperative pain and faster recovery compared with open repair. However, the choice between transabdominal preperitoneal (TAPP) and totally extraperitoneal (TEP) techniques remains controversial. A prospective randomized, clinical trial was conducted between November 2021 and June 2025. Adult male patients with unilateral uncomplicated inguinal hernias were included. Patients were randomized in a 1:1 ratio to undergo TAPP or TEP repair. The primary endpoint was 30-day postoperative complications graded according to the Clavien-Dindo classification. Secondary endpoints included chronic pain, functional recovery, and recurrence. A total of 144 patients were included and randomized, with 72 patients in each group. Briefly, 30-day postoperative complications were significantly more frequent after TAPP than TEP (19.4% versus 6.9%, P = .024). Most complications were minor (Grades I-II), and three Grade IIIa events required percutaneous aspiration. Chronic pain at 3 months was observed in 5.6% of patients after TAPP and 1.4% after TEP (P = .181). Time to return to normal activity did not differ significantly between groups. After a median follow-up of 26 months, the recurrence rate was 2.8% in both groups. TEP was associated with significantly lower short-term postoperative complications and shorter hospital stays, while long-term outcomes were comparable between techniques.

Incidental Amyand's hernia is a rare intraoperative finding during inguinal hernia repair and may pose a management dilemma, particularly in recurrent cases where prior anterior repair limits surgical options. In these settings, careful consideration is required for optimal plane selection and the safety of mesh placement after appendectomy. A 67-year-old man with a history of prior anterior Lichtenstein repair presented with a recurrent right inguinal hernia. A posterior laparo-endoscopic repair using the enhanced-view totally extraperitoneal (eTEP) technique was performed in accordance with international guidelines. During hernia sac dissection, a controlled peritoneal opening was intentionally created to safely identify the sac contents. The cecum and a macroscopically normal appendix were found within the sac, consistent with a Type I Amyand's hernia. Laparoscopic appendectomy was performed, and the repair was completed in the preperitoneal space using the eTEP approach, without conversion to a transabdominal preperitoneal (TAPP) technique. The postoperative course was uneventful, with no recurrence or chronic pain at six-month follow-up. This case demonstrates the utility of the eTEP approach as a posterior strategy for recurrent inguinal hernia repair when unexpected intraoperative findings occur. In selected patients with non-inflamed Amyand's hernia, appendectomy combined with prosthetic mesh repair can be performed safely without compromising outcomes.

A 49-year-old man was diagnosed with acute myocardial infarction and underwent percutaneous coronary intervention (PCI) for complete left anterior descending artery (LAD) occlusion. Two weeks later, transthoracic echocardiography revealed a mobile left ventricular thrombus. Due to its increasing size despite anticoagulation therapy, he was transferred to our department. Emergency surgery was performed using a totally endoscopic trans-atrial and trans-mitral approach through a right minimally invasive thoracotomy. The thrombus was completely removed under direct endoscopic visualization without the need for left ventricular incision. The postoperative course was uneventful, and no residual thrombus was observed. This minimally invasive approach is considered safe and effective for selected patients.

In this video tutorial, we describe the step-by-step procedure of a totally beating heart transplant in a setting of controlled donation after circulatory death. The donor and recipient of the cardiac allograft were present in the same hospital, the same operating block and different operating rooms. After a mandatory no-touch time of asystolic electrocardiographic registering, which per Italian law is 20 minutes, the sternum is opened and supra-aortic vessels are occluded. Thoraco-abdominal normothermic regional perfusion is promptly initiated, interrupting the warm ischaemia time. After the multiparametric evaluation of the cardiac allograft, its procurement from the donor, its transportation from the donor to the recipient and its subsequent implantation are performed completely on a beating heart. Cardiac perfusion in the aortic root was guaranteed continuously with the donor blood during procurement and transportation, and with the recipient blood from the cardiopulmonary bypass during the implantation. By avoiding the two periods of cold ischaemic cardiac arrest typically used in a donation after circulatory death setting, this procedure may reduce ischaemic cardiac injury and potentially improve the allograft performance after the transplant procedure.

This study aimed to present the clinical experience and long-term outcomes of managing small peritoneal tears (PT) during totally extraperitoneal (TEP) inguinal hernia repair using bipolar energy devices. Patients who underwent TEP inguinal hernia repair at a tertiary center were retrospectively reviewed. Those with peritoneal tears managed using bipolar energy devices and at least 1 year of follow-up were included in the PT group, while patients treated with alternative closure methods were excluded. Demographic, operative, and postoperative data were retrieved from a prospectively maintained database and compared with those of patients without PTs. Among the 571 patients, the PT group (n=86) and the No-PT group (n=485), no significant demographic differences were found. The PT group had longer operative times (50 vs. 45&#xa0;min, P<0.01), more bilateral repairs (39.5% vs. 28.5%, P=0.04), and higher lateral hernia rates (64% vs. 44.5%, P<0.01). In the PT group, 7 patients (8.1%) required Veres needle decompression, with no conversions to other approaches. Postoperative outcomes showed no significant differences in recurrence, seroma, or hematoma, with a median follow-up of 36 months for both groups. Sealing peritoneal tears with bipolar energy devices during TEP hernia repair is an effective and efficient technique, offering favorable long-term clinical outcomes without the need for additional instruments or conversion to other surgical approaches.

Totally Implantable Venous Access Ports (TIVAP) are specialized devices designed for long-term venous therapy, widely used in oncology and other groups requiring prolonged intravenous access. Since their introduction into routine clinical practice in China, they have significantly enhanced the safety and comfort of vascular access management. However, substantial challenges remain in TIVAP utilization as China lacks a unified regulatory framework and standardized full-lifecycle management protocols. Significant disparities also exist among medical institutions in terms of surgical techniques, complication management, and surveillance, leading to inconsistent outcomes and patient satisfaction. This narrative review presents a review of TIVAP clinical applications and maintenance, incorporating the latest evidence-based strategies for implantation and complication mitigation. The objective is to provide a comprehensive reference for optimizing clinical decision-making, minimizing adverse events, and improving patient quality of life.

Mesh fixation strategy is a modifiable intraoperative factor that may influence postoperative recovery following totally extraperitoneal (TEP) inguinal hernia repair. Although self-fixating meshes were developed to avoid penetrating fixation and potentially reduce pain, their effect on multidimensional recovery trajectories remains unclear. This retrospective cohort study included consecutive adults undergoing elective unilateral TEP repair at a tertiary referral center. Patients were grouped according to fixation strategy: self-fixating mesh or polypropylene mesh secured with absorbable tacks. The primary outcome was early quality of recovery measured using the Quality of Recovery-15 (QoR-15) questionnaire at postoperative week 1. Secondary outcomes included longitudinal QoR-15 and visual analog scale (VAS) pain scores at postoperative months 1 and 3, analgesic consumption, and time to functional recovery. Recovery trajectories were analyzed using linear mixed-effects models, with additional stratification by defect size (<20 mm versus &#x2265;20 mm). A total of 134 patients were included (56 tack fixation, 78 self-fixating mesh). Early recovery at week 1 was comparable between groups. Mixed-effects modeling demonstrated significant improvement over time in both groups, without an independent association between fixation strategy and overall QoR-15 trajectory. However, in defects &#x2265;20 mm, self-fixating mesh was associated with higher QoR-15 scores. Pain scores improved over time in both groups, with small but statistically significant differences favoring self-fixating mesh. In unilateral TEP repair, fixation strategy does not substantially influence overall early and short-term recovery. However, in larger defects (&#x2265;20 mm), self-fixating mesh may provide modest recovery advantages, suggesting a context-dependent rather than uniform effect.

Primary lumbar hernia is a rare lateral abdominal wall hernia with a clinically relevant risk of incarceration and strangulation. Evidence directly comparing open preperitoneal repair and laparoscopic totally extraperitoneal repair (TEP) remains limited. This study aimed to compare perioperative outcomes, early recovery parameters, and postoperative complications between the two surgical approaches. We conducted a single-center retrospective cohort study of consecutive patients undergoing surgery for primary lumbar hernia between January 2023 and December 2024. Patients received either open preperitoneal repair or TEP. Perioperative outcomes, early recovery parameters, postoperative complications, and recurrence were collected. To account for potential confounding, multivariable-adjusted analyses were performed. Log-transformed linear regression was used for operative time and estimated blood loss, linear regression for 24-hour visual analog scale (VAS) pain score, negative binomial regression for postoperative hospital days, and Firth logistic regression for the composite endpoint of any postoperative complication. A total of 38 patients were included (open, n&#x2009;=&#x2009;21; TEP, n&#x2009;=&#x2009;17). In the unadjusted analysis, TEP was associated with longer operative time (median 60 [50-65] vs. 40 [35-50] min; P&#x2009;=&#x2009;0.003), lower estimated blood loss (median 5 [3-5] vs. 10 [5-10] mL; P&#x2009;<&#x2009;0.001), and lower 24-hour pain scores (VAS 2 [1-2] vs. 3 [3-4]; P&#x2009;<&#x2009;0.001). No intraoperative vascular, nerve, or visceral injuries occurred. Postoperative events were rare; recurrence occurred in 1 open patient and none in the TEP group. In multivariable-adjusted analyses, TEP remained associated with longer operative time (33.7% increase, 95% CI 6.1% to 68.6%; P&#x2009;=&#x2009;0.020), lower estimated blood loss (48.1% reduction, 95% CI 23.7% to 64.8%; P&#x2009;=&#x2009;0.002), and lower 24-hour VAS pain scores (adjusted mean difference&#x2009;-&#x2009;1.46, 95% CI&#x2009;-&#x2009;2.12 to -&#x2009;0.80; P&#x2009;<&#x2009;0.001). No significant differences were observed in postoperative hospital days (IRR 0.74, 95% CI 0.40 to 1.37; P&#x2009;=&#x2009;0.342) or any postoperative complication (OR 0.61, 95% CI 0.06 to 4.38; P&#x2009;=&#x2009;0.628). In this cohort, TEP was associated with reduced early postoperative pain compared with open preperitoneal repair. The estimated blood loss difference (5 mL vs. 10 mL) was statistically significant but of limited clinical relevance. Short-term safety outcomes were comparable between groups. Although TEP required longer operative time, this difference may reflect technical complexity rather than inferiority. Larger prospective studies with longer follow-up are needed to confirm these findings and better define patient selection.

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