A Practical Guide to Robotic Transabdominal Preperitoneal Repair for Inguinal Hernia

Sungwoo Jung, Hyung Soon Lee

J Surg Innov Educ. 2025;2(1):1-4.   Published online June 16, 2025

DOI: https://doi.org/10.69474/jsie.2025.00052

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Abstract

Robotic transabdominal preperitoneal (R-TAPP) inguinal hernia repair offers enhanced visualization, ergonomic comfort, and improved instrument control compared to conventional laparoscopy. Although laparoscopic transabdominal preperitoneal repair has known benefits, its adoption remains limited due to technical challenges and a steep learning curve. The robotic platform addresses these limitations, making it well-suited for safe, precise dissection in the preperitoneal space. This article presents a practical, step-by-step guide to R-TAPP, highlighting key anatomical landmarks, standardized dissection techniques, and tension-free mesh placement without fixation.

Laparoscopic Extended Totally Extraperitoneal Hernia Repair with Posterior Component Separation with Transversus Abdominis Release for a Recurrent Incisional Hernia

Sa-Hong Kim, Kyoyoung Park, Chungyoon Kim, Jeesun Kim, Do-Joong Park, Hyuk-Joon Lee, Seong-Ho Kong

J Surg Innov Educ. 2025;2(1):5-8.   Published online June 17, 2025

DOI: https://doi.org/10.69474/jsie.2025.00024

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Abstract

A patient with multiple comorbidities, including hypertension, type 2 diabetes, hyperlipidemia, and edema, and a prior history of abdominal surgery presented to the gastrointestinal department with a recurrent incisional hernia larger than 10 cm. The patient underwent laparoscopic extended totally extraperitoneal (e-TEP) hernia repair under general anesthesia. The bilateral retrorectal spaces were accessed via three trocars, followed by midline crossover in the upper abdomen and caudal dissection along the fascial defect. Due to the large size of the defect and the anticipated tension, posterior component separation (PCS) with transversus abdominis release (TAR) was performed, with careful preservation of the neurovascular bundles running anterior to the head of the transversus abdominis muscle. After separate closure of the posterior and anterior layers using barbed sutures, a mesh was placed in the intercomponent space to avoid direct contact with intraperitoneal structures. Closed-suction drains were placed bilaterally to prevent seroma formation. The procedure was completed successfully, and the patient experienced no complications. The patient was discharged without complications. A follow-up computed tomography scan demonstrated the integrity of the hernia repair, with progressive resolution of fat infiltration and fluid collection. Laparoscopic e-TEP hernia repair with PCS and TAR provides a safe and effective approach for managing complex recurrent incisional hernias. This technique enables tension-free closure with mesh placement while minimizing intra-abdominal complications.

Biologic Mesh Augmentation for Repairing Diaphragmatic Hernia

Juno Yoo, Chung Sik Gong, Ba Ool Seong, Chang Seok Ko, Sa-Hong Min, In-Seob Lee, Moon-Won Yoo, Jeong Hwan Yook, Beom Su Kim

J Surg Innov Educ. 2025;2(1):9-13.   Published online June 24, 2025

DOI: https://doi.org/10.69474/jsie.2025.00045

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Abstract

Diaphragmatic hernias, whether congenital or acquired, often require surgical intervention to prevent life-threatening complications. The use of biologic mesh has gained increasing attention due to its favorable integration with host tissue and lower recurrence rates. This article presents a reproducible and effective method for diaphragmatic hernia repair using a biologic mesh via a laparoscopic approach. The technique emphasizes anatomical restoration and durable fixation, while minimizing tension and postoperative complications.

How to Perform Single-Incision Laparoscopic Totally Extraperitoneal Hernia Repair

Moon Jin Kim, Ji Hoon Kim, Ju Myung Song, Chae Dong Lim

J Surg Innov Educ. 2025;2(1):14-18.   Published online June 26, 2025

DOI: https://doi.org/10.69474/jsie.2025.00059

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Abstract

Surgery for inguinal hernia has made significant progress over a period of more than a century. The advent of minimally invasive techniques prompted further innovations. Among these, single-incision surgery offers significant advantages in creating the preperitoneal space. Therefore, it is essential for surgeons to understand and be able to perform single-incision laparoscopic totally extraperitoneal (SIL-TEP) hernia repair. This article presents a detailed description of the surgical technique for SIL-TEP.

Technique of Temporary Abdominal Closure Using Negative-Pressure Wound Therapy

Abdallah Alferdaus, Ye Rim Chang, Suk-Kyung Hong

J Surg Innov Educ. 2025;2(1):19-21.   Published online June 19, 2025

DOI: https://doi.org/10.69474/jsie.2025.00010

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Abstract

Temporary abdominal closure (TAC) is an abridged technique used after damage control surgery when primary closure is unattainable or can place patients at risk of complications such as intra-abdominal hypertension. Several techniques have been described for TAC. The ideal method should prevent bowel evisceration, prevent abdominal wall retraction or loss of domain, allow removal of infected fluids, and facilitate early definitive closure. Herein, we present a case where negative-pressure wound therapy was used for TAC. We describe the technique’s steps, aiming to simplify the procedure for experienced surgeons.

Different Choices of Surgical Methods for Duodenal Gastrointestinal Stromal Tumors

Zhuang Chun, Mohd Firdaus Che Ani, Abdullah Almayouf, Jee-sun Kim, Seong-Ho Kong, Do-Joong Park, Han-Kwang Yang, Hyuk-Joon Lee

J Surg Innov Educ. 2025;2(1):22-23.   Published online June 16, 2025

DOI: https://doi.org/10.69474/jsie.2024.00150

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Abstract

Gastrointestinal stromal tumors (GISTs) are the most common mesenchymal tumors of the gastrointestinal (GI) tract. Although GISTs can occur anywhere along the GI tract, they are most frequently found in the stomach and small intestine. Duodenal GISTs are rare but clinically significant due to their symptomatology and potential for malignant transformation. Surgical resection remains the cornerstone of curative treatment. Laparoscopic surgery is now the main method for duodenal GIST due to its advantages, including a faster recovery, less pain, and shorter hospital stay. In this video, we demonstrate how we make different choices regarding the surgical methods for duodenal GIST during operation. The technical points are as follows: (1) preliminary judgment of the tumor location according to the preoperative computed tomography scan and gastroscopy findings, (2) fine dissection of the soft tissue and vessels around the duodenum, (3) intraoperative gastroscopy to confirm the tumor location, (4) the final decision regarding the surgical method according to the tumor location and size, (5) confirmation of luminal patency and hemostasis by intraoperative endoscopy.

Methods of Insertion and Examination in Esophagogastroduodenoscopy: A Comprehensive Video Guide

Eun Young Kim, Ki Bum Park, Han Mo Yoo, Dong Jin Kim, Sang-Ho Jeong

J Surg Innov Educ. 2025;2(1):24-25.   Published online June 26, 2025

DOI: https://doi.org/10.69474/jsie.2025.00080

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Abstract

Esophagogastroduodenoscopy (EGD) is a fundamental diagnostic and therapeutic modality for various gastrointestinal diseases. As endoscopic techniques evolve, mastering the step-by-step process of EGD—including insertion, navigation, and systematic observation—is essential for ensuring patient safety and diagnostic accuracy. This video article provides a comprehensive, narrated demonstration of the techniques involved in EGD, from patient preparation to scope control and anatomical orientation. It emphasizes key technical details such as endoscope handling, the role of hand movements in scope navigation, and systematic evaluation of the esophagus, stomach, and duodenum. All demonstrations were performed using a simulation model (UGI Endoscopy Simulator; MEDICAL IP, Korea) with an Olympus GIF-HQ290 endoscope. This educational video serves as a practical guide for trainees seeking to refine their technique and increase procedural efficacy.

Gastrointestinal

Tips for Laparoscopic Feeding Jejunostomy Using a Barbed Suture

Sin Hye Park, Dong Jin Kim

J Surg Innov Educ. 2024;1(2):31-33.   Published online December 9, 2024

DOI: https://doi.org/10.69474/jsie.2024.00108

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Abstract

Feeding jejunostomy is crucial for patients with compromised oral intake, particularly after gastrointestinal surgery or esophagectomy. Traditional methods involve interrupted sutures to secure the feeding tube to the abdominal wall, but this can be cumbersome due to the need for knot tying. This paper presents the case of a 75-year-old male patient who underwent minimally invasive esophagectomy with feeding jejunostomy for esophageal cancer, and introduces the use of a knotless barbed suture, which is commonly employed in gastrointestinal operations. The laparoscopic procedure utilized four trocars for jejunostomy, employing a 3-0 silk purse string suture and a 14-Fr Foley catheter. The barbed suture was used to secure the catheter in place without knots, covering 360° around the catheter. This method aims to simplify laparoscopic feeding jejunostomy and improve clinical practice.

Colorectal

Colorectal Endoscopic Submucosal Dissection Using the Double-Clips Traction Method

Dae Kyung Sohn

J Surg Innov Educ. 2024;1(2):39-41.   Published online November 27, 2024

DOI: https://doi.org/10.69474/jsie.2024.00080

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Abstract

Endoscopic submucosal dissection (ESD) is an advanced endoscopic technique used to remove large adenomas or early colorectal cancers. This paper presents a step-by-step introduction of the methodology for performing colorectal ESD using the double-clips traction method. The technique is designed to enhance visualization, shorten the procedure time, and improve the safety and efficacy of colorectal ESD, especially in challenging cases involving large or fibrotic lesions. By providing reliable traction, this method helps to maintain a stable and clear field of view throughout the procedure, which is critical for the success of the dissection.

Liver

Indocyanine Green-Guided Precision in a Left Lateral Sectionectomy for Hepatocellular Carcinoma

Woohyung Lee, Kwang Pyo Hong, Mirang Lee, Minkyu Sung, Yejong Park, Ki Byung Song, Jae Hoon Lee, Dae Wook Hwang, Song Cheol Kim

J Surg Innov Educ. 2024;1(2):42-45.   Published online December 3, 2024

DOI: https://doi.org/10.69474/jsie.2024.00087

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Abstract

Parenchyma-sparing anatomical resection is recommended in patients with hepatocellular carcinoma due to the presence of underlying liver disease. More precise hepatectomy has been enabled by recent technical advancements, including negative staining with indocyanine green following ligation of the corresponding Glissonean pedicle, which offers intraoperative guidance by delineating the resection plane in real-time. Herein, we present a case of laparoscopic left lateral sectionectomy that used this staining technique.

Breast

LuminoMark: An Alternative for Localization

Ee Jin Kim, Tae Kyung Yoo, Jisun Kim, Il Yong Chung, Beom Seok Ko, Hee Jeong Kim, Jong Won Lee, Byung Ho Son, Sae Byul Lee

J Surg Innov Educ. 2024;1(2):46-48.   Published online December 13, 2024

DOI: https://doi.org/10.69474/jsie.2024.00178

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Abstract

Breast cancer is the most common cancer among women in Korea. Given the increased preference for breast-conserving surgery (BCS), preoperative localization is crucial, especially for non-palpable lesions, to ensure clear resection margins. Traditional methods such as wire-guided localization have limitations, including patient discomfort and wire migration. Recently, LuminoMark, an indocyanine green–macroaggregated albumin–hyaluronic acid mixture, has emerged as a promising alternative with potential benefits over existing techniques. We present a case of a 67-year-old female with a non-palpable Breast Imaging-Reporting and Data System 5 breast lesion. Preoperative localization was performed using LuminoMark, with accurate placement verified by a Lumino-imager. The lesion was successfully excised, and the absence of residual fluorescence confirmed complete resection. LuminoMark provided effective lesion localization without skin pigmentation, reducing the risk of misdiagnosis during follow-up. The procedure demonstrated a short learning curve, similar to that of charcoal localization. However, the need for a costly near-infrared fluorescence detector and the lack of long-term follow-up data are current limitations. Despite minor drawbacks, LuminoMark offers advantages over traditional localization methods, including improved aesthetics and reduced complications. This case demonstrates its feasibility as a next-generation localization technique for BCS, emphasizing the importance of an accurate injection technique to ensure adequate dispersion and complete tumor resection. Further studies are warranted to validate its long-term efficacy.

Vascular

Techniques of Creating an Arteriovenous Fistula for Hemodialysis Access: A Comprehensive Guide

Chang Sik Shin, Ji Il Kim

J Surg Innov Educ. 2024;1(2):49-52.   Published online December 27, 2024

DOI: https://doi.org/10.69474/jsie.2024.00171

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Abstract

Arteriovenous fistula (AVF) creation is crucial for patients with end-stage renal disease requiring long-term hemodialysis, due to its superior long-term patency and lower complication rates compared to arteriovenous grafts. This paper presents detailed techniques and a step-by-step tutorial for AVF creation—including radiocephalic, brachiocephalic, and brachiobasilic fistulas—offering valuable insights for both novice and experienced surgeons.

Pancreatobiliary

Hepaticojejunostomy in Minimally Invasive Surgery: A Step-by-Step Guide

Younsoo Seo, Inhyuck Lee, Go-Won Choi, Yoon Soo Chae, Won-Gun Yun, Young Jae Cho, Hye-Sol Jung, Joon Seong Park, Jin-Young Jang, Wooil Kwon

J Surg Innov Educ. 2024;1(2):53-54.   Published online December 12, 2024

DOI: https://doi.org/10.69474/jsie.2024.00192

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Abstract

With rapid advances in minimally invasive surgery (MIS) techniques, such as laparoscopy and robotics, their application has expanded across various surgical fields, including pancreatobiliary surgery. Numerous studies have demonstrated the feasibility and potential benefits of MIS. Hepaticojejunostomy, a procedure creating a connection between the hepatic duct and the jejunum, is primarily used to bypass biliary obstructions or during operations that involve bile duct resection, such as pancreatoduodenectomy or choledochal cyst excision. Proficiency in minimally invasive hepaticojejunostomy techniques is essential for surgeons in this evolving field. This video presents a detailed, step-by-step guide to the principles and techniques of performing hepaticojejunostomy using both laparoscopic and robotic platforms.

Gastrointestinal

Techniques in Jejunojejunostomy, Gastrojejunostomy, and Esophagojejunostomy in Reduced-Port Gastrectomy

Sa-Hong Min

J Surg Innov Educ. 2024;1(1):3-5.   Published online June 25, 2024

DOI: https://doi.org/10.69474/jsie.2024.00031

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Abstract

Minimally invasive gastric cancer surgery aims to reduce morbidity and mortality while maintaining satisfactory oncological outcomes. Laparoscopic gastrectomy is a standard treatment, offering reduced pain, shorter hospital stays, and faster recovery. Reduced-port gastrectomy has gained popularity due to its requirement for limited assistants; however, it poses unique challenges. This paper shares the techniques used in three cases of jejunojejunostomy, gastrojejunostomy, and esophagojejunostomy during reduced-port gastrectomy. Reduced-port techniques were successfully implemented in all three cases. Key steps included proper port placement, the use of tagging sutures, and strategic stapler insertion and adjustment. The reduced-port approach demonstrated feasibility and effectiveness despite its inherent challenges. Reduced-port gastrectomy can be effectively performed with a careful technique and meticulous planning, despite the challenges of transitioning from conventional five-port techniques. Using fewer ports results in less pain, fewer complications, and shorter hospital stays without compromising oncologic outcomes. These techniques can be helpful for trainees and novice surgeons, though careful candidate selection is paramount.

Colorectal

Laparoscopic Right Hemicolectomy with an Inferior Approach: How I Do It

Young Il Kim, Hayoung Lee, Min Hyun Kim

J Surg Innov Educ. 2024;1(1):6-9.   Published online June 28, 2024

DOI: https://doi.org/10.69474/jsie.2024.00038

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Abstract

Since its introduction in the early 1990s, laparoscopic colorectal surgery has been extensively validated through randomized controlled trials, establishing its safety and efficacy from oncological and technical standpoints. Laparoscopic right hemicolectomy (LRHC) procedures exhibit variability in dissection extent and initiation sites. Complete mesocolic excision is essential in LRHC, involving precise dissection along embryologic planes and varying in lymph node dissection extent (D2 or D3). Other variations in LRHC include the use of the medial approach (or superior mesenteric vein [SMV]-first approach), where dissection starts along the SMV, the lateral approach (or inferior approach), starting with meso-ileal and retroperitoneal dissection, and the superior approach, initiated by separation of the omentum and transverse colon. This paper presents a case of LRHC for ascending colon cancer using an inferior approach. The procedure included trocar placement, followed by inferior, superior, and medial dissection phases, concluding with specimen extraction and extracorporeal anastomosis. With a standardized procedure, mastery of diverse approaches (inferior, medial, and superior) remains crucial, as the most appropriate method varies among cases.