For Surgeons - Dr. Pramod Shinde

DR. PRAMOD SHINDE

M.S., FAMASI, FIAGES, FALS, FIBC, FACS
Director of Surgical Services, HOD & Sr. Consultant - GI, AWR, Hernia, General Laparoscopic & Robotic Surgery at KIMS Manavata Hospital, Nashik.

Laparoscopic Inguinal Anatomy

Provides an internal view of the inguinal region during laparoscopic surgery
Identifies vital structures: inguinal canal, hernia sites, vessels, and nerves
Crucial for accurate diagnosis and safe hernia repair
Enhances surgical precision and reduces risk of complications
Supports better patient outcomes and faster recovery

SPECIALITIES

Technique of TAPP (Transabdominal Preperitoneal)

Port Placement: Small incisions for camera and instruments.
Peritoneal Access: Surgeon enters abdominal cavity.
Hernia Sac Dissection: Clear view of hernia, sac is freed.
Mesh Placement: Synthetic mesh placed over hernia site.
Peritoneal Closure: Peritoneum is closed to secure mesh.

Highlights:

Minimally invasive
Faster recovery, less pain
Ideal for bilateral or recurrent hernias

eTEP Inguinal hernia surgery

What is it?

eTEP (Enhanced View Totally Extraperitoneal) is a minimally invasive technique for inguinal hernia repair using a laparoscopic approach outside the abdominal cavity.

Key Benefits:

Smaller incisions, less pain
Faster recovery, minimal scarring
Lower risk of complications

How it Works:

Surgeons access the hernia space through a natural tissue plane, place mesh precisely, and avoid entering the abdominal cavity.

Ideal For:

Patients with primary or recurrent inguinal hernias seeking quicker recovery and better comfort.

Why Choose eTEP?

Advanced, precise, and patient-friendly alternative to traditional open or standard laparoscopic repair.

Anatomy of Abdominal Wall

The abdominal wall forms the outer covering of the abdomen, providing protection, posture, and support for internal organs.

Key Layers (from outer to inner):

Skin – Outer protective layer
Subcutaneous Tissue – Fat and connective tissue
Muscles –
- External Oblique
- Internal Oblique
- Transversus Abdominis
- Rectus Abdominis (six-pack muscle)

Fascia – Encloses and supports muscles
Peritoneum – Inner lining covering abdominal organs

Functions:

Protects organs
Aids in breathing, movement, and posture
Supports abdominal pressure (e.g., during lifting, coughing)

Clinical Relevance:

Site for hernias, surgical incisions, and trauma evaluations.

Component separation

A surgical technique used to repair large or complex abdominal wall hernias by separating and repositioning muscle layers for tension-free closure.

Key Points:

Purpose: Reconstruct weakened abdominal wall
Method: Separates muscle components to allow flexible closure
Benefits: Reduces tension, improves healing, lowers recurrence
Used In: Complex hernias, post-surgical abdominal defects
Advanced Options: Can be performed open, laparoscopically, or robotically

ACST (Advanced Centre for Digestive Sciences & Therapeutics)

A state-of-the-art clinic offering expert care for digestive disorders with advanced diagnostics and minimally invasive treatments.

Key Highlights:

Expert Team: Skilled gastroenterologists & surgeons
Advanced Diagnostics: Endoscopy, colonoscopy, imaging
Comprehensive Care: From reflux to liver and pancreatic diseases
Minimally Invasive: Faster recovery, less discomfort
Patient-Centric: Personalized treatment plans

Your trusted destination for complete digestive health.

TAR (Transversus Abdominis Release)

TAR is an advanced surgical technique used in complex abdominal wall hernia repair. It allows for large mesh placement with minimal tension and improved outcomes.

Key Points:

Approach: Posterior component separation through retro-rectus space.
Muscle Release: Involves cutting the transversus abdominis muscle to access deeper space.
Mesh Placement: Large mesh placed behind abdominal muscles for strong reinforcement.
Benefits: Low tension closure, better function, and reduced recurrence.
Applications: Ideal for large or recurrent ventral hernias.

Modern, durable, and anatomically sound—TAR is a game-changer in hernia surgery.

eTEP Rives-Stoppa Technique

A cutting-edge, minimally invasive hernia repair method combining the enhanced-view totally extraperitoneal (eTEP) approach with the Rives-Stoppa mesh placement.

Key Highlights: