An Exploratory Randomized Controlled Trial Comparing Ultrasonic Dissection and Monopolar Electrocautery in Single-Incision Laparoscopic Totally Extraperitoneal Inguinal Hernia Repair

Purpose: This exploratory study aimed to compare the surgical outcomes of ultrasonic dissection and monopolar electrocautery in single-incision laparoscopic totally extraperitoneal repair (SILS-TEP) for inguinal hernia. Methods: A single-center exploratory randomized controlled trial was conducted between July 2022 and December 2023, enrolling 62 patients with unilateral inguinal hernias. Patients were randomized to undergo SILS-TEP using ultrasonic dissection (U group, n = 30) or monopolar electrocautery (E group, n = 32). The primary outcome was the completion rate of SILS-TEP. Secondary outcomes included the intraoperative complication rate, operative time, blood loss, and postoperative complication rate. Results: Patient characteristics were similar, except for a higher proportion of right-sided hernias in the U group (66.7% versus 31.3%, P = .010). Completion rates were comparable (96.7% versus 96.9%, P = 1.00). Operative time (60 [interquartile range {IQR} 53.5–71.5] minutes versus 62.5 [IQR: 51–74.5] minutes, P = .72) and blood loss were also similar. Lens cleaning was more frequently required in the U group (4 [IQR: 2.5–5] times versus 1 [IQR: 1–4] time, P = .025). Intraoperative and postoperative complications, length of postoperative hospital stay, and recurrence rates showed no notable differences. Conclusion: In this exploratory analysis, monopolar electrocautery in SILS-TEP showed comparable surgical outcomes to ultrasonic dissection. Larger confirmatory studies are warranted to validate these findings. (UMIN000057091).