Mini Totally Extra-Peritoneal Repair of Inguinal Hernia with All 5 mm Ports: An Innovative ‘‘555 Technique’’ Manish K. Gupta, MBBS, DNB, FIAGES, Kiran Kumar Muley, MBBS, Murali Krishna Bethanbhatla, MBBS, Juhil D. Nanavati, MBBS, Kumar Manish, MBBS, DNB and Rathindra Sarangi, MBBS, MS Abstract Background: Totally extra-peritoneal (TEP) repair of inguinal hernia is now a standard surgical technique. A 12 mm incision in infra-umbilical region for Hasson trocar is must for TEP repair of inguinal hernia. This is the only technique known to laparoscopic surgeons. We have innovated a ‘‘555 Technique’’ for completing Mini TEP repair of inguinal hernia by using all three 5 mm ports. Methods: Sixty-one consecutive patients were subjected for TEP repair of inguinal hernia by our innovative ‘‘555 Technique’’ since October 2014. A simple ‘‘Manish Retractor’’ is devised to make extra-peritoneal space with 5 mm trocar. Fifty-nine cases were men and 2 cases were women. The mean age of patients was 44.6 years (range 23–82 years). Results: Out of 61 cases, 27 were indirect inguinal hernia (23 unilateral, 4 bilateral), 32 direct inguinal hernia (21 unilateral, 11 bilateral), 1 femoral hernia, and 1 obturator hernia. One patient of indirect inguinal hernia had sliding hernia with sigmoid colon. Sixty cases were successfully operated by ‘‘555 Technique.’’ There was conversion to trans-abdominal pre-peritoneal repair (TAPP) in 1 case. The average time for insertion of 5 mm trocar in preperitoneal space by our technique was 150 seconds. No complications were noted on 6 months follow-up. Small infra-umbilical scar was cosmetically more acceptable to patients. Conclusion: ‘‘555 Technique’’ is a feasible option without compromising the principles of TEP repair for inguinal hernia. Innovation of simple ‘‘Manish Retractor’’ is the key in completing Mini TEP repair. This technique is simple, less invasive, less morbid, and cost effective as it avoids dependence over costly Hasson trocar with better cosmetic results. Keywords: mini TEP repair of inguinal hernia, 555 Technique of inguinal hernia repair, 555 Technique, TEP repair without Hasson trocar, extra peritoneal repair without Hasson trocar, Manish Retractor Background T otal extra-peritoneal (TEP) repair of inguinal her- nia is now a standard surgical technique. 1 The steep learning curve to master this technique is always a matter of concern among laparoscopic surgeons. 2 Entering and creat- ing the preperitoneal space (PPS) plays a key role for suc- cessful completion of this surgery. Creation of PPS with the help of Hasson trocar is the only technique known to lapa- roscopic surgeons for TEP repair of inguinal hernia. A 12 mm wide infra-umbilical incision for Hasson trocar is must for TEP repair of inguinal hernia other than two more 5mm working ports, which is a current standard surgical practice. 3,4 We have innovated a ‘‘555 Technique’’ for completing the Mini TEP repair of inguinal hernia by using all three 5 mm ports. We have innovated a very simple retractor (Manish Retractor) to facilitate dissection up to the anterior rectus sheath (ARS) and insertion of infra-umbilical 5 mm trocar for creating PPS. 5 Methods All patients having inguinal hernia since October 2014 were operated consecutively by ‘‘555 Technique.’’ A written informed consent was taken explaining about the surgical procedure, other available surgical options, probable com- plications and possibility of conversion to other laparoscopic or open procedure. Patients who were subjected for Mini TEP Department of General and Laparoscopic Surgery, Sir Ganga Ram Hospital, Delhi, India. JOURNAL OF LAPAROENDOSCOPIC & ADVANCED SURGICAL TECHNIQUES Volume 27, Number 3, 2017 ª Mary Ann Liebert, Inc. DOI: 10.1089/lap.2016.0462 295