Comparative perioperative outcomes of articulated versus conventional straight devices in single-port totally extraperitoneal inguinal hernia repair: A propensity score-matched analysis.

BACKGROUND: Single-port totally extraperitoneal (TEP) inguinal hernia repair offers enhanced cosmetic outcomes and reduced port-related morbidity but is technically demanding with conventional straight laparoscopic instruments. Articulated instruments such as ArtiSential® were developed to improve ergonomics and dexterity. This study compared perioperative and postoperative outcomes of single-port TEP inguinal hernia repair performed with articulated instruments versus conventional straight devices. METHODS: Between March 2023 and September 2024, 584 consecutive patients underwent single-port TEP inguinal hernia repair at a single tertiary institution. Conventional straight instruments were used in 443 patients, and ArtiSential® articulated instruments in 141 patients. Propensity score matching (PSM) was performed in a 1:1 ratio based on predefined demographic and clinical variables, resulting in 141 patients in each group. Perioperative outcomes and postoperative complications were compared. RESULTS: After PSM, baseline characteristics were well balanced between the two groups. Median operative time was significantly longer in the conventional group than in the ArtiSential® group (40.0 min [interquartile range (IQR) 30.0-55.0] vs. 35.0 min [IQR 25.0-50.0]; P = 0.034). No conversions to open or transabdominal preperitoneal repair occurred. A standardized 10 × 15 cm mesh was used in all cases. Length of hospital stay, overall complication rate, and specific postoperative complications, including urinary retention, seroma, skin bleeding, fever, chronic pain, and early recurrence, were comparable between groups. No major complications (Clavien-Dindo grade III-IV), readmissions, reoperations, or recurrences were observed during the study period. CONCLUSIONS: In single-port TEP inguinal hernia repair, the use of articulated instruments was associated with a significantly shorter operative time compared with conventional straight devices, while maintaining equivalent perioperative safety and early postoperative outcomes. Articulated instruments may enhance efficiency and ergonomics in minimally invasive inguinal hernia surgery, including complex cases. Long-term oncologic and functional outcomes, ergonomic assessment, and cost-effectiveness warrant further investigation.