Transballoon trocar insertion during preperitoneal hernia repair

Trocar insertion during laparoscopic preperitoneal hernia repair (TEP) can be troublesome because the space into which the trocars are inserted is sma ller than that available for transabdominal approaches. Insertion of the tr ocars directly into the balloon used to dissect the preperitoneal space can facilitate this process. The insertion of a 5-mm trocar into the balloon d oes not usually result in balloon deflation, and a second trocar can be pla ced into the balloon as well. Removing the balloon, despite the trocars ins ide it, is straightforward, allowing the placement of a cannula at the ball oon insertion site and initiation of the hernia repair.