**2. Current scenario of TEP repair**

This technique requires specialized anatomical knowledge and good two hand dexterity for dissecting hernia sac and placement of mesh. Therefore, the acceptance and implementation of TEP have been slow in comparison to other laparoscopic procedures such as cholecystectomy. Laparoscopic inguinal hernia repair has steep learning curve especially in TEP repair and due to limited working space [5, 6]. Increased operative time and complication rates during the early learning curve are other drawbacks. Creating a preperitoneal space without injuring the peritoneum is again a challenging task in the initial part of surgery. Accidental pneumoperitoneum can further compromise the pre-peritoneal space which leads to difficult dissection and prolongation of surgical time [6]. The current Hasson trocar approach is the only way to create pre-peritoneal space and the only technique known among laparoscopic surgeons. There is always dependence over the wide Hasson trocar and its broader cone to create pre-peritoneal space. A larger infra-umbilical incision is required for dissecting up to the anterior rectus sheath with the help of "S Retractor" to fix the Hasson trocar with the anchoring sutures. The insertion of Hasson trocar is a relatively blind surgical step of TEP repair of inguinal hernia [7]. Cases of port site incisional hernia were also reported at the site of 12 mm port site used for insertion of mesh [2]. Exclusive use of Hasson trocar for TEP repair in current scenario ultimately reflects in surgical cost. Management of morbidities due to larger port site wound also adds to the financial burden over the patient. Large scar below the belly button is cosmetically suboptimal especially to females. Bigger wound not only leave scar on the body but over the mind & soul as well [6, 7].
