{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,3]],"date-time":"2026-07-03T11:18:34Z","timestamp":1783077514562,"version":"3.54.6"},"reference-count":15,"publisher":"Springer Science and Business Media LLC","issue":"1","license":[{"start":{"date-parts":[[2026,7,3]],"date-time":"2026-07-03T00:00:00Z","timestamp":1783036800000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"},{"start":{"date-parts":[[2026,7,3]],"date-time":"2026-07-03T00:00:00Z","timestamp":1783036800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"}],"funder":[{"DOI":"10.13039\/100008375","name":"University of Basel","doi-asserted-by":"crossref","id":[{"id":"10.13039\/100008375","id-type":"DOI","asserted-by":"crossref"}]}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["Hernia"],"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Enhanced-view totally extraperitoneal repair (eTEP) is a promising minimally-invasive technique for ventral hernia repair, allowing extensive retromuscular dissection and large mesh placement with low rates of wound complications and a fast recovery. The learning curve, however, is substantial and technical expertise is crucial for satisfying outcomes. The aim of this study is to critically analyse intraoperative adverse events and provide guidance for safe introduction of eTEP.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Materials and methods<\/jats:title>\n                    <jats:p>All patients undergoing eTEP for primary or incisional ventral hernias between October 2023 and December 2024 at three centres were included in this prospective study. eTEP was divided in 10 surgical steps and each was rated for its difficulty (1\u20135 points) and analysed for the incidence of adverse events. Surgeon workload was measured using the NASA-Task-Load-Index (0-100) and perioperative outcomes were reported.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      A total of 125 patients with a median BMI of 31\u00a0kg\/m\n                      <jats:sup>2<\/jats:sup>\n                      and 30% female sex were included. Dissection of the hernia and steps involving suturing of the hernia orifice or posterior defects were rated as most difficult. The most common minor adverse events were peritoneal injury during hernia dissection (52%) and minor bleeding during rectus sheath dissection (up to 45%). Critical intraoperative events were common and included injury to the linea alba (6.4%), major bleeding during posterior rectus sheath dissection (up to 4.8%), conversion to open surgery (2.4%) or hybrid procedure (5.6%). Median operation time was 92\u00a0min, median length of stay was 2 days. Surgical revisions were necessary in 3.4%. Median overall procedural workload using the NASA raw score was 39.5\/100, strongly correlating with operative time.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>Hernia dissection and defect closure in laparoscopic eTEP are particularly technically challenging and associated with a high surgeon workload. Due to its technical complexity and frequent intraoperative adverse events, laparoscopic eTEP should be adopted within structured training pathways and appropriate case selection.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1007\/s10029-026-03775-8","type":"journal-article","created":{"date-parts":[[2026,7,3]],"date-time":"2026-07-03T10:22:11Z","timestamp":1783074131000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Intraoperative adverse events and management strategies in laparoscopic enhanced-view totally extraperitoneal repair (eTEP): a guide to safe introduction"],"prefix":"10.1007","volume":"30","author":[{"given":"J\u00f6rg","family":"Filser","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Isabelle","family":"Obrecht","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Daniel C.","family":"Steinemann","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5450-3100","authenticated-orcid":false,"given":"Fiorenzo","family":"Angehrn","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Michael","family":"Meir","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Christian","family":"Jurowich","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Christoph-Thomas","family":"Germer","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Beat P.","family":"M\u00fcller","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6929-6709","authenticated-orcid":false,"given":"Julian","family":"S\u00fcsstrunk","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8137-9232","authenticated-orcid":false,"given":"Johannes","family":"Baur","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2026,7,3]]},"reference":[{"issue":"9","key":"3775_CR1","doi-asserted-by":"publisher","first-page":"2233","DOI":"10.1007\/s00268-014-2578-z","volume":"38","author":"Y Zhang","year":"2014","unstructured":"Zhang Y, Zhou H, Chai Y, Cao C, Jin K, Hu Z (2014) Laparoscopic Versus Open Incisional and Ventral Hernia Repair: A Systematic Review and Meta-analysis. World J Surg 38(9):2233\u20132240","journal-title":"World J Surg"},{"issue":"3","key":"3775_CR2","doi-asserted-by":"publisher","first-page":"378","DOI":"10.1007\/s00464-006-9115-6","volume":"21","author":"RA Pierce","year":"2007","unstructured":"Pierce RA, Spitler JA, Frisella MM, Matthews BD, Brunt LM (2007) Pooled data analysis of laparoscopic vs. open ventral hernia repair: 14 years of patient data accrual. Surg Endosc Mar; 21(3):378\u2013386","journal-title":"Surg Endosc"},{"issue":"4","key":"3775_CR3","doi-asserted-by":"publisher","first-page":"1187","DOI":"10.1007\/s00464-011-1993-6","volume":"26","author":"J Daes","year":"2012","unstructured":"Daes J (2012) The enhanced view\u2013totally extraperitoneal technique for repair of inguinal hernia. Surg Endosc 26(4):1187\u20131189","journal-title":"Surg Endosc"},{"issue":"1","key":"3775_CR4","doi-asserted-by":"publisher","first-page":"282","DOI":"10.1007\/s11701-025-02443-w","volume":"19","author":"J Baur","year":"2025","unstructured":"Baur J, S\u00fcsstrunk J, Meir M, M\u00fcller BP, Germer C-T, Jurowich C et al (2025) Comparing robotic ventral transabdominal preperitoneal repair (rvTAPP) and laparoscopic enhanced view totally extraperitoneal repair (eTEP): a multicentre observational study. J Robot Surg Jun 19(1):282","journal-title":"J Robot Surg Jun"},{"issue":"6","key":"3775_CR5","doi-asserted-by":"publisher","first-page":"1511","DOI":"10.1007\/s10029-021-02557-8","volume":"26","author":"D Aliseda","year":"2022","unstructured":"Aliseda D, Sanchez-Justicia C, Zozaya G, Lujan J, Almeida A, Blanco N et al (2022) Short-term outcomes of minimally invasive retromuscular ventral hernia repair using an enhanced view totally extraperitoneal (eTEP) approach: systematic review and meta-analysis. Hernia 26(6):1511\u20131520","journal-title":"Hernia"},{"issue":"12","key":"3775_CR6","doi-asserted-by":"publisher","first-page":"9351","DOI":"10.1007\/s00464-023-10349-7","volume":"37","author":"K Korneffel","year":"2023","unstructured":"Korneffel K, Nuzzo W, Belden CM, McPhail L, O\u2019Connor S (2023) Learning curves of robotic extended totally extraperitoneal (eTEP) hernia repair among two surgeons at a high-volume community hospital: a cumulative sum analysis. Surg Endosc 37(12):9351\u20139357","journal-title":"Surg Endosc"},{"issue":"2","key":"3775_CR7","doi-asserted-by":"publisher","first-page":"1392","DOI":"10.1007\/s00464-022-09365-w","volume":"37","author":"K Mitura","year":"2023","unstructured":"Mitura K, Roma\u0144czuk M, Kisielewski K, Mitura B (2023) eTEP-RS for incisional hernias in a non-robotic center. Is laparoscopy enough to perform a durable MIS repair of the abdominal wall defect? Surg Endosc 37(2):1392\u20131400","journal-title":"Surg Endosc"},{"issue":"1","key":"3775_CR8","doi-asserted-by":"publisher","first-page":"20","DOI":"10.1007\/s00104-023-02000-x","volume":"95","author":"J Baur","year":"2024","unstructured":"Baur J, Meir M (2024) Narbenhernien: minimalinvasive Operationsverfahren. Die Chir 95(1):20\u201326","journal-title":"Die Chir"},{"issue":"3","key":"3775_CR9","doi-asserted-by":"publisher","first-page":"1525","DOI":"10.1007\/s00464-017-5840-2","volume":"32","author":"I Belyansky","year":"2018","unstructured":"Belyansky I, Daes J, Radu VG, Balasubramanian R, Reza Zahiri H, Weltz AS et al (2018) A novel approach using the enhanced-view totally extraperitoneal (eTEP) technique for laparoscopic retromuscular hernia repair. Surg Endosc 32(3):1525\u20131532","journal-title":"Surg Endosc"},{"issue":"7","key":"3775_CR10","doi-asserted-by":"publisher","first-page":"960","DOI":"10.1080\/00140139.2021.2006317","volume":"65","author":"R Hernandez","year":"2022","unstructured":"Hernandez R, Roll SC, Jin H, Schneider S, Pyatak EA (2022) Validation of the National Aeronautics and Space Administration Task Load Index (NASA-TLX) adapted for the whole day repeated measures context. Ergon Jul 65(7):960\u2013975","journal-title":"Ergon Jul"},{"issue":"5","key":"3775_CR11","first-page":"753","volume":"260","author":"K Slankamenac","year":"2014","unstructured":"Slankamenac K, Nederlof N, Pessaux P, de Jonge J, Wijnhoven BPL, Breitenstein S et al (2014) The comprehensive complication index: a novel and more sensitive endpoint for assessing outcome and reducing sample size in randomized controlled trials. Ann Surg Nov 260(5):753\u2013757","journal-title":"Ann Surg Nov"},{"issue":"1","key":"3775_CR12","doi-asserted-by":"publisher","first-page":"208","DOI":"10.1007\/s10029-025-03345-4","volume":"29","author":"DA Montechiari","year":"2025","unstructured":"Montechiari DA, Rossi MM, Soria MB, Rossini A, Signorini FJ (2025) Ventral ETEP, results of our experience after exceeding 150 cases. Operative outcomes and learning curve. Hernia Jun 29(1):208","journal-title":"Hernia Jun"},{"issue":"1","key":"3775_CR13","doi-asserted-by":"publisher","first-page":"81","DOI":"10.1089\/lap.2022.0270","volume":"33","author":"DL Lima","year":"2023","unstructured":"Lima DL, Berk R, Cavazzola LT, Malcher F (2023) Learning Curve of Robotic Enhanced-View Extraperitoneal Approach for Ventral Hernia Repairs. J Laparoendosc Adv Surg Tech A Jan; 33(1):81\u201386","journal-title":"J Laparoendosc Adv Surg Tech A"},{"issue":"8","key":"3775_CR14","doi-asserted-by":"publisher","first-page":"3597","DOI":"10.1007\/s00464-019-07132-y","volume":"34","author":"R Lu","year":"2020","unstructured":"Lu R, Addo A, Ewart Z, Broda A, Parlacoski S, Zahiri HR et al (2020) Comparative review of outcomes: laparoscopic and robotic enhanced-view totally extraperitoneal (eTEP) access retrorectus repairs. Surg Endosc Aug; 34(8):3597\u20133605","journal-title":"Surg Endosc"},{"issue":"5","key":"3775_CR15","doi-asserted-by":"publisher","first-page":"3354","DOI":"10.1007\/s00464-022-09843-1","volume":"37","author":"P Mazzola","year":"2023","unstructured":"Mazzola P, de Figueiredo S, Belyansky I, Lu R (2023) Pitfalls and complications of enhanced-view totally extraperitoneal approach to abdominal wall reconstruction. Surg Endosc May; 37(5):3354\u20133363","journal-title":"Surg Endosc"}],"container-title":["Hernia"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1007\/s10029-026-03775-8.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/article\/10.1007\/s10029-026-03775-8","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1007\/s10029-026-03775-8.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,7,3]],"date-time":"2026-07-03T10:22:12Z","timestamp":1783074132000},"score":1,"resource":{"primary":{"URL":"https:\/\/link.springer.com\/10.1007\/s10029-026-03775-8"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,7,3]]},"references-count":15,"journal-issue":{"issue":"1","published-online":{"date-parts":[[2026,12]]}},"alternative-id":["3775"],"URL":"https:\/\/doi.org\/10.1007\/s10029-026-03775-8","relation":{},"ISSN":["1248-9204"],"issn-type":[{"value":"1248-9204","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,7,3]]},"assertion":[{"value":"10 February 2026","order":1,"name":"received","label":"Received","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"16 June 2026","order":2,"name":"accepted","label":"Accepted","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"3 July 2026","order":3,"name":"first_online","label":"First Online","group":{"name":"ArticleHistory","label":"Article History"}},{"order":1,"name":"Ethics","group":{"name":"EthicsHeading","label":"Declarations"}},{"value":"All procedures performed were in accordance with the ethical standards of the local research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.","order":2,"name":"Ethics","group":{"name":"EthicsHeading","label":"Ethical approval"}},{"value":"All patients included in the CROSSFIRE database gave informed consent for their data to be recorded, analysed and published.","order":3,"name":"Ethics","group":{"name":"EthicsHeading","label":"Informed consent"}},{"value":"All authors have no conflicts of interest to declare.","order":4,"name":"Ethics","group":{"name":"EthicsHeading","label":"Competing interests"}}],"article-number":"276"}}