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Technical difficulties in totally extraperitoneal inguinal hernia repair (TEP) may be strongly associated with poor operability in a limited operative field. Needlescopic instruments could be helpful in a limited space, and the aim of this study was to evaluate the clinical efficacy of needlescopic TEP.The study population constituted 150 consecutive patients undergoing needlescopic TEP, and we compared these patients with 151 consecutive patients who underwent conventional TEP regarding patients’ demographic features and operative outcomes. Inclusion criteria were: (1) being treated by an experienced surgeon and (2) replying to our questionnaire regarding postoperative outcomes.The mean skin opening to closing times for unilateral and bilateral repairs were, respectively, 95.3±30.1 and 130.2±48.7 minutes for conventional TEP and 75.7±24.5 and 114.5±46.3 minutes for needlescopic TEP. The difference for unilateral repairs between the 2 surgical groups was significant (P=0.01). Conversion rates, postoperative hospital stays, and perioperative morbidity rates showed no significant differences between the 2 groups.Needlescopic TEP is a useful procedure that decreases operative duration with no significant differences in perioperative morbidity compared with conventional TEP.