PIRS-hydrodissection-lasso technique with modification Ponsky (2013)/ PIRS-гідродиссекція-лассо техніка в модифікації Ponsky (2013)

PIRS-hydrodissection-lasso technique with modification Ponsky (2013)26*

    • Surgeon stands on left side of pt (rt-handed surgeon)
    • Starts laterally on hernia on either side
    • Veress needle
    • 3-mm umbilical trocar and laparoscope
    • 3-mm Maryland dissector
    • 18 gauge spinal needle (create gentle curve of the tip) or Tuohy needle
    • Prolene suture
    • Ethibond suture
  • STEPS:

1.Stab incision for Maryland contralateral to hernia

2.Use the Maryland dissector to burn the peritoneum on the superior half of the ring without completely burning a hole through the peritoneum27

3.Make a 1-mm incision at the 12 o’clock position of the internal ring

4.Use 0.25% bupivicaine to hydrodissect the peritoneum from vas and vessels

5.Preload Tuhoy needle with a loop of Prolene in the hollow with the end near the tip of the needle

6.Introduce needle into 1-mm incision

7.Advance the needle laterally around the ring above the vessels to a point medial to the the vas deferens then advance the tip into the peritoneum

8.Advance the suture so that the loop is intraperitoneal

9.Remove the needle, leaving the suture and secure extracorporeally

10.Thread another suture into the needle as before

11.Introduce needle and suture into the same 1-mm incision

12.Advance the needle medially around the ring, entering the peritoneum through the same hole

13.Put the needle through the first loop, tightening the loop around the needle and then advance the second suture

14.Pull out the needle, leaving second loop within the first loop

15.Pull the first loop up snaring the 2nd and pull out until the 2nd loop completely encircles the ring

16.Pass one end of Ethibond suture through the loop of Prolene to exchange the two27

17.Pull the other loop of the Prolene entirely through until Ethibond comes out the other side and encircles the entire ring

18.Cut the loop of Ethibond which releases the Prolene

19.Tie both Ethibond sutures extracorporeally for double ligation