{"id":1445,"date":"2018-03-05T19:50:32","date_gmt":"2018-03-05T19:50:32","guid":{"rendered":"http:\/\/www.drshevchuk.com.ua\/?p=1445"},"modified":"2018-03-05T19:50:48","modified_gmt":"2018-03-05T19:50:48","slug":"pirs-hydrodissection-lasso-technique-with-modification-ponsky-2013-pirs-%d0%b3%d1%96%d0%b4%d1%80%d0%be%d0%b4%d0%b8%d1%81%d1%81%d0%b5%d0%ba%d1%86%d1%96%d1%8f-%d0%bb%d0%b0%d1%81%d1%81%d0%be-%d1%82","status":"publish","type":"post","link":"http:\/\/www.drshevchuk.com.ua\/?p=1445","title":{"rendered":"PIRS-hydrodissection-lasso technique with modification Ponsky (2013)\/ PIRS-\u0433\u0456\u0434\u0440\u043e\u0434\u0438\u0441\u0441\u0435\u043a\u0446\u0456\u044f-\u043b\u0430\u0441\u0441\u043e \u0442\u0435\u0445\u043d\u0456\u043a\u0430 \u0432 \u043c\u043e\u0434\u0438\u0444\u0456\u043a\u0430\u0446\u0456\u0457 Ponsky (2013)"},"content":{"rendered":"<p><strong>PIRS-<\/strong><strong>hydrodissection-lasso technique with modification\u00a0Ponsky (2013)<\/strong><a href=\"https:\/\/www.sages.org\/wiki\/pediatric-laparoscopic-inguinal-hernia-repair-a-review-of-techniques\/#Ref25\"><sup>26<\/sup><\/a>*<\/p>\n<ul>\n<li>POSITION:\n<ul>\n<li>Surgeon stands on left side of pt (rt-handed surgeon)<\/li>\n<li>Starts laterally on hernia on either side<\/li>\n<\/ul>\n<\/li>\n<li>EQUIPMENT\/SUTURE:\n<ul>\n<li>Veress needle<\/li>\n<li>3-mm umbilical trocar and laparoscope<\/li>\n<li>3-mm Maryland dissector<\/li>\n<li>18 gauge spinal needle (create gentle curve of the tip) or Tuohy needle<\/li>\n<li>Prolene suture<\/li>\n<li>Ethibond suture<\/li>\n<\/ul>\n<\/li>\n<li>STEPS:<\/li>\n<\/ul>\n<p>1.Stab incision for Maryland contralateral to hernia<\/p>\n<p>2.Use the Maryland dissector to burn the peritoneum on the superior half of the ring without completely burning a hole through the peritoneum<a href=\"https:\/\/www.sages.org\/wiki\/pediatric-laparoscopic-inguinal-hernia-repair-a-review-of-techniques\/#Ref26\"><sup>27<\/sup><\/a><\/p>\n<p>3.Make a 1-mm incision at the 12 o\u2019clock position of the internal ring<\/p>\n<p>4.Use 0.25% bupivicaine to hydrodissect the peritoneum from vas and vessels<\/p>\n<p>5.Preload Tuhoy needle with a loop of Prolene in the hollow with the end near the tip of the needle<\/p>\n<p>6.Introduce needle into 1-mm incision<\/p>\n<p>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<\/p>\n<p>8.Advance the suture so that the loop is intraperitoneal<\/p>\n<p>9.Remove the needle, leaving the suture and secure extracorporeally<\/p>\n<p>10.Thread another suture into the needle as before<\/p>\n<p>11.Introduce needle and suture into the same 1-mm incision<\/p>\n<p>12.Advance the needle medially around the ring, entering the peritoneum through the same hole<\/p>\n<p>13.Put the needle through the first loop, tightening the loop around the needle and then advance the second suture<\/p>\n<p>14.Pull out the needle, leaving second loop within the first loop<\/p>\n<p>15.Pull the first loop up snaring the 2nd and pull out until the 2nd loop completely encircles the ring<\/p>\n<p>16.Pass one end of Ethibond suture through the loop of Prolene to exchange the two<a href=\"https:\/\/www.sages.org\/wiki\/pediatric-laparoscopic-inguinal-hernia-repair-a-review-of-techniques\/#Ref27\"><sup>27<\/sup><\/a><\/p>\n<p>17.Pull the other loop of the Prolene entirely through until Ethibond comes out the other side and encircles the entire ring<\/p>\n<p>18.Cut the loop of Ethibond which releases the Prolene<\/p>\n<p>19.Tie both Ethibond sutures extracorporeally for double ligation<\/p>\n<p>&nbsp;<\/p>\n<p><iframe loading=\"lazy\" width=\"696\" height=\"392\" src=\"https:\/\/www.youtube.com\/embed\/nsIHTlfhrM4?feature=oembed\" frameborder=\"0\" allow=\"accelerometer; autoplay; encrypted-media; gyroscope; picture-in-picture\" allowfullscreen><\/iframe><\/p>\n","protected":false},"excerpt":{"rendered":"<p>PIRS-hydrodissection-lasso technique with modification\u00a0Ponsky (2013)26* POSITION: Surgeon stands on left side of pt (rt-handed surgeon) Starts laterally on hernia on either side EQUIPMENT\/SUTURE: 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 [&hellip;]<\/p>\n","protected":false},"author":1,"featured_media":0,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":[],"categories":[9],"tags":[31,361,362,30],"_links":{"self":[{"href":"http:\/\/www.drshevchuk.com.ua\/index.php?rest_route=\/wp\/v2\/posts\/1445"}],"collection":[{"href":"http:\/\/www.drshevchuk.com.ua\/index.php?rest_route=\/wp\/v2\/posts"}],"about":[{"href":"http:\/\/www.drshevchuk.com.ua\/index.php?rest_route=\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"http:\/\/www.drshevchuk.com.ua\/index.php?rest_route=\/wp\/v2\/users\/1"}],"replies":[{"embeddable":true,"href":"http:\/\/www.drshevchuk.com.ua\/index.php?rest_route=%2Fwp%2Fv2%2Fcomments&post=1445"}],"version-history":[{"count":2,"href":"http:\/\/www.drshevchuk.com.ua\/index.php?rest_route=\/wp\/v2\/posts\/1445\/revisions"}],"predecessor-version":[{"id":1447,"href":"http:\/\/www.drshevchuk.com.ua\/index.php?rest_route=\/wp\/v2\/posts\/1445\/revisions\/1447"}],"wp:attachment":[{"href":"http:\/\/www.drshevchuk.com.ua\/index.php?rest_route=%2Fwp%2Fv2%2Fmedia&parent=1445"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"http:\/\/www.drshevchuk.com.ua\/index.php?rest_route=%2Fwp%2Fv2%2Fcategories&post=1445"},{"taxonomy":"post_tag","embeddable":true,"href":"http:\/\/www.drshevchuk.com.ua\/index.php?rest_route=%2Fwp%2Fv2%2Ftags&post=1445"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}