Laparoscopic Hydrocele Repair Technique

Laparoscopic hydrocele repair requires a 3 or 5 millimeter trocar for umbilical port with corresponding camera size based on patient age and weight, plus 3mm grasper with Maryland teeth and 3mm scissors.

The first step in laparoscopic hydrocele repair is to push the sac into the abdomen, create a hole while avoiding cord structures, and drain the fluid.

Sac resection is performed through a 3mm stab incision in the ipsilateral lower quadrant using scissors, but if there is no safe separation from cord structures, this step can be avoided or the sac resected only partially.

Sac resection can alternatively be performed with hook cautery, but requires maintaining safe distance from vas deferens and cord vessels to avoid thermal spray injury.

The internal inguinal orifice is closed using a double-loop technique with prolene suture.

Hydrodissection with local anesthetic serves dual purposes: postoperative pain control and dissecting the peritoneum to avoid injury to cord structures.

The double-loop technique involves creating a 1mm skin incision and passing an 18-gauge spinal needle through half of the internal inguinal orifice.

A prolene loop is threaded through the needle into the abdomen, the needle is retracted, then passed again through the same skin incision with a new prolene loop that must pass through the first loop.

The first loop is snagged around the needle, and once the second prolene loop is in the abdomen, the needle is retracted and the first loop is used as a snare to pull out the second loop, surrounding the inguinal orifice.

The internal inguinal orifice opening is closed by tying the prolene loop knots.

The same double-loop closure technique can be used to close a contralateral patent processus vaginalis.

Throughout laparoscopic hydrocele repair, the surgeon must always work at a safe distance from cord structures including vas deferens and cord vessels.