Laparoscopic Hydrocele Repair Technique

Global Cat MD along with Cincinnati Children's Hospital, sharing knowledge to improve child health around the globe. Hello everyone. Today we are presenting a laparoscopic repair of a hydrocele by Doctor Todd Ponsky, a pediatric surgeon from Cincinnati Children's Hospital. For this, we will need a 3 or 5 millimeter trocar for the umbilical port with a 3 or 5 millimeter camera according to patient's age and weight. We will also need a 3 millimeter grasper with Maryland teeth and a 3 millimeter scissor. Now let's start. First we enter through the umbilicus with the camera and we look. In this particular patient, we have a right hydrocele and a small patent processes vaginalis or PPB in the left. Now let's address the hydrocele. Step one, push the sac into the abdomen and avoiding the cord structures, create a hole and drain the fluid. Step 2, reset the sack. For this, we create a stab incision in the ipsilateral lower quadrant and insert a 3 millimeter scissor. You should be very careful with the cord structures, so if there is no safe separation you can avoid the step or resect the sack partially. Sometimes this step can also be done with a hook cutlery. But again, being really careful with the vast deference and core vessels. Looking for a safe distance to avoid thermal spray. Step 3, close the opening in the internal inguinal orifice. For this, we use the double loop technique. Step 1, we do a hydro dissection with local anesthetic. This will not only help with postoperative pain. But also helps dissecting the peritoneum to avoid the lesion of the cord structures. Step 2, we create a 1 millimeter incision in this scheme. And pass an 18 gauge spinal needle through half of the internal inguinal orifice. We then thread a loop of prole through the needle into the abdomen and retract the needle. After, through the same skin incision, we pass the same needle with a new proline loop. These too have to be passed through the first loop. Then the first loop is snug around the needle. Once the second prowling loop is in the abdomen, we retract the needle, and we use the first loop as a snare to take out the second loop and surround the inguinal orifice. This opening is closed by tying the knots. Let's see this part again while we close the left PPB. Step 1, hydro dissect the peritoneum with local anesthetic to avoid lesion of the cord structures. Step 2, make a 1 millimeter incision in the skin and pass the 18 gauge spinal needle. Step 3, thread a loop of prole into the abdomen and retract the needle. Step 4, pass the needle through the other side, and once it is in the abdomen, pass it through the first loop. Step 5, snag the first loop in the needle. Step 6, thread a second loop through the needle, and once into the abdomen, retract the needle. Step 7, use the first loop as a snare and pull to take out the second loop through the other side. Step 8, tie the threads, closing the opening so as a reminder for the laparoscopic repair of a hydrocele. Step 1, push the hydrocele sac into the abdomen. Step 2, reset the sac completely or partially. Step 3, close the opening and remember, always be careful with the cord structures working at a safe distance. Thank you for watching. Don't forget to subscribe to the Stay Current MD YouTube channel. Follow our social media channels and download the Stay Current MD app for tons of content in pediatric surgery. Global Cat MD along with Cincinnati Children's Hospital, sharing knowledge to improve child health around the globe.