Indications
Although the use of this surgical procedure is not quite as popular as it was in the late 1990s it is still a widely performed operation. Most experienced surgeons use it for repair of bilateral inguinal hernias and recurrent hernias. In addition, some surgeons use it for young patients who may be at risk of developing long-term chronic pain after an open repair
Surgical Details of the Procedure
1. After the incision is made, dissection is done through the subcutaneous tissue with Bovie cautery
2. The anterior rectus fascia is visualized and incised using Bovie cautery or alternately with sharp dissection with a scalpel
3. The decision is made at this time as to which rectus muscle is to be used for the surgical approach. Typically the contralateral rectus sheath is used to allow for more exposure and visualization, but some surgeons prefer to use the side consistent with their most dominant operating hand
4. Two S-shaped retractors are used to retract the rectus muscle up off the posterior rectus sheath and laterally
5. The tip of the uninflated dissecting balloon is lubricated with gel and then placed into incision, above the posterior rectus sheath and below the belly of the rectus muscle
6. The balloon tip is then advanced slowly but with firm pressure caudally until the tip abuts the cephalad border of the symphysis pubis
7. A gentle sweeping, back-and-forth motion is then applied to the tip to clear the tissues off the lateral edges of the symphysis pubis
8. The inflation bladder is then attached to the dissecting balloon and the camera is inserted through the proximal end of the balloon catheter at the umbilicus
9. The balloon is then slowly inflated by squeezing the inflation bladder approximately twenty times, with visual inspection of the tissues during balloon insufflation.
10. Care must be taken to visualized the epigastric vessels on the underside of the rectus muscle to insure that they are slowly pushed laterally
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