1, a good mindset during surgery, no matter how difficult it is, there are ways to solve it.
2, the screws of the fiber and lens should be tightened.
3. the skin incision at the inner annulus should be slightly larger so that the outer casing of the epidural puncture needle can be easily pierced into the skin so that the trocar does not pierce the peritoneum too violently but stays relatively easily in the extraperitoneal space.
4. adjusting the lens angle of the 30-degree mirror when looking at the 0-point (ceiling) entry position of the inner ring opening when the hernia is too large.
5, the second assistant pulling the testicle on the side of the operation, very important!!! especially when the external cannula crosses the vas deferens, the spermatic vessels and when the final ligation is performed.
6. not to have the thread frayed by the tip of the outer cannula when it is brought in.
7. the skin incision at the umbilical observation hole should be slightly less than 5mm Trocar diameter and the 3mm incision next to the umbilicus should also be slightly less than 3mm Trocar diameter, in order to make the skin snap tightly around the Trocar, so that the Trocar will not easily come out even if the abdominal wall is thin in children.
8, it is best to use black silk to bring out the blue 2-0 non-absorbable line, if all use the blue 2-0 non-absorbable line, it is not easy to distinguish the color, leading to confusion.
9, the lens fogged up, to soak through the lens with hot water.
10, the general order, the inner ring mouth 0 point direction into the needle, first the inner half circle, across the vas deferens after 6 point direction out of the needle, and then the outer half circle, across the spermatic cord vessels after 6 point direction out of the needle.
11, the ligation position should not be just at the mouth of the inner ring, but slightly higher to achieve a super high ligation.
12, can be appropriate to change the position, such as the head low feet high position, gravity to make space for the intestinal tube.
13, if the pneumoperitoneum pressure of 8 mmHg still can not maintain the pneumoperitoneum to ensure space, at this time, the pressure needs to be slightly increased to 10 mmHg to ensure that the operation can be completed successfully, at this time, pay attention to the child’s ventilation.
14, you can use the pneumoperitoneum plastic tubing – fine rubber tubing – tee – Trocar intake hole, to ensure that no air leakage.
15, when punching the umbilical observation hole, not using towel clamp, can reduce 4 needle holes. Specific method: the operator’s left hand lifts the skin and subcutaneous on the left side of the umbilicus, and the first assistant lifts the skin and subcutaneous on the upper and lower right side of the umbilicus with both hands respectively.
16, when the epidural puncture needle casing is submerged outside the peritoneum, separating forceps can be used to pull the peritoneum slightly in front of the direction of travel of the casing to facilitate the travel of the casing between the peritoneum and the vas deferens or spermatic vessels.
17.What kind of thread is good for tying knots? Silk thread (three knots are sufficient, but easy to be infected and the knot is easily broken), non-absorbable thread is better (5 knots are needed to avoid slipping); absorbable thread, easy to hernia recurrence (communicate with peers).
18. must be explored bilaterally! High detection rate of occult hernias, especially in smaller children with preoperative left-sided hiatal hernia.
19. if the hernia is large, squeeze the gas in the scrotum before ligating the hernia sac in high position
20, the outer casing is brought one single line of 4 wire and U-shaped 2-0 non-absorbable line at a time, and after completing the inner half circle, the U-shaped 2-0 non-absorbable line is dragged out of the casing, and the outer casing is retracted to the anterior peritoneal space without exiting the abdominal wall, and then the outer half circle is completed, the 4 wire is dragged out in a U-shape, the casing is withdrawn, and the U-shaped 2-0 non-absorbable line is brought out with the U-shaped 4 wire, allowing 2 knots to be tied while reaching the true the extraperitoneal ligation.
21. Modification of the position of the abdominal Torcar: a 5mm observation hole is left on the right edge of the umbilicus and a 3mm operation hole is left on the left edge of the umbilicus so that the umbilical scar is not obvious later.
22, For larger hernias, it can be considered that the inner ring opening is sutured first, and then the hernia sac is ligated at a high level with the same line.
23. When wearing the U-shaped 2-0 non-absorbable wire, the 4 wire should be tensed tightly against the wall of the canal inside the outer canal to avoid crossover of the 2 wires.