Many different techniques for laparoscopic @entity169 have been introduced recently, using either an intraperitoneal [1-3] or an extraperitoneal [4-6] approach. One of the main challenges is to obtain a complete circumferential closure of the sack at the level of the internal ring without @entity130 or spermatic vessels. In an effort to separate these structures from the peritoneum before passing a suture around the base of the sack, we developed the hydrodissection-lasso technique, which is performed using a single-incision endosurgical approach.With the @entity1 in Trendelenburg position, an 8-mm skin incision is made in the umbilicus, and a 5-mm trocar is placed in the inferior aspect for the endoscope. A 3-mm Maryland grasper is placed directly through the fascia in the upper part of the incision. Using a 22-gauge needle inserted percutaneously over the internal inguinal ring, saline is injected into the subperitoneal plane circumferentially, hydrodissecting the peritoneum off the vas deferens and vessels and creating a safe space through which the suture can pass without compromising these structures. A 2-mm stab incision is made directly over the internal inguinal ring, and a lasso technique is used to pass two strands of braided @entity2635 suture around the @entity547 sack, as demonstrated in the video. Both sutures are tied tightly, leaving the knots under the skin. No direct or indirect manipulation of the vas deferens or vessels takes place during any part of the procedure.In contrast to other described techniques [7], the hydrodissection-lasso technique can be used for all indirect inguinal @entity547 in both @entity1 and @entity1 , and hydrodissection itself may be a useful adjunct to any of the other aforementioned techniques. Although an age limit for exclusive high ligation of the @entity547 sack for indirect inguinal @entity547 has not been established, the recurrence rate may be higher for adults if the procedure is not combined with inguinal floor reconstruction [8]. At this time, we therefore limit the proposed technique to prepubertal @entity1 .We have performed the described procedure for 22 @entity1 without any recurrences during a maximum follow-up period of 12  months (Table  1). The @entity1 had minimal @entity282 . There were no complications except for a transient @entity129 paresis experienced by one @entity1 in whom the hydrodissection was performed using 1% @entity3303 instead of the usual normal saline solution. Although the sack was not resected, there were no cases of postoperative hydroceles.To evaluate whether this novel technique is an adequate long-term solution, a prospective clinical trial comparing standard open and single-incision endosurgical @entity169 using hydrodissection should be performed.

Multimedia manuscript: XXXX by single-incision pediatric endosurgery (SIPES) using the hydrodissection-lasso technique.

@entity1 :: ('9606', 'Species') :: ['girl', 'patients', 'patient', 'girls', 'boys'] @entity129 :: ('MESH:D003389', 'Disease') :: ['genitofemoral nerve'] @entity3303 :: ('MESH:D008012', 'Chemical') :: ['lidocaine'] @entity547 :: ('MESH:D006547', 'Disease') :: ['hernia', 'hernias'] @entity2635 :: ('CHEBI:60160', 'Chemical') :: ['polyester'] @entity169 :: ('MESH:D006552', 'Disease') :: ['inguinal hernia repair'] @entity282 :: ('MESH:D010149', 'Disease') :: ['postoperative pain'] @entity130 :: ('MESH:D014947', 'Disease') :: ['injury to the adjacent vas deferens']
@entity169 :: (MESH:D006552,Disease) :: ['inguinal hernia repair']
