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A D V E R T I S E M E N T
A D V E R T I S E M E N T
The anterior rectus sheath is incised to one side of midline below the umbilicus, and the rectus muscle is retracted laterally. A space is bluntly created within the medial part of rectus sheath down toward the pubis. The posterior rectus sheath down to the arcuate line helps keep the dissection in the proper plane outside of peritoneum. The preperitoneal fat aids in the dissection. The bladder is decompressed with a Foley catheter.
A D V E R T I S E M E N T
A balloon trochar is introduced into the rectus sheath and the dissection continued with the trochar down to pubis. The balloon is then slowly inflated under direct vision with the camera in the port (within the balloon). The balloon is left inflated a few minutes for hemostasis, then deflated and withdrawn. The balloon dissection opens the space of Retzius, pushing the bladder posteriorly.
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A D V E R T I S E M E N T
Depending on the system used, a working trochar is then placed (with or without a retracting balloon) and two smaller trochars are placed, usually in the midline between the 10mm camera port and pubis. A supplementary port can be placed laterally if necessary. The dissection exposes both inguinal areas including pubis, Cooper's ligaments, falx, inferior epigastric vessels, vas, iliac and spermatic vessels the deep inguinal ring, the direct space and the femoral canal. Initial instrument dissection sweeps the remaining peritoneal attachments posteriorly to complete the exposure.
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This page was last modified on 3/1/1999.
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