00:00hello friends this is a case of left-sided ovarian dermoid and this
00:07patient has a approximately four centimeter dermoid cyst so we will
00:11perform laparoscopic surgery for ovarian dermoid cyst and this patient has he
00:19sees unmarried girl so we will not do the lithotomy position and we will not
00:23use uterine manipulated also with the simple supine position we will perform
00:28the surgery and we will remove the dermoid cyst by commercially available endo
00:34bag so let us see this surgery and we hope that you will like it here this is
00:40the left-sided ovarian dermoid
01:01so the probable location of this cyst will be here although we will confirm after
01:07entering the telescope inside but this will be the probable location of the
01:12dermoid cyst here and according to baseball diamond concept here we will put the
01:18telescope in the inferior crease of umbilicus because we want the minimum
01:24scar and this is not a large cyst so we will put over the inferior crease of
01:29umbilicus so a small stab wound will be given and after that you can just put the
01:35various needle and lift the abdominal wall and go perpendicular to the abdominal wall
01:40but oblique to the body of the percent here this is one and two click and you can
01:45enter inside the abdomen after that as usual we will perform the irrigation test and
01:51followed by suction test and then hanging drop test as you know hanging drop test is
01:59very important which will suck the fluid in and it will make it sure that it is going
02:03inside so now all the test is over and then we will attach the tubing of the
02:10insufflator and as usual insufflator we generally use the preset pressure 15 and
02:17the initial flow rate is 1 liter per minute and total amount of gas used
02:24minimum 1.5 maximum 6 and in that much gas automatically actual pressure will reach
02:31to the preset pressure so here slowly we will wait till the insufflator will give
02:36its reading as we can see preset pressure is 15 and actual pressure is
02:41slowly rising and once 15 is reached we will remove the various needle and then
02:47enlarge the incision and the incision will be enlarged to 11 mm
02:52so this is a labunemum incision after that you can take one small mosquito forcep and you
03:06can just try to dilate the obliterated with low intestinal tract as we know it is called
03:13as a Scandinavian technique and in that there is a minimum chance of infection and minimum chances
03:20of hernia because you are in the dry surface and we don't go through the base of the
03:26umbilicus now head of the trocar should rest over thin armenes middle fingers should wrap
03:33around the air inlet and index finger should be pointed towards the sharp end and then the
03:39first primary trocar will be introduced by just supporting or two hand technique
03:45they are both the technique perpendicular to the abdominal wall again tubing of the insufflator
03:54will be attached and the flow rate will be now 6 to 10 liter per minute and here we can see now
04:02this is the telescope inside and according to baseball diamond concept you will put the index finger
04:08over the target and this is one snuff box is one port and another again 7.5 cm lateral will be the
04:17other port so after filling the abdominal cavity with the pneumoperitonium under vision these ports
04:23will be introduced and initially you should do diagnostic laparoscopy patient head is slowly going down down down
04:30and patient head will be 30 degree down so that easily you can push the bovel away and you can move the all the small interest
04:39time and even the cecum and appendix all will be pushed and then move it below momentum also should be pulled down
04:49left sided sigma and colon also has to be little bit displaced and then with the left side you will hold the
04:56ovary and with the right side you can open the outer ovarian cortex and after opening the outer ovarian cortex
05:04without rupturing also it is possible to perform the surgery although sometime it gets ruptured but most
05:11of the time if you are little careful you can prevent rupturing the ovary you have to use here ambidexity
05:19both the hands should be used left hand you will use atraumatic rasper and with the right hand with
05:26the meri land you can keep on stripping the ovary and cortex slowly by opening the jaw of the meri land
05:34you can make a good plane and once a good plane is formed after that ovary will come out without
05:40rupturing so this is how you can hold it and then again catch the cyst with the right hand and transfer it
05:48into the left hand so this way slowly slowly ovary and cystectomy can be performed without rupturing
05:55it although if it ruptures immediately we have to take a measure copious lavage has to be performed
06:01in many situations we keep the endobag first inside the abdomen and after that we will open the
06:08ovarian cyst inside the endobag so this is slowly slowly the entire cyst is coming out
06:15and by sweeping movement of the jaw of the meri land you can achieve a good plane
06:28so now almost all the cyst intact without puncturing is out and then simply you will drop one endobag
06:39and you will drop this ovary in the endobag and then take it out with the 10 mm umbilical port
06:48so friends thank you very much for watching this video this was just a simple case of dermoyad
06:53for watching this video we were looking forward to watching this video this video is more
07:04of a great like this video now.
07:06Let us see you in the next video and see how the video was,
07:10let us see if you can find out or feel a little better after doing this video.
07:13Let us see if you can find out and see the video and see how the video be selected and see
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