00:00hello friends this is a case of laparoscopic dermoid cystectomy ovary and cysts are of many
00:09type today we will see how to perform ovary and dermoid surgery without a spillage spillage is
00:16very important to control and for that we will use endobag if you use proper endobag you can
00:23prevent the spillage of the dermoid ovary and cyst surgery here we have started the surgery
00:30and this patient has four centimeter dermoid cyst on the left side and we will introduce the varus
00:38needle in the inferior crease of the umbilicus and the three click sound will come and then irrigation
00:46suction and hanging drop test will be performed just to make it sure that varus needle has entered
00:52into the abdominal cavity nicely and then pneumo petronium is started here we will use the
00:5815 millimeter of mercury preset pressure and approximately 1.5 liter gas has been used to
01:05create the pneumo petronium after that we will enlarge the same incision to 11 mm and then we will
01:13introduce the 11 mm primary trocar that is optical trocar here we are just dilating little bit the
01:20inferior crease of umbilicus and this 11 mm trocar has been introduced after that we will connect the
01:28tubing and we will increase the preset pressure and then telescope has been introduced we can see here
01:34that after introducing telescope this is a sigmaoid colon here the uterus this is the dermoid cyst on the left
01:43side here the first we will use one endobag and that endobag will be introduced with the contralateral port
01:51port that is a self-retaining disposable endobag that is made of high quality polypropylene and that is
02:00useful for the dermoid ovary and cystectomy now you can drop the cyst and ovary into the endobag so that
02:09if any spillage happen it will control it now we can see here this side sigmaoid colon is little more stuck
02:17to the left side of the triangle of doom so we will do little bit mobilization of the sigmaoid colon
02:25that may be required because here we can see it is it is disturbing and it's coming in the way and maybe
02:31the energy can touch the sigmaoid colon so it was little bit mobilized and after that we are doing the
02:40ovarian cystectomy this ovarian cystectomy is very easy and with the harmonic you can open the
02:46outer ovarian cortex and with one Maryland and one atraumatic rasper you can just separate it easily
02:54care should be taken that directly holding the cyst with the Maryland should be avoided and by opening
03:02the jaw you should do dissect all around equally and it should be gentle another important point is
03:09that when you separate it you should try not to hold the fimbria of the tube that may create a
03:16structure and care should be taken that it should not puncture if you will remain gentle and pushing
03:23and pulling technique it won't get punctured and try to keep the convexity of the Maryland towards the
03:29cyst so that you can use one grasper also here we have removed the Maryland and this is the atraumatic
03:36grasper now because being pointed Maryland sometime can rupture the cyst and this is having a very good
03:43plane and you can hold with the left hand the ovarian cortex and with the light right hand you can slowly
03:49separate the cyst inside the endobag
03:59gentle traction on the left side and then slowly the cyst is coming out you should try to do it all
04:06around equally going one side more and another side less is not a good idea it should slowly stripped
04:14at this point there is a more chances of spillage so you should be gentle
04:18an atraumatic grasper is very important to separate it without puncturing again we will encircle it and
04:26try to remain all around equal some people they use hydro dissection at this point but mostly in the
04:32hydro dissection cysts get ruptured and we will try it that it should come out without puncturing so it's
04:39almost over now just 25 percent of the part of the cyst is only attached and slowly it can be punctured
04:49so it is now almost out and there is no any blood loss there is no any bleeding because once you have
05:04a good pain here the fimbria is there so you should try to remain away from the fimbria this is the ovarian
05:10cortex and then slowly it is the last part is separated
05:31once it is separated then you can do little suction irrigation just to wash the inside of the cystic
05:38area to make it sure and to visualize that there should not be any bleeding so absolutely no bleeding
05:44is found and if the bladder is there with the bipolar you can just try to desiccate the small points
05:52and bleeding can be stopped there is no need of suturing just you should invert it just put all the
05:59content inside the cyst and you should invert the outer wall of the ovarian cortex and drop in the ovarian
06:05fossa after that we will puncture the cyst inside the endobag because sometime when you try to puncture
06:14it from outside with the ovum forcep it may get slipped so with the harmonic we are carefully puncturing
06:21it so that any part should not be spilled out if you puncture it right now taking it out will be very
06:28easy and once the mouth of the endobag will come out with the ovum forcep you can drag the cystic content
06:35and here the fatty content of the dermoid is coming out there are few hair balls inside the dermoid
06:41which we will take it out with the ovum forcep so now it's punctured and after that we will here
06:49outside we can see with the ovum forcep the cyst is pulled and when you are using endobag this port
06:55should must be closed otherwise there is a chance of hernia so thank you very much
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