c l i n i c a l f o l i o s : n a r r a t i v e





A D V E R T I S E M E N T

 

Hernia Technique Master Class: 13

A D V E R T I S E M E N T

   

This video has been downloaded by your browser as a separate file.

 

A nick is made on either side of the nerve in the thin fascia binding the nerve down to the cremaster. A right angle clamp is passed under the nerve and the nerve is gently elevated. The frenulum of fascia on either side of the nerve is sharply divided with Mezzenbaum scissors, freeing the length of the nerve from medial to the superficial ring to lateral to the deep ring. The blood supply to the nerve comes from vasa nervorum originating from the cremaster. These are sharply divided as the nerve is mobilized and are not cauterized so as not to injure the nerve. The bleeding on the nerve side will stop, and the cremaster ends can be touched with the cautery if they do not stop spontaneously.   

Notes:

Link to this frame from your Personal Thumbnails page? Yes No


 

Hernia Technique Master Class: 14

A D V E R T I S E M E N T

   

This video has been downloaded by your browser as a separate file.

 

The nerve is then lateralized by replacing the clamp holding one of the flaps of external oblique, usually the caudal side, with the nerve now outside the clamp. The Wheatlaner is now replaced to retract the external oblique flaps and the hemostats are removed from the edges of the flaps.    

Notes:

Link to this frame from your Personal Thumbnails page? Yes No


 

Hernia Technique Master Class: 15

A D V E R T I S E M E N T

   

This video has been downloaded by your browser as a separate file.

 

The spermatic cord is next isolated at the pubic tubercle. A blunt Pean clamp is gently spread beneath the cord caudally separating the cord from the pubic tubercle. On the medial side of the cord, if the separation of the cremaster from the internal oblique fibers is not evident, elevating the cremaster with a Debakey forceps accentuates the dimple between the muscle fibers and the cremaster. The clamp is passed from medially to join the space dissected from below. This technique is much less traumatic than blunt finger dissection and results in less post-op pain.   

Notes:

Link to this frame from your Personal Thumbnails page? Yes No

 

Click the "Update" button to save your Notes and Personal Thumbnails.

 

Thumbnails

This page was last modified on 2/10/2009.