Next, Tanglou started to puncture the second and third casings.

"5mm casing..."

Due to his talent and concentration, Tanglou didn't even realize that there was a big boss in the operating room and continued to issue instructions. The equipment nurse naturally cooperated conscientiously.

"Hey, this kid is going to..."

Seeing Tanglou's operation, Professor Lin immediately reacted, and he was more and more impressed: "This little guy is really brave and skilled."

Generally speaking, there are three ways to puncture the second and third cannula: midline position, midline position, and bilateral position.

Generally speaking, under normal circumstances, the most commonly used method is the midline position.

The method is to puncture the preperitoneal space at about 1/3 and the lower 1/3 of the line between the umbilicus and the pubic symphysis. Relatively speaking, the operation is the simplest, but the disadvantage is that the three cannula sites are located in the midline.

On the other hand, the resulting operating angle is not ideal and may cause mutual interference between the instruments.

However, it is easy to operate and most doctors will use it.

As for the mid-lateral position, it has limitations and cannot be used for bilateral hernias, so it is not suitable for this patient's situation.

As for the last one, it is also the most difficult one, which is exactly what Tanglou is trying.

In the so-called bilateral position, before puncturing the cannula, you need to insert your fingers first, enter the peritoneal space, and perform complex separation on both sides, and then under the guidance of your fingers, puncture the lateral rectus abdominis muscles on both sides at the same level as the umbilicus.

Second and third casing.

Since finger manipulation is used blindly, the operator's operation requirements are very high, and the strength must be just right. Non-experienced operators dare not try it.

After all, Kato Taka is not easy to cultivate.

Of course, the greater the risk, the greater the benefit. Using this method, the equipment maintains a certain operating angle and is less likely to interfere with each other.

"This hand uses only fingers to pre-separate the preperitoneal space. It's really beautiful."

In his mind, Professor Lin compared Tang Lou's operation with his own. He couldn't find any mistakes in Tang Lou's. Even in some details, due to his youth and strength, he was more durable and his work was a little more perfect than his.

"This little guy is amazing!"

Professor Lin is a big boss. He has seen too many outstanding young people. In the magic city, there are many who are faster than Tanglou, and there are also those who show how difficult the operation is. But when all these advantages are combined,

There are very few left.

At first, Professor Lin wanted to replace him as the surgeon, but now, he doesn't even need to give guidance and correct mistakes.

"This is really the easiest flying knife ever." Professor Lin felt a little guilty and sighed, "What a waste of money."

"Balloon separator..."

The next step was to separate and enlarge the preperitoneal space. Since the patient's family was rich, Tanglou used the most expensive balloon separator separation method.

Soon, the building was completed in the gap between the superficial layer of the transversalis fascia and the peritoneum.

"It's so fast."

Professor Lin was slightly surprised. Dr. Tang's operation was so intensive that he didn't even breathe at all.

"Young people are different. They have really good physical strength."

On the operating table, Tang Lou had already further separated the pubo-vesical space (Retzius space). Hesitant Tang Lou took a step forward and established the preperitoneal space very successfully, so the pubo-vesical space was formed naturally, with just a few simple separations.

Expose the pubic symphysis and pubic pectineal ligament.

"pretty."

Professor Lin gave a soft cheer, this surgery looked really comfortable.

Qing Ping also had a proud look on his face. Tanglou was really up to the task. With such an excellent operation, even Professor Lin from the Magic City couldn't find any mistakes.

Next, Tanglou began to explore and treat direct and femoral hernias, and completed the dissection of the hernia sac very skillfully.

Looking at the completely exposed direct hernia defect, it is very obvious that the transversalis fascia in the defect is significantly thickened.

Professor Lin also did not expect that the patient's situation was quite special, and his face finally became a little more serious. This situation is called "pseudohernia sac". It would be terrible if he mistakenly thought that the hernia sac was forcibly removed.

Professor Lin was considering whether to give a verbal reminder that the tenement building had begun operations.

Since a large direct hernia defect will leave a cavity during the operation, Tanglou directly pulls out the "pseudohernia sac" and fixes it with the lacunar ligament or pectineal ligament.

"clever."

Professor Lin's eyes lit up and he took a step closer. Even he had to go through dozens of surgeries before summarizing this kind of surgery.

This kind of treatment has several benefits. The first is that it can tighten the loose transversalis fascia, and the second is that it can reduce the incidence of postoperative seroma.

Seeing that Tanglou was able to handle it with such ease, Professor Lin was a little doubtful whether this young doctor had gone through a huge amount of intensive training in this kind of surgery.

"Doctor Qing, your hospital really has an extraordinary talent."

Professor Lin looked at Qing Ping beside him and praised him.

Qingping and Yourongyan, although it is normal for Tanglou to be praised, this is the first time for Professor Lin to be of this level.

"Professor Lin, you still need to keep an eye on the next operation, especially the Danger Triangle, the Crown of Death and the Pain Triangle."

Of course, Qingping didn't float. He was very strict about the operation. He didn't dare to be careless as long as it didn't reach the last step.

Professor Lin also strongly agrees with Qingping's attitude. These important structures must not be damaged at all, otherwise it will lead to serious complications or even death. This is also the difficulty of TEP.

The two of them continued to observe the operation of the tenement building.

The so-called danger triangle, proposed by Spaw in 1991, also known as Doom's triangle, is located in the triangular space surrounded by the vas deferens and spermatic vessels, through which the external iliac arteries and veins pass.

On the monitor, Tanglou's operation is very dexterous, and the angle formed by the vas deferens and spermatic blood vessels is 38 degrees or 48 degrees on the right side, and it can be moved accurately.

"This control is really terrifying."

Professor Lin was also a little impressed, especially under the high-tempo operation of Tanglou.

Soon, Tanglou completed the operation of the dangerous triangle with ease.

Then came this surgery, the most difficult crown of death, ortis.

The patient has an anastomotic branch between the inferior epigastric artery and the obturator artery. This anastomotic branch is relatively thick and is an abnormal obturator artery branch. It is located on the outside of the pubic pectineal ligament near the iliac vein.

In the monitor, this abnormal obturator artery branch passes in a loop from the inside of the femoral vein and behind the pectineal ligament, forming a ring, which is the origin of the crown of death.

When Tanglou separated him, Rao Shiqingping was very confident about Tanglou, but also very nervous. Professor Lin also held his breath.

Three minutes later, both Professor Lin and Qingping heaved a sigh of relief: "The crown of death has been perfectly solved. It seems that this operation is successful!"

Sure enough, in the following time, Tanglou completed the separation of the retropubic venous plexus and the pain triangle more and more efficiently.

Under Tang Lou's precise operation, the range of peritoneal space separation was determined: medially to the pubic symphysis and crossing the midline, lateral to the iliopsoas muscle and anterior superior iliac spine, above to 2cm above the symphyseal tendon, and medially to 2cm below the pubic pectineal ligament.

Laterally and downwardly, it reaches the abdominal wall of the spermatic cord.

This range can already ensure that a sufficiently large patch can be placed.

"10cmX15cm patch...suture..."

Hearing Tanglou's choice, Professor Lin raised his brows slightly, and his heart stabilized again. This Tanglou was really walking on the edge of a knife every step of the way.
Chapter completed!