percuvance redo nissen

This video represents the use of the 3 millimeter percuant system in a redo fundoplication in a 30 kg child. Here you see the port placement. Here you see the percuvan instrument being inserted. Initially ava needle tip is inserted on the shaft of the instrument. The instrument is then inserted through the 5 millimeter trocar which was placed in the left mid quadrant, and the grasper is attached. In all, there are 3 percuants instruments in supplying both liver retraction. Here the stomach retractor is being inserted again. The very needle tip is inserted directly through the abdominal wall, and then a grasper is attached to retract on the stomach. This port was attached through the umbilical trocar and the scope was used to visualize the instrument coming directly into the trochar. Here you can see the 5 millimeter effector tips holding the stomach. A Maryland dissector in the left hand and a more a traumatic bowel grasper in the left hand. The stitches from the previous fundoplication are removed. The wrap appears to be intact but is loosened, and there is a small hiatal hernia. A 5 millimeter hook is used for the dissection, which is placed through the 5 millimeter port in the left mid quadrant. Here you can see complete mobilization of the wrap and again how well the 5 millimeter affector tips allow for manipulation of the stomach. Uh, in this larger child. The wrap is completely taken down, the left crease exposed, so the wrap can be completely undone. A key maneuver and redo fundoplication. With the wrap completely mobilized, the retroesophageal window is again established, and the small hiatal defect is seen. In this case, the left hand is using the 3 millimeter Percuvan with the 5 millimeter Maryland tip, and the right hand is using a 3 millimeter needle driver. You can see the difference in the end of the effector tip between a standard 3 millimeter instrument and the 5 millimeter percuvan tip. The two stitch idle repair. Uh, was performed. Using 20 at the bond suture. The extremely important and redo fund application, I believe to completely take down. The uh previous wrap so that the Hal defect can be well visualized and repaired appropriately. A 2nd suture is placed, and this completes the closure of the defect. The stomach is then brought back around behind the esophagus to form the 360 degree wrap. Again, the 5 millimeter tip allows for. Good grasping and atraumatic manipulation in the stomach. A good length of intraabdominal esophagus has been established, but here the stomach is being retracted down to further lengthen the esophagus to ensure there is adequate length. Wrap is then formed going from stomach. The anterior wall of the esophagus, with the top stitch also including the anterior diaphragmatic rim. This helps lock the wrap into the abdomen and hopefully will prevent recurrent herniation. 3 such sutures are placed. Each suture incorporates a bite of the stomach. By the esophagus. And a bite of the wrap portion of the stomach. With 3 such sutures in place. The repair is completed. Here you can see that the 5 millimeter tip allows for manipulation. Here you see removal of the Percyvan's tips. The Maryland tip is put out through the trocar. is unscrewed from the 3 millimeter shaft. Through the 5 millimeter trocar. And then is pulled out. Similar procedure is performed which each of the three percuants tips. This portion of the procedure took approximately one minute. The final tip, the one in the left upper quadrant, is brought out through the. Telescope, trochar side or umbilical side. And it is removed in a similar fashion. This completed the 5 millimeter troke art removed.