case_images: PMC6417398_01
case_images: A) Preoperative image: Chest X-ray showed intestinal herniation into the thoracic cavity. B) Postoperative image.
case_images: gr1.jpg
case_images: PMC6417398_01_gr1.jpg
case_images: fig0005
case_images: Chest X-ray showed intestinal herniation into the thoracic cavity (Fig. 1A). The operative time was 65 min, and there were no intraoperative complications (Video, Fig. 1B).
case_images: The procedure of twisting technique.. A) The fundus of the hernia sac is grasped with a blunt endosurgical grasper. B-D) The grasper is turned, twisting the sac around the shaft of the instrument and thereby reducing the hernia content. Once maximal reduction with one hand is achieved, the twisted tissue is grasped with the contralateral instrument and the maneuver repeated until the entire hernia content is reduced.
case_images: gr2.jpg
case_images: PMC6417398_01_gr2.jpg
case_images: fig0010
case_images: Once maximal reduction with one hand was achieved, the twisted tissue was grasped with the contralateral instrument and the maneuver repeated until the entire hernia content was completely reduced. (Fig. 2) Subsequently, the sac was removed circumferentially using the monopolar electrocautery hook.