University:
Western Sydney University
Course:
MEDI 2003 | Clinical Sciences 2
Academic year:

2024
Views:

365

Pages:

2
Author:

Mariam A.

Technique of Laparoscopy Basics   Usually performed under general anaesthesia. Most often with muscle relaxation to allow full and safe insufflation of the abdominal cavity. Techniques 1. A pneumoperitoneum is created by introducing carbon dioxide under controlled pressure to lift the abdominal cavity away from the viscera -> allows inspection of the peritoneal cavity. - Gas is most safely introduced via a blunt cannula placed via an open technique to allow the visualisation of the peritoneal contents. - The gas pressure should be kept as low as possible while maintaining a satisfactory view to minimise cardiac and respiratory risk. 2. A 5 to 10 mm diameter laparoscopy with video camera is then introduced into the abdominal cavity. 3. Additional cannulae (trocars) are made to which pass the diathermy hooks, graspers, needle holders, clip appliers and linear staplers. - These secondary trocars are inserted through a new access point under direct vision within from within the abdomen to prevent injury to the bowel and other viscera. - Port sites differ with according to the nature and type of operation. For example, a patient undergoing cholecystectomy who is obese, requires different port sites than a thin patient. Sharp vs blunt dissections     May be used in an open surgery. Sharp dissections - Sharp dissections use laparoscopic scissors. Blunt dissections - Blunt dissections is carried using a fine dissecting forceps (Petelins or Marylands), laparoscopic gauze pledgets or the tip of a suction probe. - Tears rather than cuts small blood vessels -> deliberately causing a minor tissue damage -> rapidly actives a coagulation cascade -> spontaneous cessation of bleeding. - This is safer than sharp dissections which may require (potentially excessive) use of diathermy. Haemostasis still requires diathermy, and this must be cautiously used to prevent the arcing to adjacent organs. - Increasingly safer alternatives are being used such as bipolar diathermy forceps or the harmonic scalpel, which uses ultrasound to coagulate and cut vessels and tissue. Important Points     In laparoscopy-assisted surgery such as colectomy, a large part of the dissection is performed laparoscopically and then a small incision is made to deliver the bowel for anastomosis outside the abdomen or to remove the resected specimen. After the operation, patients experience abdominal discomfort at trocar insertion sites, shoulder discomfort from retained gas in the peritoneal cavity. Fre restrictions are placed on the patient after discharge. The patient can return to work as soon as comfortable, often after a few days.