Principles of Laparoscopic Surgery

Principles of Laparoscopic Surgery

Introduction

Generic Equipment and Supplies

   

  • Operating room table with padded stirrups
  • Operating room light source
  • Endotracheal tube
  • Bard Parker handle and appropriate sized surgical blade
  • Appropriate suture material
  • Vasopressors/haemostatic agents: vasopressin, misoprostol, bupivacaine plus epinephrine, oxytocin, tranexamic acid, uterine artery embolization agent, gonadotropin-releasing hormone (GnRH) agonists

C. Hand instruments:

  • Veress needle
  • Trocars and cannulas
  • Uterine manipulator
  • Traction devices: myoma corkscrew, tenaculum
  • Suturing instruments
  • Electromechanical morcellator
  • Manual morcellation devices: ring forceps, scalpel, scissors 
  • Tissue retrieval bags


A. Imaging equipment:

  • Laparoscope
  • Endo-vision camera unit with camera head
  • Light source and light cable
  • Video cable and monitor, video signal processor

B. Exposure and manipulation equipment:

  • Electronic carbon-dioxide insufflator
  • Energy sources: monopolar/bipolar electrosurgery devices, ultrasonic cutting device

D. Specific equipment for robotic-assisted laparoscopic myomectomy (RLM) with the DaVinci telerobotic system where available:

  • -Surgeon console
  • -InSite Vision System
  • -Patient side cart with telerobotic arms and EndoWrist instruments


Operating Room Setup

  • Patient is placed on the operating table in dorso-lithotomy position with the buttocks at or slightly over the table's edge to allow placement and use of a uterine manipulator, with the legs supported by stirrups
  • Generally, a right-handed surgeon stands on the patient's left side with the surgical assistant on the patient's right. Some surgeons however prefer the patient's right side
  • If only one video monitor is available, this is usually placed between the patient's legs. If two monitors, these are usually placed over the patient's lower legs, opposite the surgeon and assistant respectively. Newer surgical suites have ceiling-mounted, movable flat screens
  • The insufflator monitor is usually placed across from the surgeon so intraabdominal pressure can be viewed
  • If using the DaVinci telerobotic system, the surgeon controls the robotic system remotely from the surgeon console. A stereoscopic viewer as well as hand and foot controls are contained in this unit. With the robotic trocars inserted, the surgical cart is brought between the patient's legs and docked


Anesthesia

Access to the Peritoneal Cavity

Visualization of the Peritoneal Cavity and Pelvis

Cutting and Hemostasis

Suturing

Wound Management

Post Operative Care and Management

Include discharge criteria and post discharge followup (telephonic etc)

Adverse Events

References

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