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Basic Principles of Laparoscopy PowerPoint Presentation

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Description : Check out this medical PowerPoint presentation titled "Basic Principles of Laparoscopy” by Mete Kilciler, MD.

This medical PowerPoint presentation is about laparoscopy, also known as minimally invasive surgery. Laparoscopy is a surgical technique used to diagnose and treat various conditions by inserting a thin, lighted instrument called a laparoscope through small incisions in the abdomen. Here are some basic principles of laparoscopy:

Anesthesia: Laparoscopy is performed under general anesthesia, which means the patient is unconscious during the procedure.
Pneumoperitoneum: Before the surgery begins, the surgeon inflates the abdomen with carbon dioxide gas to create a space for the laparoscope to be inserted and to provide better visualization of the organs.
Trocar insertion: Once the abdomen is inflated, the surgeon inserts a trocar, a long, thin tube, through a small incision in the abdomen. The laparoscope is then inserted through the trocar.
Visualization: The laparoscope provides the surgeon with a magnified view of the organs in the abdomen. The images are displayed on a monitor, allowing the surgeon to see the organs and perform the surgery.
Instrument insertion: Other instruments may be inserted through additional incisions to perform the surgery. These instruments are specially designed for laparoscopic surgery and are thin and flexible.
Minimally invasive: Laparoscopy is a minimally invasive surgery, meaning that it involves smaller incisions and less trauma to the body than traditional open surgery. This often results in less pain and a faster recovery time for the patient.
Closure: Once the surgery is complete, the instruments and laparoscope are removed, and the incisions are closed with stitches or surgical glue.

Laparoscopy is used for a variety of procedures, including diagnostic tests, such as biopsies, and surgical treatments, such as removing tumors or repairing hernias. The basic principles of laparoscopy are the same for all procedures and are designed to minimize patient discomfort and promote a faster recovery time.

Tags : laparoscopy, minimally invasive surgery, laparoscope, surgery, surgery PowerPoint presentation

Published on : Jun 20, 2023 | Views : 1980 | Downloads : 0

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Slide 1-

Urological Institute Section of Minimally Invasive Surgery Basic Principles of Laparoscopy Mete Kilciler, M.D. Research Fellow, Cleveland Clinic Foundation.
Slide 2-

IndicationsLaparoscopic Urology Standard Exploration (undescended testes) Adrenalectomy Simple Nephrectomy Radical Nephrectomy Donor Nephrectomy PLND Advanced Prostatectomy Partial nephrectomy Pyeloplasty Cystectomy/diversion RPLND
Slide 3-

ContraindicationsLaparoscopic Urology Absolute Inadequate experience of surgeon Uncorrected coagulopathy Shock Not Contraindicated prior abdominal surgery large abdominal masses obesity
Slide 4-

Relative ContraindicationsLaparoscopic Urology Infectious States ·Peritonitis ·Abdominal wall Infection ·Sepsis Anatomic Consideration ·Dilated bowel (obstruction, ileus) ·History severe adhesions ·Morbid obesity ·Ascites ·Large AAA ·Near-term pregnancy ·abdominal wall/ diaphragmatic hernia Systemic Factors ·Cardiopulmonary disease ·Shock ·Coagulopathy
Slide 5-

Patient Preparation Informed consent (for lap and open) Bowel Prep (mechanical) Foley catheter (empty bladder) NG or OG tube (empty stomach) DVT prophylaxis (sequential compression stockings) +/- Antibiotics Shave prep
Slide 6-

Patient Positioning Must balance optimal surgical exposure vs. patient safety use only as much flexion, kidney rest, Trendelenburg as is necessary (and not more) remember padding secure patient to bed
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Transperitoneal Positioning
Slide 8-

Retroperitoneal Positioning
Slide 9-

Surgical Access Examine the abdomen for scars organomegaly intra-abdominal masses Location (Trocars) depends on: surgery being performed surgeon preference anatomy (scars, masses, habitus…) Safe spots lower fold umbilicus lateral border rectus (in any of 4 quadrants)
Slide 10-

Access-ClosedVeress needle 2-mm blunt-tipped inner stylet, spring loaded sharp outer needle Alternatively a 3-mm laparoscopic port can be used
Slide 11-

Access-ClosedTechnique inspect needle and spring mechanism as the needle is passed through abdominal layers, the stylet retracts and allows penetration of sharp tip the peritoneal cavity is entered and the blunt stylet snaps back into place, protecting underlying organs confirm position (next)
Slide 12-

Access-Closed Confirmation of needle placement 10 ml syringe aspirate should be no blood, gastric or bowel contents or urine inject 5 ml of saline should be no resistance to flow aspirate should be no return Begin insufflation (start w/ low flow) look for low pressure initially with Veress, flow will be <=2.5 L/min look for symmetric distension (can also insert scope if a 3-mm port is used)
Slide 13-

Access-Closed Troubleshooting needle placement Aspirate blood small amount - reposition trocar large amount - laparotomy Aspirate bowel content reposition trocar, continue with approach examine bowel laparoscopically High pressure, Asymmetric distension can occur when needle is improperly placed (extraperitoneal or loop of bowel)
Slide 14-

Access-ClosedTechnique Insufflate abdomen to 15 mm Hg Remove Veress Insert Trocar (10 or 12 mm) Insert laparoscope and inspect abdomen
Slide 15-

Access-Open Use: multiple prior surgeries difficulty encountered w/ Veress needle placement Technique: skin incision, down to fascia/peritoneum incise fascia/peritoneum inspect w/ finger blunt (Hassan or balloon) trocar insertion
Slide 16-

Secondary Trocar Placement Size, number and position of trocars will depend on procedure, approach and personal preference should be done under direct vision transillumination of abdominal wall avoid vessels in abdominal wall (e.g. epigastrics)
Slide 17-

Secondary Trocar Placement skin incision trocar held in palm of hand stabilize port with other hand (thumb and index finger) drilling motion to insert open valve to confirm (rush of CO2) insert scope and examine abdomen suture trocar in place
Slide 18-

Gas Pros Cons Room Air • cheap • not soluble in water (air embolus) O2 • cheap • risk of combustion N2O • not peritoneal • less soluble in H2O (than CO2) irritant • small risk of combustion CO2 • rapidly dissolves • peritoneal irritant • no combustion • can cause acidosis Insufflation-Choice of Insufflant CO2 Physiological Effects ·pH ·pO2 · pCO2 ·Vasodilation CO2 • rapidly dissolves • peritoneal irritant • no combustion • can cause acidosis
Slide 19-

Insufflation-Insufflator
Slide 20-

Pneumoperitoneum Pressure <15 mmHg to prevent hemodynamic compromise lengthy procedure @10 to 20 mmHg can cause reversible oliguria (renal parenchymal compression, reduced renal v. flow) adjusting ventilation can prevent hypercarbia and acidosis
Slide 21-

Electrosurgery Purpose is to produce heat for a desired surgical effect (cutting, fulguration, dessication) Monopolar: CurrentActive ElectrodeTarget Tissue Patient’s BodyReturn Electrode Bipolar: Current passes between two poles (+,-) located close together (poles=tines of forceps) Current is restricted to the tissue between the poles of the instrument
Slide 22-

Direct coupling Insulation failure Capacitive coupling ElectrosurgeryHazards and MIS
Slide 23-

ElectrosurgeryHazards and MIS Direct Coupling
Slide 24-

ElectrosurgeryHazards and MIS Insulation Failure
Slide 25-

Capacitive Coupling ElectrosurgeryHazards and MIS
Slide 26-

ElectrosurgeryArgon Beam Ionized gas Advantages: produces smooth, pliable eschar beam disperses blood, improving visualization gas displaces O2, therefore less smoke is produced
Slide 27-

Instrumentation
Slide 28-

InstrumentsTelescopes
Slide 29-

InstrumentsPorts 2 mm 5 mm 10mm 12 mm Scope Scope Scope Clip Applier Clip Applier Weck Clips Weck Clips Right Angle Right Angle Fan Retractor Endo-Catch I Endo-Catch II (15mm) Endo-GIA Satinsky
Slide 30-

InstrumentsBalloon Dissector
Slide 31-

InstrumentsEndoShears
Slide 32-

InstrumentsRetractors EndoPaddle Fan Retractor
Slide 33-

Instruments-EndoGIA
Slide 34-

Instruments-EndoCatch
Slide 35-

Major Lap. Procedures Partial Nephrectomy Pyeloplasty Radical Cystectomy Ureteral Reimplant RPLND Adrenalectomy