Laparoscopic adhesiolysis

To obtain access during any laparoscopic procedure. Adhesiolysis for chronic or recurrent abdominal pain. As an emergency to relieve obstruction. Three cannulae (3.5-1 zmm). An angled telescope (30 45 ) may prove very helpful. A 0 telescope may be adequate. Two atraumatic, grasping forceps, preferably insulated. Scissors, preferably insulated with double-action curved thin blades. Fine hook or needle monopolar diathermy. Bipolar diathermy may occasionally help. Suction and irrigation (separate...

Inguinal hernia repair

Laparoscopic approaches to inguinal hernia repair have been developed over the past 5 years but are currently undergoing assessment by clinical trial. It is as yet uncertain whether or not there are any health-care economic benefits to laparoscopic hernia repair. The procedure may be performed transperitoneally or extra-peritoneally depending on the surgeon's preference and expertise. It is absolutely crucial for the surgeon to memorize the anatomy (Fig. 109). Although femoral hernias can be...

Physiological changes during laparoscopy

Although the surgical technique of laparoscopic surgery is of a minimally invasive nature, a number of physiological changes occur as a result of creating a C02 and postural changes involved in patient positioning. These changes may be particularly noticeable in elderly and very young patients, and significant in those with pre-existing diseases such as cardiovascular, pulmonary and neurological disorders. In addition, other pathophysiological changes related to access and instrument injuries...

Laparoscopic cholecystectomy

Laparoscopic cholecystectomy has, over the past 10 years, evolved to become the standard procedure for symptomatic gallstones. The majority of cholecystectomies are now performed via this route but certain preconditions must apply before this should be undertaken. These are as follows There must be no evidence of biliary obstruction as determined by the liver function tests. Transabdominal ultrasound should always be performed to confirm the diagnosis of gallstones and exclude the presence of...

Laparoscopic Nissens fundoplication

Nissens Fundoplication

Failed antireflux medical treatment. Potential long-term use of proton pump inhibitors. Fig. 94 Monopolar scissor diathermy cut after ligation of the appendix allows energy concentration and burn at the base. Patients with complications of gastro-oesophageal reflux. Adjunct to repair of complex types II or III hiatus hernias. Adjunct to insertion of gastrostomy in paediatric patients with vomiting. In reflux associated with significant oesophageal shortening. In patients with reflux caused by...

Problems and solutions of primary cannulae

The blind insertion of the primary cannula trocar is by far the most dangerous step in any laparoscopic procedure even if there is an already established pneumoperitoneum. Do not insufflate through the primary cannula unless you are certain of the position or have first inspected the peritoneal cavity with a telescope. Subcutaneous or extraperitoneal cannulation Fig. 2,3 Extraperitoneal position is commoner because of the loose attachment, of the peritoneum, particularly in the lower abdomen....

Pneumoperitoneum by Veress needle

Although the Veress needle remains in widespread use, open cannulation by the technique of Hasson or Fielding is our preferred method for inducing a pneumoperitoneum especially in a scarred abdomen. However, safe use of the Veress needle is as follows. The Veress needle is most often inserted at the site where the primary 'laparoscope' cannula will be sited. The most common site entry is usually through, just above, or just below the umbilicus Fig. 15 . This is because the abdominal wall is...

Problems and solutions of Veress needle and pneumoperitoneum

Laparoscopy Subcutaneous Emphysema

Misplaced Veress needle Fig. 20 is the commonest source of complications in laparoscopy and rarely causes significant problems unless the gas flow is commenced. Misplaced needle with or without insufflation Happens in the obese and results from oblique insertion of needle If connected to gas flow, localized emphysema with a crackling feel develops Reposition the needle, emphysema resolves spontaneously. Extraperitoneal space Relatively common especially in obese patients, with oblique insertion...

Gasless laparoscopy

Gasless Laparoscopy

To avoid the disadvantages of COz insufflation, devices are available for lifting the anterior abdominal wall to facilitate gasless laparoscopy. Some devices provide tenting of the anterior abdominal wall by traction of the skin and subcutaneous tissues U shaped retractor or subcutaneous wires , whereas others lift up the entire abdominal wall via an intraperitoneal retractor wires, or L, T, or fan shaped retractor Fig. 14 . Despite these inventions the technique of gasless laparoscopy has not...