LAPAROSCOPY

Dr. Hiwa Omer Ahmed Assistant Professor In General Surgery

laparoscopy

laparoscopy

Benifits
Perceived benefits Reduced post operative pain and analgesic requirement Reduced operative trauma Reduced bleeding Faster recovery, discharge and return to work Reduced wound infection, seroma and haematoma Reduced chronic wound pain Less cardiorespiratory complications

Benifits
Less ileus from reduced handling Improved cosmesis Reduced contamination of theatre staff (Hepatitis and HIV) Interesting for surgeons Reduced outpatient/social costs

Benifits
Reduced risk of DVT/PE Reduced incisional hernia rate Fewer adhesions and less likely to develop obstruction Immunological benefits Better visualisation for the surgeon

Risks
Perceived risks High risk of co-lateral injury eg Common bile duct in lap cholecystectomy Bowel/bladder/vascular injury in hernia surgery Verres needle injury Diathermy may lead to organ damage eg late cbd stricture Increased operating time

Risks
Increased costs due to theatre time and equipment Tumour seeding Poor quality surgery eg cancer resection Loss of tactile sensation Long learning curve Loss of training opportunity eg appendicitis and inguinal hernia Some surgeons not able to develop skills

Operations : Now fully accepted
Cholecystectomy ? CBD exploration Fundoplication Splenectomy Nephrectomy Adrenalectomy Diagnostic - eg Ca staging, abdo pain

Operations : Still being evaluated
? Appendicectomy ? Inguinal, Femoral, Incisional, Paraumbilical Hernia repair ? Colectomy ? Gastrectomy ? Other gastric surgery eg Obesity surgery

Veress needle
Veress needle (closed and blind with risks) / cutdown (Hassan, open and ?safer)

High risk patients likely to benefit most
Elderly Obese Cardiorespiratory Aids Thoracic

Gaseous insufflation and Pressures
Keep pressure as low as possible to reduce CVS and respiratory effects Also reduces post operative pain 14mm mercury intraperitoneal 10 mm mercury extraperitoneal to avoid surgical emphysema CO2 most commonly used. Helium may be theoretically better but expensive Usual volume 2.5-3.5 litres intraperitoneally

Gaseous insufflation and Pressures
May cause acidosis with respiratory depression and hypercapnia Cardiac output may fall as much as 30% due to reduced venous return Bradycardia most common arrhythmia, easily reversed with atropine Respiratory depression due to splinting of diaphragm Other complications may include Pneumothorax, Emphysema, Air embolus

What can you expect?
Laparoscopy is direct visualization of the peritoneal cavity, ovaries, outside of the tubes and uterus by using a laparoscopy. The laparoscopy is an instrument somewhat like a miniature telescope with a fiber optic system which brings light into the abdomen. It is about as big around as a fountain pen and twice as long.

Insuflation technique
Carbon dioxide (CO2) is put into the abdomen through a special needle (Veress) that is inserted just below the navel. This gas helps to separate the organs inside the abdominal cavity, making it easier for the physician to see the reproductive organs during laparoscopy. The gas is removed at the end of the procedure.

Prior to Surgery
Do not eat or drink anything after 12:00 midnight the night before surgery. Do not smoke or chew gum after 12:00 midnight. If you are currently taking medication, ask you doctor if you should stop taking it.

Prior to Surgery
Bowel Preparation: You may be given instructions regarding this during your preoperative office visit. Bowel preparation is usually recommended for patients with endometriosis, pelvic adhesions or pelvic pain. Preparing the bowel with a purging agent such as Go-lytely or Magnesium Citrate is often followed by an oral antibiotic and enemas. While unpleasant, this procedure minimizes the risk of surgical complications from bowel injury during your surgery

Prior to Surgery
Patient must shower or bathe the night prior to surgery. Vaginal Prep: None is usually required. Nail polish, make-up and jewelry should be removed the night before surgery. Wear loose-fitting clothes to prevent any unnecessary pressure on the umbilicus on the day of surgery.

Immediately Before Surgery
Immediately prior to surgery, you will be asked to empty your bladder. Glasses, contact lenses, dentures and jewelry should be removed. Valuables should be left in the safekeeping of the person who accompanies you or should be left at home.

In the Operating Room

In the Operating Room

In the Operating Room

In the Operating Room

In the Operating Room

In the Operating Room

In the Operating Room

In the Operating Room

In the Operating Room

In the Operating Room

After Surgery
After surgery, you will wake up in the recovery room. The nurse will check your blood pressure, pulse and temperature frequently. The nurse will check your dressing and intravenous. If you are cold, ask for an extra blanket. The nurse or physician will tell you when you will be allowed to drink something

After Surgery
As soon as you are transferred from the Recovery Room (about one hour after surgery), you may have visitors. You may not remember conversations immediately after surgery, which is normal and lasts only a short period.

Your physician will discuss the findings with your family immediately after the surgical procedure is complete. If your family leaves the waiting area please have them notify the receptionist regarding how they can be contacted.

After Surgery
You will remain in the Outpatient Surgery Center for approximately three or four hours after the procedure. After you are able to empty your bladder, you will be allowed to go home. If additional medications are required, you will be given prescriptions to take with you. If you are unable to empty your bladder or nausea is severe, a 23 hour hospital stay over night may be considered

Medication will be available for pain or nausea. Ask your nurse for this medication if you are uncomfortable. Medication will be in the form of injections until you are able to drink. Once you are able to drink, the doctor will change your medication to pills. Pain medication is usually allowed every 34 hours. Medication for nausea is usually allowed every 4-6 hours.

Diet
You may be given specific instructions regarding diet prior to leaving the hospital. In general, you must consume only clear liquids (juices, Jello, or both) until you pass gas from you rectum or have a bowel movement. At this time, you may begin to advance your diet. Eat light, easily digested food for a few days. In the event that you have not passed gas the morning after surgery AND have no nausea, you may try something light to eat, such as a piece of toast. If you are able to tolerate this, you may then begin advancing your diet very slowly.

activity
Expect to feel sore and "washed out" for a few days following surgery. Remember to get up and move about, even through you may not want to. Increase your activity gradually during this time. For a week or two after surgery expect to tire easily even after the slightest effort of work or exercise. Do not engage in strenuous activity until after your first post-op visit at our office. If you plan to travel, please check with your physician prior to surgery if possible. If an emergency arises and you must travel during the first week of surgery, please notify our office before you leave

activity
The pain pills do what they are supposed to do, which is mask your pain. Therefore, you may feel a false sense of wellness due to the pain pills, so even though you feel fine the next day or two, be aware that your body is still recovering and take it easy. Eat and drink carefully. The last thing you will want to do following this type of surgery is choke or cough. Sneezing, laughing, crying and shivering from the cold may also be uncomfortable. So snuggle up and treat yourself well.

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