laparoscopy


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nedal    on Oct 24, 2009 Says :

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  Notes
 
 
1 : LAPAROSCOPY Dr. Hiwa Omer Ahmed Assistant Professor In General Surgery
2 : laparoscopy
3 : laparoscopy
4 : Benifits Perceived benefitsReduced post operative pain and analgesic requirementReduced operative traumaReduced bleeding Faster recovery, discharge and return to workReduced wound infection, seroma and haematomaReduced chronic wound painLess cardiorespiratory complications
5 : Benifits Less ileus from reduced handlingImproved cosmesisReduced contamination of theatre staff (Hepatitis and HIV)Interesting for surgeonsReduced outpatient/social costs
6 : Benifits Reduced risk of DVT/PEReduced incisional hernia rateFewer adhesions and less likely to develop obstructionImmunological benefitsBetter visualisation for the surgeon
7 : 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 injuryDiathermy may lead to organ damage eg late cbd strictureIncreased operating time
8 : Risks Increased costs due to theatre time and equipmentTumour seedingPoor quality surgery eg cancer resectionLoss of tactile sensationLong learning curveLoss of training opportunity eg appendicitis and inguinal hernia Some surgeons not able to develop skills
9 : Operations : Now fully accepted Cholecystectomy ? CBD exploration Fundoplication Splenectomy Nephrectomy Adrenalectomy Diagnostic - eg Ca staging, abdo pain
10 : ? Appendicectomy? Inguinal, Femoral, Incisional, Paraumbilical Hernia repair? Colectomy ? Gastrectomy? Other gastric surgery eg Obesity surgery
11 : Veress needle Veress needle (closed and blind with risks) / cutdown (Hassan, open and ?safer)
12 : High risk patients likely to benefit most ElderlyObeseCardiorespiratoryAidsThoracic
13 : Gaseous insufflation and Pressures Keep pressure as low as possible to reduce CVS and respiratory effectsAlso reduces post operative pain14mm mercury intraperitoneal10 mm mercury extraperitoneal to avoid surgical emphysemaCO2 most commonly used.
14 : Gaseous insufflation and Pressures May cause acidosis with respiratory depression and hypercapniaCardiac output may fall as much as 30% due to reduced venous return Bradycardia most common arrhythmia, Respiratory depression due to splinting of diaphragm Other complications may include Pneumothorax, Emphysema, Air embolus
15 : What can you expect? Laparoscopy is direct visualization of the peritoneal cavity The laparoscope 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.
16 : Insuflation technique Carbon dioxide (CO2) is put into the abdomen through a special needle (Veress) that is inserted just below the navel.
17 : Prior to Surgery Not to eat or drink anything after 12:00 midnight the night before surgery. Not to smoke or chew gum after 12:00 midnight. Currently taking medication, some should be stopped ..
18 : Prior to Surgery Bowel preparation is usually recommended for patients with endometriosis pelvic adhesions pelvic pain.
19 : Prior to Surgery Patient must take a shower or bathe the night prior to surgery.. Nail polish, make-up and jewelry should be removed the night before surgery. Wearing loose-fitting clothes to prevent any unnecessary pressure on the abdomen on the day of surgery.
20 : Immediately Before Surgery Immediately prior to surgery 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 the patient or should be left at home.
21 : In the Operating Room
22 : In the Operating Room
23 : In the Operating Room
24 : In the Operating Room
25 : In the Operating Room
26 : In the Operating Room
27 : In the Operating Room
28 : In the Operating Room
29 : In the Operating Room
30 : In the Operating Room
31 : After Surgery Early mobilization Checking vital signs: blood pressure, pulse and temperature frequently. Checking the dressing and intravenous. If the patient is cold, an extra blanket given The nurse or physician will tell the patient when he will be allowed to drink something
32 : discuss the findings with your patient and his family immediately after the surgical procedure is complete.
33 : After Surgery Kept in Surgery Center for approximately three or four hours after the procedure.
34 : Medication will be available for pain or nausea.
35 : Diet consume only clear liquids (juices, Jello, or both) until the patient pass flatus or have a bowel movement. At this time, may begin to advance the diet. To eat light, easily digested food for a few days.
36 : activity To get up and move about, even through may not want to. Increase the 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. Not to engage in strenuous activity until after the first post-op visit at office.

 

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