Module 1 Preop Assessment
Absolute CI to Laparoscopy
1) Inability to tolerate pneumoperitoneum
2) Inadequate surgeon competency
Relative CI to Laparoscopy
1) Severe cardiac, pulm disease
2) Shock states
3) Disorders of coagulation
4) Prior failed laparoscopic approach
5) “Frozen” abdomen
6) Intestinal distension
Preop History
1. cardiovascular disease patients cannot tolerate pneumoperitoneum
2. Pulmonary disease patients cannot tolerate displaced diaphragm and increased CO2
3. Cirrhosis increase bleeding
4. Pelvic radiation history
5. Previous operations including hollow viscus perforation with peritonitis, hernia with mesh, etc
Preop Exam
,Where to place trocars? Mesh placed? This can help find operative approach
Abdominal Entry
Closed (Veress, direct visualization) vs Open (Hasson) techniques
Laparoscopy in Pregnancy
Current SAGES guidelines support lap approach. Shown to decrease
wound complications, postop hypoventilation,
thromboembolic events and respiratory depression
-lower insufflation should be considered as CO2 displaces
diaphragm
-preop and postop fetal HR monitoring is sufficient usually (no need
for continuous unless other concerns)
-lower pressure can be used
-left lateral decubitus position
Consent Discussion
- Visceral or vascular injuries during entry
- Conversion to an open procedure
- Physiologic changes during insufflation especially in patients with severe cardiac or pulmonary diseases
- Laparoscopy can be used for acute abdomen
Laparoscopy and Trauma
- Usually in patients who are hemodynamically stable
, - DO NOT USE in patients with immediate life-threatening injuries and unstable vital signs
Advantages
- Less pain, fewer wound infections, reduced hospital stay, reduced morbidity and mortality, earlier
return to work
Module 2 Operating Room Setup and Patient Positioning
Answer: A – include footboard
, Answer: D
Surgeon Ergonomics
- Monitors at eye level of surgeon to reduce fatigue, need to be in line of instrument work
- Surgeon shoulders relaxed, with <30 degrees abduction, elbows bent between 90-120 degrees
- Instruments ideally between 45-60 degrees
Recognizing and Avoiding Potential for Complications
- Make sure extremities are secured
Absolute CI to Laparoscopy
1) Inability to tolerate pneumoperitoneum
2) Inadequate surgeon competency
Relative CI to Laparoscopy
1) Severe cardiac, pulm disease
2) Shock states
3) Disorders of coagulation
4) Prior failed laparoscopic approach
5) “Frozen” abdomen
6) Intestinal distension
Preop History
1. cardiovascular disease patients cannot tolerate pneumoperitoneum
2. Pulmonary disease patients cannot tolerate displaced diaphragm and increased CO2
3. Cirrhosis increase bleeding
4. Pelvic radiation history
5. Previous operations including hollow viscus perforation with peritonitis, hernia with mesh, etc
Preop Exam
,Where to place trocars? Mesh placed? This can help find operative approach
Abdominal Entry
Closed (Veress, direct visualization) vs Open (Hasson) techniques
Laparoscopy in Pregnancy
Current SAGES guidelines support lap approach. Shown to decrease
wound complications, postop hypoventilation,
thromboembolic events and respiratory depression
-lower insufflation should be considered as CO2 displaces
diaphragm
-preop and postop fetal HR monitoring is sufficient usually (no need
for continuous unless other concerns)
-lower pressure can be used
-left lateral decubitus position
Consent Discussion
- Visceral or vascular injuries during entry
- Conversion to an open procedure
- Physiologic changes during insufflation especially in patients with severe cardiac or pulmonary diseases
- Laparoscopy can be used for acute abdomen
Laparoscopy and Trauma
- Usually in patients who are hemodynamically stable
, - DO NOT USE in patients with immediate life-threatening injuries and unstable vital signs
Advantages
- Less pain, fewer wound infections, reduced hospital stay, reduced morbidity and mortality, earlier
return to work
Module 2 Operating Room Setup and Patient Positioning
Answer: A – include footboard
, Answer: D
Surgeon Ergonomics
- Monitors at eye level of surgeon to reduce fatigue, need to be in line of instrument work
- Surgeon shoulders relaxed, with <30 degrees abduction, elbows bent between 90-120 degrees
- Instruments ideally between 45-60 degrees
Recognizing and Avoiding Potential for Complications
- Make sure extremities are secured
