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 3-
4 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.
‫ته‌واو‬
‫پرس و وه‌ڵام‬
‫سوپاس‬