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BASIC PRINCIPLES OF LAP AROSCOPIC SURGERIES D. Diamond Ovuede• Minimal access surgery is a product of innovation in science and the Surgeon’s desire to minimise trauma - both somatic & psychological. • Laparoscopic surgery primarily is a form of minimal access surgery which deals with the abdominal cavity.• The challenges of open surgery arise mainly because of the need for adequate access to the structures to be dealt with. • The surgeon therefore has to make an incision which is usually much larger than the structure in question.• Often, in addition, there is the need for retraction of the wound margins to gain good access. • These all contribute to the trauma & morbidity ; including infection & wound dehiscence the patient may have to entertain. • These are some of the challenges which are dealt with by Laparoscopic Surgery. INDICA TION • Any intra-abdominal procedure on both Solid organs and hollow viscera. CONTRA-INDICA TION ABSOLUTE CONTRAINDICATION - Coagulopathy RELATIVE CONTRAINDICATIONS - Intra-abdominal adhesions - Morbid obesity BMI > 50 - Cardiopulmonary insufficiency - Malignancy PRINCIPLES 1. INSUFFULATION – Pneumoperitoneum is achieved using Carbon dioxide, 12-15mmHg. Important to monitor the cardiovascular system. 2. VISUALISATION - 5mm or 10mm rigid laparoscopes (Cameras) at 0, 30, 45 degrees PREP ARA TION OF P A TIENT • HISTORY – AS FOR G.A ( Coagulopathy , MI etc) • Adhesions, scars • EXAMINATION - to exclude cardiac arrythmias, ischaemic heart disease. Jaundice, abdominal scars, obesity, abdominal masses. • PRE MEDICATION – DVT Prophylaxis. 1. Get informed consent. 2. Ensure patient is fit. LAP AROSCOPIC PROCEDURES ALMOST ANY PROCEDURE. COMMONLY – • Cholecystectomy • Appendicectomy • Splenectomy • Hernia repair • Colectomies • Beriatric surgeries etc.ADVANTAGES OF LAPAROSCOPIC SURGERY 1. Better cosmetics 2. Shorter stay in hospital & early return to work. 3. Decreased stress response. 4. Less post op. Pain. 5. Less ileus 6. decreased wound complications ( infections, incisional hernia). 7. Improved vision 8. Decresed heat loss DISADVANT AGES 1. Absence of tactile feedback. 2. Visualisation – mostly 2 dimensional 3. Longer op. Time. 4. Learning curve 5. Cost is high - training - treatment - equipment. 6. Extraction of large specimens Insuffulator, light source & camera • Insufflation • VisualizationMaryland forcepExposure of the appendixInstrumentation grapersBowel grasper Trocar Placement • There must be triangulation Trocar placement for Splenectomy Camera Trocar placement in appendicectomy • 5 mnm torcar • 5-12 mm trocar • 12 mm trocar COMPLICA TIONS 1. INJURY TO VISCERA - BOWEL - NERVE INJURY – POSITIONING 2. BLEEDING 3. CARDIORESPIRATORY 4. POT METASTASIS 5. CONVERSION TO OPEN SURGERY 6. DVT• Thank Y ou