Laparoscopic abdominal surgery and Open abdominal surgery (incl. laparotomy)

Question 1

What are some complications of laparoscopy?

Answer 1

Acute:

• general risks of anaesthetic
• vasovagal reaction (e.g. bradycardia) in response to abdominal distension
• extra-peritoneal gas insufflation: surgical emphysema
• injury to gastro-intestinal tract
• injury to blood vessels e.g. common iliacs, deep inferior epigastric artery

Medium-term:

• Shoulder tip pain - due to diaphragm irritation by air

Question 2

What are the benefits of laparoscopy?

Answer 2

• Less pain following the procedure.
• Lower risk of complications.
• A shorter hospital stay and a quicker recovery.
• A much smaller scar.

Question 3

Define laparoscopy.

Answer 3

Intraabdominal surgical procedure where laparoscopes (thin telescopes) are used to magnify structures in abdomen. Inserted through small incisions.

Question 4

What are some indications for diagnostic laparoscopy?

Answer 4

Suspected:
Endometriosis
PID
Ectopic pregnancy
Ovarian cyst
Appendicitis

Question 5

What are some indications for laparoscopic surgery?

Answer 5

• Cholecystectomy
• Appendicectomy
• Endometriosis ablation
• Small bowel resection
• Sterilisation
• Oophrectomy
• Biopsy

Question 6

How is laparoscopy done?

Answer 6

• General anaesthesia
• 1-2cm cuts
• Camera cut below the umbilicus, and 2 or 3 other cuts (although single-port laparoscopies are done now)
• Carbon dioxide used to inflate abdomen for better visualisation
• Once finished incisions are sutured and dressings applied

Question 7

What does this scar indicate?

Answer 7

Midline laparotomy

Question 8

Label these incisions.

Answer 8

1. Kocher’s - for open cholecystectomy
2. Right para-median laparotomy
3. Midline laparotomy
4. Nephrectomy
5. McBurney’s/Gridiron - appendicectomy
6. Laparoscopy - can be used for lapchole/ appendicectomy/ gynae surgeyr
7. Left para-median - anterior rectal resection
8. Pfannenstiel (transverse suprapubic) - C-section, total abdominal hysterectomy
9. Inguinal hernia (either side) - hernia repair

Right angle to no. 5 would be Lanz for appendicectomy.