Laparoscopy

Question 1

Laparoscopy freq risks

Answer 1

• No cause for pain
• Bruising
• Should tip pain
• Wound infection
• Hernia

For ectopic- advise salpingectomy.
If salpingotomy- trophoblastic tissue can be left behind

Question 2

Laparoscopy serious risks

Answer 2

• Damage to bowel, bladder, bloods vessels needing laparotomy
• Failure to gain entry laparoscopically
• Overall serious complications 2:100
• Death, very rare 8:100 000

Question 3

Rates of injuries- overall, bowel, vascular

Answer 3

Overall- 1 – 12.5/1000 for Bowel – 0.4/1000
Vascular 0.2/1000

Question 4

Risk of serious complications

Answer 4

1:500

Question 5

High risk factors- inc risk of complications

Answer 5

BMI >35
Low BMI <20
Prev midline Abdo incision
Prev surgery/CS
IBD
Peritonitis

Question 6

Entry methods

Answer 6

• Gynae prefer veress needle
• RCOS advised open hasson

Question 7

When to abandon veress entry

Answer 7

2 attempts

Question 8

Other entry types

Answer 8

• Palmers point
• Open hasson

Question 9

Insufflation pressure

Answer 9

20-25mmHG for trocars
Operate at 12-15mmHG

Question 10

Check points for entry

Answer 10

• Check veress needle
• Flat table
• Insert needle and right angle
• 2 click
• Saline test
• 360 deg check on entry

Question 11

Adhesion formation %

Answer 11

• Umbilicus 50%
• Low transverse incision 23%

Question 12

Palmers point

Answer 12

• Left upper quad
• Mid calvicular line
• 3cm below L costal margin