What is laparoscopy?
Minimally invasive surgical technique using gas to insufflate the peritoneum and instruments manipulated through ports introduced through small incisions with video camera guidance
What gas is used in laparoscopy and why?
CO2 because the better solubility in blood and thus less risk of gas embolism (also noncombustible)
Which operations are performed with laparoscopy?
Cholecystectomy, appendectomy, inguinal hernia repair, ventral hernia repair, Nissen fundoplication. (Also bowel resection, colostomy, surgery for PUD, colectomy, splenectomy, adrenalectomy.)
What are the contraindications to laparoscopy?
Absolute: hypovolemic shock, severe cardiac decompensation Relative: extensive intraperitoneal adhesions, diaphragmatic hernia, COPD
What are the associated complications with laparoscopy?
PTX, bleeding, perforating injuries, infection, intestinal injuries, solid organ injury, major vascular injury, CO2 embolus, bladder injury, hernia at larger trocar sites, DVT
What are the classic findings with a CO2 gas embolus?
1. Hypotension 2. Decreased end-tidal CO2 (low flow to lung) 3. Mill-wheel murmur
What prophylactic measure should every patient get when they are going to have a laparoscopic procedure?
SCD boots (Sequential Compression Device)
What are the cardiovascular effects of a pneumoperitoneum?
Increased afterload and decreased preload (but the CVP and PCWP are deceivingly elevated)
What is the effect of CO2 insufflation on end-tidal CO2 levels?
Increased as a result of absorption of CO2 into the bloodstream. The body compensates with increased ventilation and blows the extra CO2 off and thus there is no acidosis.
What are the advantages of laparoscopy over laparotomy?
Shorter hospitalization, less pain and scarring, lower cost, decreased ileus
What is the Veress needle?
Needle with spring-loaded, retractable blunt inner-protective tube that protrudes from the needle end when it enters peritoneal cavity. Used for blind entrance and then insufflation of CO2 through the Veress needle.
How can it be verified that the Veress needle is in the peritoneum?
Syringe of saline. Saline should flow freely without pressure through the needle drop test.
If the Veress needle is not in the peritoneal cavity, what happens to the CO2 flow/pressure?
Flow decreases and pressure is high
What is the Hasson technique?
No Veress needle. Cut down and place trocar under direct visualization.
What is the cause of post-laparoscopic shoulder pain?
Referred pain from CO2 on diaphragm and diaphragm stretch
What is a laparoscopic-assisted procedure?
Laparoscopic dissection, then part of the procedure is performed through an open incision
What is FRED?
Fog Reduction Elimination Device: Sponge with anti-fog solution used to coat the camera lens
At what length must you close trocar sites?
> 5 mm should be closed
How do you get the spleen out through a trocar site after a laparoscopic splenectomy?
Morcellation in a bag, then remove piecemeal
What is an IOC?
What is the safest time for laparoscopy during pregnancy?