Laparoscopy To examine peritoneal cavity and its viscera A type of endoscope, called a laparoscope, is placed through a small ______________ in the skin of the ventral abdomen *What was the other type of endoscopy that requires an incision?

Laparoscopy: Advantages Smaller incisions Decreased hospitalization time Lower post operative infection rate Decreased post-op pain

Laparoscopy: Contraindications

Laparoscopy Equipment Veress insufflation needle Gas insufflator and hose Trocar Cannula Laparoscope Fiber-optic light cable Light source Camera/video system (optional)

Laparoscopic Equipment Veress insufflation needle Used during insufflation of the peritoneal cavity Needle pierces through abdominal layers, into peritoneal cavity; left in place During insufflation set-up: _________ person will connect hose to the veress needle ____________ person will connect other end of hose to the gas insufflator

Gas Insufflator Tubing is connected from the gas insufflator to the Veress needle.

Laparoscopic Equipment Gas insufflator Machine that allows a gas to continuously expand the abdominal cavity Required for better visualization of the viscera Other parts needed: insufflation needle, sterile hose, and gas cylinder ______________ – the recommended gas due to rapid absorption Flow rate of __________________ Nitrous oxide and room air are also options (not common) Must monitor intra-abdominal pressure! Not to exceed ______________

Laparoscopic Equipment Trocar–cannula units Sharp trocar (inside of the cannula) punches through the abdominal wall Sharp trocar can be replaced with a blunt trocar or the laparoscope Cannula is left in place

Laparoscopic Equipment Laparoscope _________, metal tube with a light port Can also have an instrument port Come in various lengths and diameters Cannot be autoclaved! Use: ____________________

Laparoscopic Equipment Fiber optic light cable and light source The cable emits light from the source, through the scope.

Laparoscopic Equipment Camera/video system (optional)

Laparoscopic Equipment Camera/video system

Laparoscopic Equipment Hand instruments These instruments can be passed through cannulas of accessory ports to aid in biopsy retrieval or to perform surgical procedures. *Can grasp, cut, cauterize, staple, or biopsy.

Laparoscopic Equipment Biopsy and grasping hand instrument tips

Laparoscopy Procedure Patient prep: fasting, bladder expressed Clip from _________ process to ___________; surgical scrub Recumbency depends on procedure Draping Surgeon will remove scope from sterile packaging Sterile sleeve is used to cover the camera; scope placed on the head of the camera (camera does not get sterilized) Skin incision made Entry of Veress needle  trocar is ___________  insufflation tubing can be connected to the needle Second skin incision made Entry of trocar-cannula  trocar is _______________  scope is inserted Any other ports are created

Laparoscopic Procedure

Laparoscopic Procedure

Laparoscopic Procedure https://www.youtube.com/watch?v=qOp_GArRWRQ&nohtml5=False