University of California - Irvine Medical Center, Orange, CA Laparoscopic Surgery Brian Nguyen University of California - Irvine Medical Center, Orange, CA

Laparoscopic Surgery Minimally invasive technique Introduced in 1987 Utilizes 3+ small incisions in abdomen Trochar placed in ports Laparoscope passed through trochar Key tool is laparoscope Transmit images from cavity to monitors Surgeon’s eyes First performed 1987 laparoscopic cholecystectomy .5-1cm incisions Carbon dioxide (CO2) is put into the abdomen through a special needle that is inserted just below the navel. This gas helps to separate the organs inside the abdominal cavity, making it easier for the physician to see the reproductive organs during laparoscopy. Laparoscopic grasping forceps, needle holders, scisscors a one-half inch fiber-optic rod with a light source and video camera

Laparoscope

Laparoscopic Surgery

Laparoscopic Surgery

Laparoscopic View

Procedures Gastrointestinal surgery Gynecologic surgery Urology Hand-access device Allows for pancreatic, liver and biliary procedures Hand access devices allow surgeon to place a hand into the abdomen during laparoscopic surgery and perform functions previously only available to open surgery.

Benefits Less pain Faster return to function Less scarring Shorter hospital stay (1-3 days) Less scarring Less post-operative complications SSI reduced Less SSI Traditional treatment requires midline abdominal incision and recovery period of 4-8 weeks

Benefits

Benefits No large midline abdominal incision

Comparison of Colectomy for Diverticulitis   Laparoscopic Open Typical operative time (h) 3 2.5 Typical length of stay (d) 3–4 7 Typical return to work (wks) 2 6 OR cost Higher Lower Wound infection rate (%) 5 10 Incisional hernia rate (%) Risk of postoperative small bowel obstruction Low Moderate Applicability in urgent setting Unknown Yes Importance of surgeon (procedure-specific experience) Critical Routine Bordeianou L, Rattner D. 2010. Is laparoscopic sigmoid colectomy for diverticulitis the new gold standard? Gastroenterology. 138(7): 2213-6.

Challenges Requires more technical experience Adhesions Learning curve > 40 cases Adhesions Risk of puncture, injury Risk of conversion Bleeding, leakage