Dissection Planes Barry Salky, MD FACS Franz W. Sichel Professor of Surgery Division of Laparoscopic Surgery The Mount Sinai Hospital New York

Dissection Planes This type of difficult dissection occurs in inflammatory processes, endometriosis, and reoperative surgery. The principles are the same as in open surgery. The question is how can we use laparoscopic techniques to solve this problem. Can we do it better?

Dissection Planes In general, start with the easiest part of the procedure first. This almost always means to find a “normal” embryological surgical plane first and work towards the pathology. Hemostasis if incredibly important in these dissections.

Dissection Planes Proper instrumentation with sharp dissection is usually the best technique, but blunt dissection has its role as well. Atraumatic graspers Hemostasis Identify anatomic planes.

Dissection Planes Inflammatory Disease

Endometriosis

Diverticulitis

Crohn’s Disease

Dissection Planes What about reoperative colon surgery? Adhesiolysis: proper plane on the bowel wall. Identify and protect the retroperiteum Sharp dissection preferred

Don’t get tripped up!

Dissection Planes It’s about the process. Be flexible in your technique. Know medial to lateral and lateral to medial. Know different instrumentation. Know the various energy sources. Keep it simple.

SAGES & CAGS host the 12 th World Congress of Endoscopic Surgery April , 2010 Gaylord National Resort and Convention Center Landover, MD (just outside Washington, DC) Registration & Program Information will be available Summer, 2009 Program Chairs: Daniel Herron, MD (SAGES Co-Chair) Barry Salky, MD (SAGES Chair) Christopher Schlachta, MD (CAGS Chair) Hosted by SAGES & CAGS Society of American Gastrointestinal and Endoscopic Surgeons and Canadian Association of General Surgeons