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

2. 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

3. Laparoscope

4. Laparoscopic Surgery

5. Laparoscopic Surgery

6. Laparoscopic View

7. 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.

8. 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

9. Benefits

10. Benefits
No large midline abdominal incision

11. 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 Is laparoscopic sigmoid colectomy for diverticulitis the new gold standard? Gastroenterology. 138(7):

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