1. Laparoscopy  To examine peritoneal cavity and its viscera  A type of endoscope called a laparoscope is placed through a small incision in the ventral abdomen  Can be midline or opening into the abdominal wall (lateral to midline)  Necessary equipment  Laparoscope  Trocar  Cannula  Fiber-optic light cable  Light source  Veress insufflation needle  Gas insufflator and hose  Camera/video system (optional)  To examine peritoneal cavity and its viscera  A type of endoscope called a laparoscope is placed through a small incision in the ventral abdomen  Can be midline or opening into the abdominal wall (lateral to midline)  Necessary equipment  Laparoscope  Trocar  Cannula  Fiber-optic light cable  Light source  Veress insufflation needle  Gas insufflator and hose  Camera/video system (optional)

2. Laparoscopy: Advantages

3. Laparoscopy: Contraindications

4. Laparoscopic Equipment Laparoscope  Come in various sizes  Rigid, metal tube with a light port  Can also have an instrument port  Cannot be autoclaved Laparoscope  Come in various sizes  Rigid, metal tube with a light port  Can also have an instrument port  Cannot be autoclaved

5. Laparoscopic Equipment Gas insufflator  Machine that allows a gas to continuously insufflate the abdominal cavity  Required for better visualization of the viscera  Other parts needed: insufflation needle, sterile hose, and gas  CO 2 – the recommended gas due to rapid absorption  Nitrous oxide and room air are also options  Must monitor intra-abdominal pressure!  Not to exceed 15 mmHg Gas insufflator  Machine that allows a gas to continuously insufflate the abdominal cavity  Required for better visualization of the viscera  Other parts needed: insufflation needle, sterile hose, and gas  CO 2 – the recommended gas due to rapid absorption  Nitrous oxide and room air are also options  Must monitor intra-abdominal pressure!  Not to exceed 15 mmHg *Tubing is connected from the gas insufflator to the Veress needle.

6. Gas Insufflator

7. Laparoscopic Equipment Veress insufflation needle  Used during insufflation of the peritoneal cavity  Needle (trocar) pierces through abdominal layers, into peritoneal cavity; stylet is left in place  Surgeon will connect hosing to the needle  You will connect hose to the insufflator Veress insufflation needle  Used during insufflation of the peritoneal cavity  Needle (trocar) pierces through abdominal layers, into peritoneal cavity; stylet is left in place  Surgeon will connect hosing to the needle  You will connect hose to the insufflator

8. Laparoscopic Equipment Trocar–cannula units  Trocar punches through the abdominal wall  Cannula follows, and is left in place so the laparoscope can be inserted through it Trocar–cannula units  Trocar punches through the abdominal wall  Cannula follows, and is left in place so the laparoscope can be inserted through it

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

10. Laparoscopic Equipment Camera/video system (optional)

11. Laparoscopic Equipment Camera/video system

12. 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.

13. Laparoscopic Equipment Biopsy and grasping hand instrument tips

14. Laparoscopy Procedure  Patient prep: fasting, bladder expressed  Clip from xiphoid process to pubis; surgical scrub  Recumbency depends on procedure  Draping  Surgeon will remove scope from sterile packaging  Glutaraldehyde or ETCO2  Sterile sleeve 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 retracted  insufflation tubing can be connected to the needle  Second skin incision made  Entry of trocar-cannula  trocar is removed  scope is inserted  Patient prep: fasting, bladder expressed  Clip from xiphoid process to pubis; surgical scrub  Recumbency depends on procedure  Draping  Surgeon will remove scope from sterile packaging  Glutaraldehyde or ETCO2  Sterile sleeve 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 retracted  insufflation tubing can be connected to the needle  Second skin incision made  Entry of trocar-cannula  trocar is removed  scope is inserted

15. Laparoscopic Procedure