laparoscopic abdominal surgery

Question 1

definition of laproscopic abdominal surgery

Answer 1

minimal access surgery of the abdomen or pelvis

creation of pneumoperitoneum - then a rigid endoscope is introduced into the peritoneal cavity through a sleeve

for inspection and to guide manipulation by other insturments in other ports

Question 2

diagnostic indications for laproscopy

Answer 2

investigation of abdo or pelvic pain

focal liver disease

abdo mass

staging of malignant disease

directed biopsy

emergency evaluation of abdo trauma

Question 3

therapeutic indictions for laproscopy

Answer 3

abdo operations

cholecystectomy

appendicectomy

fundoplication

hernia repair

splenectomy

adrenalectomy

colectomy

prostatectomy

nephrectomy

rectopexy

nephrectomy for benign disease

palliation of incurable disease by resection/bypass

can assist in other procedures - laparoscopic hysterectomy

Question 4

absolute CI for laproscopy

Answer 4

active infection in abdo wall by entry sites

Question 5

relative CI for laproscopy

Answer 5

uncorrected coagulopathy

resp insufficiency

distended bowel

obestity and previous surgery - increased liklihood of adhesions

Question 6

immediate complications of laproscopy

Answer 6

injury to viscera or vessels

extraperitoneal insufflation

diaphragmatic splinting due to excessive insufflation

pneumothorax

gas embolism

risk have to convert to open

Question 7

early complications of laproscopy

Answer 7

shoulder tip pain

wound infection

unrecognised visceral injury - peritonitis following bowel injury/bile duct injury

Question 8

late complications of laproscopy

Answer 8

incisional hernia

port-site met in cases of malignancy

Question 9

procedure for laproscopy

Answer 9

either GA or LA

prep - NG tube and catheter can decompress the stomach adn bladder

pneumoperitoneum

• transverse/lonitudinal inra or supraumbilical incision
• open
  
  • linea alba identified and incised
  • peritoneum identified - picked up with 2 clips and opened (ensuring no bowel in clips)
  • threaded cannula used to minimise the gas leak
• closed
  
  • abdo wall manually elevated
  • Veress needle introduced into the peritoneal cavity
  • controlled pressure insufflation of peritoneal cavity with CO2
  • more risk of damage to the bowel or blood vessels as done blind

insertion of laparoscope - introduced after adjustment of the white balance (to compensate for the yellow light of the halogen bulb) - used to visualise the peritoneal cavity and guide introduction of the other ports

closure - ports removed, deflation of pneumoperitoneum, wound closure

Question 10

anatomy of laproscopy

Answer 10

physiological consequence of pneumoperitoneum are usually well tolerated

less so if cardiac disease:

• low CO, high systemic and pulmonary vascular resistence, high cardiac preload, reduced hepatic, splanchnic and renal flow

metabolic and autonomic - increased renin and aldoseterone, sympathomimetic response and renal vasoconstriction

Question 11

advantage of laparoscopy

Answer 11

pt feels better sooner

less post op pain

return to work sooner

fewer complications

Question 12

challenges of laparoscopy

Answer 12

cant palpate organs - harder to locate lesions before resection

2d image - different appearance of anatomy