Preventing entry-related gynaecological Lap injuries RCOG 2008 + Diagnostic Lap consent RCOG 2017

Question 1

Risk of serious complication from Dx Lap

Answer 1

2/1000

Question 2

What % of bowel injuries are not recognised at time of laparoscopy?

Answer 2

15%

Question 3

Diagnostic Lap - risk hernia at site entry

Answer 3

1/100

Question 4

Diagnostic Lap risk death

Answer 4

3-8/100,000

Question 5

What is the intra-abdominal pressure before inserting primary trochar

Answer 5

20-25mmgHg

Question 6

Once insertion of trochar is complete, distention pressure should be reduced to what?

Answer 6

12-15mmHg

Question 7

How to insert primary trochar

Answer 7

90degrees to skin
Thinnest part of abdominal bass, base of umbilicus, stop as soon as in abdo cavity
360 degree check for adherent bowel

Question 8

If concern bowel may be under umbilicus?

Answer 8

Primary trochar should be visualised from secondary port, preferable with 5mm laparoscope

Question 9

What is the name of open entry technique at the umbilicus?

Answer 9

Hanssons technique

Question 10

What is the alternative site for primary trochar or verses needle insertion?

Answer 10

Palmer’s point
3cm below L costal margin in midclaviclar line
25mmHg pressure, insert 2-5mm endoscope to inspect adhesions , then insert trochar

Question 11

Rates of umbilical adhesion formation after midline laparotomy

Answer 11

50%

Question 12

Rates of umbilical adhesion formation after lower transverse C/S

Answer 12

23%

Question 13

How should secondary port be inserted?

Answer 13

Direct vision, maintaining 20-25mmgHg
Visualise the inferior epigastric vessel
One tracer has pierced the peritoneum, angle towards the anterior pelvis under visual control

Question 14

What entry techniques are recommended for the primary entry in women who are morbidly obese?

Answer 14

Hasson or palmers point

Question 15

What is the mean vertical distance from umbilicus to peritoneum in morbidly obese women i?

Answer 15

6cm +/-3cm

Question 16

If insertion of port at 45 degrees in morbidly obese women what is the fiestnace to peritoneum>

Answer 16

11-16cm, too long for standard verses needle

Question 17

Which women are highest risk of vascular injury?

Answer 17

Yong, thin, P0, well developed abdominal muscles.
Aorta may lie <2.5cm under skin

Consider Hanson or palmer point

Question 18

Describe the location of the inferior epigastric arteries seen at laparoscopy

Answer 18

Branch external iliac artery, origin just above inguinal ligament. Lie medial to the round ligament where it passes into deep inguinal ring & lateral to the obliterated umbilical arteries (median umbilical ligament)

Question 19

How often is the inferior epigastric artery injured at laproscopy?

Answer 19

2%