• Before Your First: Laparoscopy

  • Nov 19 2017
  • Durée : 29 min
  • Podcast

  • Résumé

  • Review anatomy– you’ll be able to see well!
    Pimped- Youtube Channel videos for laparoscopic anatomy

    What case are you doing and why?
    Review common indications, steps to procedure and potential risks/complications

    Saying hi to the patient first
    Being helpful setting up — yellowfins or stirrups for lithotomy
    Scrubbing in — ask to grab your gown/gloves for the scrub, open carefully or get help if unsure

    Abx: If entering uterus or vagina ie hyst
    Prep: infection prevention with chloraprep or something
    EtOH based, needs to evaporate before draping or risk fire!
    Vaginal prep — betadine or chlorhexidine
    Then everyone scrubs

    Let resident/attending drape unless asked.
    You may be asked to help with foley/manipulator
    Uterine manipulators: Many sizes/shapes/types
    Vagina is dirty– can’t go from vagina to abdomen

    Abdomen:
    Entry: Typically in umbilicus or just above. Can use Palmer’s Point if needed.
    Direct visualization with Hassan
    Visiport
    Veres needle
    Insufflate with CO2

    Port placement: Typically middle ⅓ of distance between ASIS and umbilicus. Avoid obvious superficial vessels and inferior epigastric –watch from below

    Common procedures:

    • Dx LSC– endometriosis, adhesions
    • Tubal ligation or bilateral salpingectomy
    • Cystectomy
    • BSO
    • Hysterectomy

    Closing ports: Close fascia on ports >5mm due to increased risk of hernia

    Post-op checks: Many LSC cases are same-day, meaning patients go home
    -Nausea/vomiting, eating/drinking, voiding, passing flatus, ambulating
    -UOP, BPs,

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