Laparoscopy

To examine peritoneal cavity and its viscera A type of endoscope called a laparoscope is placed through a small

incision in the ventral abdomenCan 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)

Laparoscopy: Advantages

Laparoscopy: Contraindications

Laparoscopic Equipment

LaparoscopeCome in various sizesRigid, metal tube with a light port Can also have an instrument portCannot be autoclaved

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 CO2 – 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.

Gas Insufflator

Laparoscopic Equipment

Veress insufflation needleUsed during insufflation of the peritoneal cavityNeedle (trocar) pierces through abdominal layers,

into peritoneal cavity; stylet is left in placeSurgeon will connect hosing to the needleYou will connect hose to the insufflator

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

Laparoscopic Equipment

Fiber optic light cable and light source The cable emits light from the source, through the scope.

Laparoscopic Equipment

Camera/video system (optional)

Laparoscopic Equipment

Camera/video system

Laparoscopic Equipment

Hand instrumentsThese instruments can bepassed through cannulas of accessory ports to aid in biopsy retrieval or toperform surgical procedures.

Can grasp, cut, cauterize, staple, or biopsy.

Laparoscopic Equipment

Biopsy and grasping hand instrument tips

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

Laparoscopic Procedure

Laparoscopic Procedure

Laparoscopic Procedure