By Daniel Kruschinski
Physiologically, gasless laparoscopy is much less invasive than pneuomoperitoneum insufflation, permitting the doctor to accomplish laparoscopic surgical procedure in high-risk sufferers with stipulations reminiscent of middle insufficiency, lung obstruction, and being pregnant.
Exploring the advantages of lift-laparoscopy and its cost-effectiveness for sufferers, surgeons, hospitals, and the healthcare approach, this article discusses the demanding situations concerned with gasless laparoscopy, the diversity of functions of the strategy, and new demanding situations within the box. With whole insurance of surgeries, An Atlas of raise Laparoscopy is a priceless advisor to utilizing this minimally invasive surgical procedure.
Read or Download Atlas of Lift-Laparoscopy: The New Concept of Gasless Laparoscopy (Encyclopedia of Visual Medicine Series) PDF
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Extra info for Atlas of Lift-Laparoscopy: The New Concept of Gasless Laparoscopy (Encyclopedia of Visual Medicine Series)
If extensive surgery is likely to be carried out, and bowel manipulation or injury anticipated, as in the case of extensive adhesions or endometriosis, it is advisable to administer a mechanical bowel preparation prior to surgery. The use of a nasogastric tube is not strictly mandatory, as no blind puncture to insert a trocar is to be performed. 45 184214118X_Ch05 31/1/07 10:06 AM Page 46 ATLAS OF LIFT-LAPAROSCOPY ANESTHESIA If general anesthesia is chosen and the operating time is scheduled to be more than 90 minutes, the anesthetist should perform a TIVA (total intravenous anesthesia) without the use of N2O, as nitrous oxide begins to inflate the bowel after 90–120 minutes, with the consequence that the distended bowel is placed in the pouch of Douglas and might disturb parts of the operation.
26 The abdominal cavity can then be elevated using one hand while the other hand is holding the endoscope. The trocar sheath is removed from the incision while the optic remains in the abdomen. 27 To prevent hernia formation, the fascia of the umbilical and ancillary ports should be closed. Closure of ancillary ports should be performed under endoscopic visualization. 28 As the ancillary ports can be introduced in the suprapubic region very close to each other and about 1 cm under the pubic hairline, the cosmetic results obtained by lift-laparoscopy are better than in pneumoperitoneum laparoscopy.
A steep Trendelenburg position (up to 30°) allows the bowel to slide to the upper abdominal quadrant that serves as a ‘reservoir’ for the intestine. Routinely, two ancillary ports can be introduced in the suprapubic region. ) and about 1 cm under the pubic hairline, since using conventional curved instruments makes it possible to reach all pelvic organs and structures. After a few weeks the pubic hair covers the incisions and the cosmetic results obtained by this technique are better than in pneumoperitoneum laparoscopy.
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