Download Laparoscopic surgery

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Lichele Palmer
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Andrea Stubbs
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Christy Scritchfield
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Randi Bonnell
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Laparoscopic surgery, also referred to as minimally
invasive surgery, describes the performance of
surgical procedures with the assistance of a video
camera and several thin instruments. During the
surgical procedure, small incisions of up to half an inch
are made and plastic tubes called ports are placed
through these incisions. The camera and the
instruments are then introduced through the ports
which allow access to the inside of the patient.
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The camera transmits an image of the organs inside the
abdomen onto a television monitor. The surgeon is not
able to see directly into the patient without the
traditional large incision. The video camera becomes
the surgeon’s eyes in laparoscopy surgery, since the
surgeon uses the image from the video camera
positioned inside the patient’s body to perform the
procedure.
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1980s: First combined with video cameras,
Laparoscopy allowed surgeons to free their hands to
work better with instruments.
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Initially used for tubaligations
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1985, First gallbladder removal in France
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Then used for the appendix and beyond
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Used for exploratory surgery in abdominal or pelvic pain or
injury
Check for tumors, find conditions that make pregnancy
difficult for women (cysts, adhesions, fibroids, infection),
cancer that may have spread to the abdomen, damage to
internal organs
Check and treat for endometriosis, ectopic pregnancy,
pelvic inflammatory disease
Biopsy
Removal of the colon and kidney during live donor
transplants
Removal of uterus, spleen, gallbladder, ovaries, appendix,
partial colon resection
Gastric Bypass, vertical banding gastroplasty
Tubal ligation
Hiatal hernia, inguinal hernia
 Gastric
Bypass Surgery
• Stomach is stapled and bowel are rerouted
 Hysterectomy
• Surgical removal of the Uterus
 Cholecystectomy
• Surgical removal of the Gallbladder
 Appendectomy
• Surgical removal of the Appendix
 Hernia
Repair
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Less post operative discomfort since the incisions are
much smaller
Cosmetic appeal – much smaller scars
Reduced blood loss, less likely to need transfusion
Quicker recovery times
Shorter hospital stays
Earlier return to full activities
There may be less internal scarring because
laparoscopy is minimally invasive compared to
standard open surgery.
Decreased risk for infection
Decreased risk for incisional hernias
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Contraindicated for patients who have adhesions from
previous abdominal procedure, or coagulation disorders
Higher risk for vascular injury, which is not recognized as
quickly as it is during open surgery
Gas embolism from CO2 with a vascular injury
Increased intra abdominal pressure from CO2 can cause
pooling of blood in legs, decreased venous return,
hypotension, increased risk for DVT
Bowel injuries: stomach, small bowel, colon, spleen
Pneumothorax from misplaced Veress needle
Electrical burns from electrodes used to maintain
hemostasis – can perforate organs and cause peritonitis
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Use disposable laparoscopes, which are usually
sharper and require less force to insert; lessens risk of
compressing trocar against bowel or blood vessels.
Use ultrasounds to “map” abdominal wall
Some trocars have plastic sheaths that spring to cover
sharp edge after insertion
Unsurprisingly, surgeons who have performed more
Laparoscopic surgeries had less complications during
their procedures
Pre-Op
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1 hour before surgery patient should empty their
bladder
IV fluids are given: LR or NS
Medicine may be given IV to help patient relax
(Versed)
In The OR
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An airway will be placed to help patient breathe if
given general anesthesia.
Urinary catheter may be placed (depending on
surgery).
Hair may be shaved.
Abdomen and pelvic area will be washed and
sanitized.
In The OR
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During laparoscopy, a small incision is made in the
belly. More than one incision may be made if other
tools will be used during the surgery. A hollow needle
is put through the first incision and gas (carbon dioxide
or nitrous oxide) is slowly put through the needle to
inflate the abdomen. The gas lifts the abdominal wall
away from the organs inside so the doctor can see
clearly.
In The OR
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A thin, lighted tube (laparoscope) is then put through
the incision to look at the organs. Other tools can be
used to take tissue samples, fix damage, or drain cysts.
A laser may be attached to the laparoscope to help
with the surgery.
In The OR
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After the surgery, all the tools will be removed and the
gas will be released. The incisions will be closed with
stitches and covered with a bandage.
Laparoscopy takes 30 to 90 minutes, depending on
what is done, but can take longer if a condition (such as
endometriosis) is found and treated.
After Surgery
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After the laparoscopy, patient will go to the recovery
room for 2 to 4 hours.
Monitor vital signs and overall patient recovery from
surgery.
Monitor I/O’s
Patients are encouraged to get up and move around
(the sooner the better).
Patient teaching about compliance of post-surgery
instructions and medications
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Explain any special instructions from the doctor.
Patient may have some bloating from the CO2, as well
as bruising and pain around incisions for a few days.
Advise against drinking carbonated beverages for 1 to
2 days after the laparoscopy to lower chance of gas
pains and vomiting.
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The gas used during the laparoscopy can irritate the
diaphragm for a few days. Patient may experience
some pain or achiness in the site for several hours after
the laparoscopy.
Some of the gas in the abdomen may leak into the skin
and cause a crackling sound if patient rubs the skin
surrounding the stitches. This is not serious and will go
away in a few days.
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The patient can usually do normal activities the next
day, but should avoid any strenuous activity or exercise
for about a week depending on type of surgery.
Patient may be tired and have some pain for a few days
after a laparoscopy. Patient may have a mild sore throat
from the tube in the throat. Have patient use throat
lozenges and gargle with warm salt water to help sore
throat.