1. Laparoscopic Insufflation
The Society of American Gastrointestinal and Endoscopic Surgeons
Laparoscopic Insufflation
Iranian Association of Surgeons
Association of Iranian Endoscopic Surgeons
Dr.Nazari,MD
SAGES
The Society of Endoscopic and Laparoscopic Surgeons of Asia

2. The Pioneers1
The great physician, Hippocrates of Ancient Greece( circa BC) made the original reference to a speculum to examine the rectum.

3. The Pioneers2
In the early 1800s, Philip Bozzini of Austria examined the urethra of a patient using a simple tube and candlelight. (Basic design of Lichtleiter was a instrument for future development of endoscopes)
Segalas in Paris, John Fisher in USA, Desormeaux in Paris developed their improved cystoscopes.

4. The Pioneers3
Bruck, a dentist, developed a platinum wire cooled by water to illuminate the inside of the mouth.
Based on Bruck design, Nitze finally developed his first improved cystoscope in 1855 in which the light rays were gathered into his instrument via mirrors.
Thomas Edison invented the incandescnt light bulb.(1879)
Newman of Glasgow miniaturzed Edison`s invention and incorporated it into the Nitze`s cystoscope(first Laparoscop).

5. The Pioneers4
Georg Kelling of Dresden performed the first cholecystectomy in living dog(COELIOSCOPIE -1902) / the first human laparoscopy with pneumoperitoneum using room air insufflation with Nitze cystoscope.

6. The first experimental laparoscopy
was performed in Berlin in 1901 by the Georg Kelling, who used a cystoscope
He insufflated the abdomen of a dog with air.

7. The Pioneers 5
Jacobaeus of Sweden presented his series of patients who had laparoscopy in 1910 (published a series of over 100 laparoscopy and thoracoscopy(LAPAROSCOPY).

8. The Pioneers 6
Dimitri von Ott from St.Petersburg examined the intraabdominal contents and the pelvis via an inscision in the vaginal vault to insert a speculum to examine the pelvis./Gynecologic laparoscopy/ (1901)

9. Laparoscopy Laparotomy

10. Advanced Laparoscopic Room

11. Recommended Set for Advanced Laparoscopic Surgery
Forward-Oblique Telescope30(10mm)
Trocars(6mm,11mm)
Liver Retractor (Cuscheri`s)
Dissecting & Grasping forceps
Scissors
Dissecting Electrode ,L-Shaped
Bipolar Grasping forceps
Suction and irrigation handle +Unit
Needle holder & Knot tier
Clip Applicator
Light source & Accessories
Endoflator +/- Veress needle
Color Monitors

12. Electronic Endoflator

13. Electronic Thermoflator

14. Veress needle
Veress needle was invented by a chest physician for aspiration of pleural effusion keeping in mind that its spring mechanism and blunt tip will prevent the injury of lung tissue..
Veress needle is available in three length 80mm, 100mm, 120mm.
Spring action of Veress needle should be checked.
Patency of Veress Needle should be checked.
Veress needle should be held like a dart at the time of insertion.

15. Veress needle
Veress needle consists of an outer cannula with a beveled needle point for cutting through tissues. Inside the cannula is an inner stylet, which is loaded with a spring that spring forward in response to the sudden decrease in pressure encountered upon crossing the abdominal wall and entering the peritoneal cavity. The lateral hole on this stylet enables CO2 gas to be delivered intra-abdominally

16. Veress needle Veress needle should be checked: 1-Before insertion
-Patency
-Spring movement
2-After insertion
-Saline drop test
-Injection/Aspiration test

17. Closed Insertion

18. Umbilical entrance

19. Umbilical entrance

20. Pre-Pritoneal Insufflation

21. Other Potential Sites

22. Non-obese Patient

23. Overweight Patient

24. Obese Patient

25. Open Insertion

26. Open Insertion

27. Hasson Trocar

28. Trocar Insertion

29. Complications