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Safe Laparoscopy Reducing Complications Jonathan Frappell FRCS.FRCOG.

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Presentation on theme: "Safe Laparoscopy Reducing Complications Jonathan Frappell FRCS.FRCOG."— Presentation transcript:

1 Safe Laparoscopy Reducing Complications Jonathan Frappell FRCS.FRCOG.

2 Driving without due care and attention



5 Equipment Stack system Camera/TV Light source Light lead
High speed insufflator Video/Still recorder

6 Equipment Grasping forceps Johannes Manhes Scissors Diathermy
monopolar/bipolar Suction/irrigation 5/ 10cms

7 Consent LAPAROTOMY Risk of serious complication requiring 3-5 per 1000
3 per 1000 intestinal injury 1 per 1000 vascular injury

8 Safe Entry RCOG Greentop Guideline No.48(Oct.2007) SratOG Module 2
Perioperative care in gynaecology

9 Safe entry Primary trocar Veress needle technique Hasson open entry
Alternative entry site “Safety” trocars optical Ternamian screw ‘Step’ system

10 Safe Entry Veress needle Patient flat Sharp
Intra-umbilical vertical incision Tests of correct placement Maximum of two attempts Insufflate to 25mmHg

11 Safe Entry HIGH RISK Patients Very thin Hasson open entry Avoid scars
Previous Laparotomy Avoid scars Consider a)Hasson entry b)Alternative entry site Palmer’s point Obese Hasson Optical ports

12 Major Vascular Injury Immediate Midine Laparotomy Apply pressure
Call for help Surgical/Anaesthetic O Neg Blood X match 6 units/FFP Written protocol in theatre


14 Safe Entry After insertion of primary trocar Reduce pressure to 15mmHg
Visual check Head down tilt Secondary trocars inserted under direct vision

15 Electrical Energy Check for insulation defects
Actvate only when forceps in contact with tissue Use lowest effective current setting Instrument tip and tissue gets HOT

16 Electrical Energy Bipolar
Current flows only between tips of the forceps “blades” Excellent for haemostasis No risk of stray current damage

17 Electrical Energy Monopolar Risk of stray current
Cutting current has lower voltage than coagulating current

18 Post-op Recovery Delay can be fatal
Suspect bowel damage if condition deteriorates hrs post-op <50% bowel injuries recognised at time of op. Av.time to diagnosis 1.7 days Delay can be fatal

19 Port Closure

20 John Black PRCS EWTD So lets see what that looks like in practise





25 Fundamental Attributes of a Safe Surgeon
Communication Decision making Judgment Leadership “the strength of simulation is as an adjunct rather than as an alternative to clinical experience” Which brings us back to where we started,talking of leadership and inspiration,something

26 Lifelong interest in teaching----Lecturer in Anatomy
Not everyone complementary about teachers—GBS “those who can do,etc Not nice about most professions,doctors in particular

27 Thank You

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