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Safe Laparoscopy Reducing Complications Jonathan Frappell FRCS.FRCOG.
Driving without due care and attention
Equipment Stack system Camera/TV Light source Light lead High speed insufflator Video/Still recorder
Equipment Grasping forceps Johannes Manhes Scissors Diathermy monopolar/bipolar Suction/irrigation 5/ 10cms
Consent Risk of serious complication requiring LAPAROTOMY 3-5 per per 1000 intestinal injury 1 per 1000 vascular injury
Safe Entry RCOG Greentop Guideline No.48(Oct.2007) SratOG Module 2 Perioperative care in gynaecology
Safe entry Primary trocar Veress needle technique Hasson open entry Alternative entry site “Safety” trocars optical Ternamian screw ‘Step’ system
Safe Entry Veress needle Patient flat Sharp Intra-umbilical vertical incision Tests of correct placement Maximum of two attempts Insufflate to 25mmHg
Safe Entry HIGH RISK Patients Very thin Hasson open entry Previous Laparotomy Avoid scars Consider a)Hasson entry b)Alternative entry site Palmer’s point Obese Hasson Optical ports
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
Safe Entry After insertion of primary trocar Reduce pressure to 15mmHg Visual check Head down tilt Secondary trocars inserted under direct vision
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
Electrical Energy Bipolar Current flows only between tips of the forceps “blades” Excellent for haemostasis No risk of stray current damage
Electrical Energy Monopolar Risk of stray current Cutting current has lower voltage than coagulating current
Post-op Recovery 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
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”
Royal Free Hospital, London Endoscopic Surgery: Risk Management and Medico-Legal issues.
SAFE USE OF DIATHERMY RACHEAL AFOLABI, RN, RM, H. Dip. PERI-OPERATIVE NURSING, H.Dip. HEALTH SYSTEM MANAGEMENT.
Laparoscopy To examine peritoneal cavity and its viscera A type of endoscope called a laparoscope is placed through a small incision in the ventral.
Diagnostic Laparoscopy Alexander Parata. Diagnostic Laparoscopy - a procedure that allows a health care provider to look directly at the contents of a.
Objective In Japan, laparoscopic inguinal herniorrhaphy(LH) is not popular. We performed a retrospective study to evaluate the results of LH in our hospital.
Electrosurgical Unit. Overview History Components Placement of active and inactive electrode. Monopolar/Bipolar Functions Safety considerations.
Safe Laparoscopic Entry SAFE ENTRY IN LAPAROSCOPY Yasser Orief M.D., PhD. Lecturer of Obstetrics & Gynecology, Alexandria University Fellow, Lϋbeck University,
Laparoscopic Instruments & Tower 5 th Practice Department of Surgical Research and Techniques.
Laparoscopic surgery Meaning of Laparoscopy Laparoscopy is minimally invasive technique for viewing the internal structure of the abdominal cavity. The.
Safe Laparoscopic Access: technologies and techniques 洪煥程 醫師 台北榮總 婦產部
Laparoscopic Instruments & Tower 5 th Practical Department of Surgical Research and Techniques.
الجامعة السورية الخاصة كلية الطب البشري قسم الجراحة LAPAROSCOPIC SURGERY M.A.Kubtan, MD - FRCS M.A.K1.
High voltage testing of laparoscopic accessories Bruce Morrison Hunter Area Health Service John Hunter Hospital Newcastle, NSW.
Laparoscopic Insufflation Dr.Nazari,MD SAGES The Society of American Gastrointestinal and Endoscopic Surgeons The Society of Endoscopic and Laparoscopic.
Laparoscopic Grasping Instrument by Lynn Murray, Becky Jones, Ann Sagstetter and Richard Bamberg.
Diathermy Kenny Low Dec 2009 Urology registrar Thursday teaching.
Complications of laparoscopic surgery Fereshteh Daneshmand M.D.
Suturing Tanith D. Turner-Lumb Clinical Education Manager BRI.
Suture Materials ABSORBABLE: lose their tensile strength within 60 days. NON- ABSORBABLE:
What is a Watt? Everything you ever wanted to know about Electrosurgery. Fahad bamehriz, MD.
Assisting with minor surgery and suture removal. Minor Surgery includes Removal of warts, cysts, tumors, growths, foreign objects Performing biopsies.
ENDOSCOPY. TERMINAL OBJECTIVE n State the duties and responsibilities of the scrub and circulator technologist during endoscopic surgery.
TEMPLATE DESIGN © Major surgery in a minor way Sin WT, Woldman S, Attilia B, Gauthaman N, Karpouzis H, Patwardhan M South.
Total Laparoscopic Hysterectomy Andrew Doering Minimally Invasive Surgery Lab University of Kentucky.
1.What do you mean by Electrosurgery? What is Surgical Diathermy Machine? 2.Explain Monopolar Electrosurgery Technique with block diagram. Where it is.
TEMPLATE DESIGN © Laparoscopic assisted vaginal hysterectomy in a District General Hospital- Audit of clinical practice.
Dr alibakhshi general&cancer surgeon. HEMATOMA AND SEROMA Treatment — Small hematomas and seromas can be managed expectantly, while large collections.
Dr. Raghad Abdul Halim. The single most important change in gynecological surgical practice over the last 20–30 years is the endoscopic surgery.
Requires a working knowledge of the sequential steps for a specific surgical procedure based upon four concepts: Approach Procedure Possible.
Abdominal Retractor Tray. Malleables Ribbons Harrington / Sweethart / Valentine Richardson Wide Deaver Baby Deaver.
Robotic Assisted Laparoscopic Pyeloplasty Dr J. Hagerty Pediatric Urology
SILS Complications Dan Geisler, MD, FACS, FASCRS.
Basic Surgical Instruments Professor Magdy Amin RIAD Professor of Otolaryngology. Ain shames University Senior Lecturer in Otolaryngology University of.
Dr.Saifuddin Ahmed IMO Department of surgery, Unit 1 Chittagong Medical College Hospital.
Best Access to the Abdomen Bipan Chand, MD FACS, FASGE, FASMBS Associate Professor Chief of Minimally Invasive Surgery Loyola University Chicago Stritch.
Copyright © 2016 McGraw-Hill Education. All rights reserved. No reproduction or distribution without the prior written consent of McGraw-Hill Education.
Surgical Procedures for Adults and Adolescents Chapter 5 Chapter 5: Surgical Procedures for Adults and Adolescents 1.
TEMPLATE DESIGN © How well do we counsel women prior to laparoscopic procedures? Khaund A, Jamieson R South and North.
A1. MODULE – Asepsis and antisepsis A2. MODULE – Surgical deontology A3. MODULE – Surgical interventions A4. MODULE – Bleedings A4. practical: skin incisison,
Laparoscopic Placement of the BardPort Intraperitoneal Catheter and Reservoir Dr. Arlan F. Fuller, Jr. Gillette Center for Women's Oncology Massachusetts.
VARICOSE VEINS Power point by: Laurie Harriet Amber Gabby.
Complex Cases and Future Directions for Ventral Hernia Repair Bruce Ramshaw MD FACS Consultant, Halifax Health Daytona Beach, FL.
بسم الله الرحمن الرحيم IN THE NAME OF ALLAH THE MOST GRACEFUL THE MOST MERCIFUL.
Surgical Instruments and Terminology 4-H Veterinary Science Extension Veterinary Medicine Texas AgriLife Extension Service College of Veterinary Medicine.
Chapter 28 Surgical Instruments and Aseptic Technique.
Basic Suturing Presented by Angel Sheridan FNP. Objectives Identify important components in evaluating lacerations and wound healing. Identify and demonstrate.
Veterinary Clinical Procedures Surgeries. The Surgery Team Surgery Team consists of a surgeon, an anesthetist (or a few sterile assistants-scrub nurse),
Modified Instrumentation to Simplify Big Bubble technique for Deep Anterior Lamellar Keratoplasty (DALK) Dr Rajesh Fogla DNB, FRCS, MMed Senior Consultant,
Gynaecological Endoscopy Max Brinsmead MB BS PhD May 2015.
The Perioperative Nursing Role January 12th, 2009.
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