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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”
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Presented by Barbara Parker, CPC Prepared by Lori Dafoe, CPC Understanding How to Code Colonoscopies.
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INTRAVENOUS CANNULATION Eileen Whitehead Cannulation The aim of intravenous management is safe, effective delivery of treatment without discomfort.
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Upper GI Bleeding Presenter: Dr. Abdulaziz Almusallam Moderator: Dr. Maher Morris.
1. 2 Module 1: Electrical Fundamentals Objective Define electricity Identify mechanisms for distributing electricity (how it travels) Identify required.
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Bleeding time is a medical test done on someone to assess their platelet function, count and integrity of the blood vessels.
To Do Or Not To Do (about the hysterectomy) Dr Muhammad El Hennawy Ob/gyn specialist Rass el barr - Dumyat – Egypt Mobile
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Agricultural Lab Equipment and Safety Competencies
Vasectomy for Men Simple surgical procedure Usually cannot be reversed. Please consider carefully: Might you want more children in future? What if you.
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Listening to Learn NE-II-159. Learning Objectives Become aware of how we listen Explore good listening as a communication skill Practice the skills of.
Quality in Practice Claire Tester Senior Strategic Lead for Quality The Quality Unit Scottish Government Health & Social Care Directorates 7 th August.
Meeting the Musculo-Skeletal Challenge Avril Imison Dept of Health:Access Policy Lead - Orthopaedics and Musculo-Skeletal Services.
CMS Operator Training September 20, 2006 CMS Operator Training September, 2006.
Subcutaneous (C), superficial (B), deep (A) The rectum and anal canal are supplied by the superior rectal artery (the continuation of the inferior.
2 © 2012 Delmar, Cengage Learning Chapter 3 Shielded Metal Arc Welding, Setup, and Operation.
PERMIT TO WORK P.T.W MDPI/GOODWILL OIL AND GAS TRAINING.
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ENDOSCOPE INTRODUCTION The name endoscope is derived from two Greek words which are endom (within) and skopein (view). The endoscope is an optical instrument.
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