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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

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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 Risk of serious complication requiring LAPAROTOMY 3-5 per 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 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

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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 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

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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”

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27 Thank You


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