1. Principles of Surgery Laparoscopic Skills 2 D. Trottier MIS Fellow March 31 2009

2. Why should I care? Laparoscopy is the Standard of Care for many procedures oPt expectations oImproved post-operative outcomes Fundamentals of Evolving Technologies oRobotics oTeleSurgery oSingle Port Surgery oNOTES

3. Why am I here? To familiarize yourself with the challenges of videoscopic surgery in a controlled environment oSkills learned in the lab can then be transferred to the OR Challenges of Laparoscopy o2D field of vision instead of 3D oLoss of normal degrees of freedom for manipulation of surgical instruments / loss of tactile feedback oUnstable video camera positioning oOperative ergonomics / working angles oLaparoscopy is gentler on the patient but tougher on the surgeon!

4. The SKILLS Study Balaa et al. Validation of the GOALS model in a Lap Box Trainer (Fried et al.) Model Design – made possible by this study Laparoscopic cholecystectomy: porcine model –Instructions: Groups of 2 / 20 minutes Use desiccation instead of fulgaration Technical problems

5. Lab Objectives 1] Depth Perception Develop comfort level working with monocular optical system (2D) Use Small, Precise movements (avoid overshooting, wide swings) Stay in correct plane

6. Lab Objectives 1] Depth Perception 2] Bimanual Dexterity Optimize use of both hands (principles of ambidexterity) Countertraction

7. Lab Objectives 1] Depth Perception 2] Bimanual Dexterity 3] Tissue Handling Adapt to a certain loss of tactile feedback (“Surgery of the Eyes”) Learn to properly handle tissues (no excessive traction, tearing) Avoid dissecting into liver

8. Lab Objectives 1] Depth Perception 2] Bimanual Dexterity 3] Tissue Handling 4] Instrument Handling Minimize recoil Avoid “off-screen” injuries Optical port: more important than you would think! Maximize exposure/field of vision

9. Lab Objectives 1] Depth Perception 2] Bimanual Dexterity 3] Tissue Handling 4] Instrument Handling ENJOY!