Laparoscopic Insufflation The Society of American Gastrointestinal and Endoscopic Surgeons Laparoscopic Insufflation Iranian Association of Surgeons Association of Iranian Endoscopic Surgeons Dr.Nazari,MD SAGES The Society of Endoscopic and Laparoscopic Surgeons of Asia

The Pioneers1 The great physician, Hippocrates of Ancient Greece( circa 460-377 BC) made the original reference to a speculum to examine the rectum.

The Pioneers2 In the early 1800s, Philip Bozzini of Austria examined the urethra of a patient using a simple tube and candlelight. (Basic design of Lichtleiter was a instrument for future development of endoscopes) Segalas in Paris, John Fisher in USA, Desormeaux in Paris developed their improved cystoscopes.

The Pioneers3 Bruck, a dentist, developed a platinum wire cooled by water to illuminate the inside of the mouth. Based on Bruck design, Nitze finally developed his first improved cystoscope in 1855 in which the light rays were gathered into his instrument via mirrors. Thomas Edison invented the incandescnt light bulb.(1879) Newman of Glasgow miniaturzed Edison`s invention and incorporated it into the Nitze`s cystoscope(first Laparoscop).

The Pioneers4 Georg Kelling of Dresden performed the first cholecystectomy in living dog(COELIOSCOPIE -1902) / the first human laparoscopy with pneumoperitoneum using room air insufflation with Nitze cystoscope.

The first experimental laparoscopy was performed in Berlin in 1901 by the Georg Kelling, who used a cystoscope He insufflated the abdomen of a dog with air.

The Pioneers 5 Jacobaeus of Sweden presented his series of patients who had laparoscopy in 1910 (published a series of over 100 laparoscopy and thoracoscopy(LAPAROSCOPY).

The Pioneers 6 Dimitri von Ott from St.Petersburg examined the intraabdominal contents and the pelvis via an inscision in the vaginal vault to insert a speculum to examine the pelvis./Gynecologic laparoscopy/ (1901)

Laparoscopy Laparotomy

Advanced Laparoscopic Room

Recommended Set for Advanced Laparoscopic Surgery Forward-Oblique Telescope30(10mm) Trocars(6mm,11mm) Liver Retractor (Cuscheri`s) Dissecting & Grasping forceps Scissors Dissecting Electrode ,L-Shaped Bipolar Grasping forceps Suction and irrigation handle +Unit Needle holder & Knot tier Clip Applicator Light source & Accessories Endoflator +/- Veress needle Color Monitors

Electronic Endoflator

Electronic Thermoflator

Veress needle Veress needle was invented by a chest physician for aspiration of pleural effusion keeping in mind that its spring mechanism and blunt tip will prevent the injury of lung tissue.. Veress needle is available in three length 80mm, 100mm, 120mm. Spring action of Veress needle should be checked. Patency of Veress Needle should be checked. Veress needle should be held like a dart at the time of insertion.

Veress needle Veress needle consists of an outer cannula with a beveled needle point for cutting through tissues. Inside the cannula is an inner stylet, which is loaded with a spring that spring forward in response to the sudden decrease in pressure encountered upon crossing the abdominal wall and entering the peritoneal cavity. The lateral hole on this stylet enables CO2 gas to be delivered intra-abdominally

Veress needle Veress needle should be checked: 1-Before insertion -Patency -Spring movement 2-After insertion -Saline drop test -Injection/Aspiration test

Closed Insertion

Umbilical entrance

Umbilical entrance

Pre-Pritoneal Insufflation

Other Potential Sites

Non-obese Patient

Overweight Patient

Obese Patient

Open Insertion

Open Insertion

Hasson Trocar

Trocar Insertion

Complications