1. Safe Laparoscopy Reducing Complications Jonathan Frappell FRCS.FRCOG.

2. Driving without due care and attention

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 LAPAROTOMY Risk of serious complication requiring 3-5 per 1000
3 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 Avoid scars
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

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 Delay can be fatal
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

20. John Black PRCS EWTD
So lets see what that looks like in practise

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”
Which brings us back to where we started,talking of leadership and inspiration,something

26. Lifelong interest in teaching----Lecturer in Anatomy
Not everyone complementary about teachers—GBS “those who can do,etc Not nice about most professions,doctors in particular

27. Thank You