Common Surgical Techniques
All patients who are going to undergo surgery for an acute abdomen. They correctly inform of the wide variety of diagnostic possibilities (and the variety of prognostic severity). In their case, given that the operation and its result fundamentally depend on the specific diagnosis. This is even more so if the initial laparoscopic approach considers. Laparoscopic Trainer.
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Also given that many patients associate laparoscopy with the concept of a minor and not very serious procedure. And are also unaware that this is the way to start and accurately diagnose. But that -according to the findings– the continuation may be an extensive laparotomy, a stoma. And a highly serious situation, with admission to the ICU and non-negligible risk of mortality.
Positioning Of the Patient and Surgeons
The patient places under general anesthesia and positioned in the supine position. Preferably with both upper extremities collected along the trunk. This allows the surgeon and assistants to positions on either side depending on the laparoscopic diagnosis and the surgical technique. The surgical table must allow the change of positions. Like (Trendelenburg, reverse Trendelenburg, right and left lateral decubitus). And the separation of the patient’s lower extremities to operate from the perineum if necessary.
If there is a possibility that it will be necessary to make an intestinal stoma. Then it is very convenient to mark it before taking the patient to the operating room. The most frequently used forced table positions in the acute abdomen forces lateral decubitus. So, it is necessary to put a belt that holds the patient’s thighs and/or chest to the table.
Positions To Stand on Surgeon and The Assistant
Depending on the most probable diagnostic suspicion. The surgeon and the assistant will stand on the opposite side of the pathology to operates on. If pathology of the upper abdomen suspects (cholecystitis, gastroduodenal perforation). The surgeon stands on the perineum and the assistant on the patient’s left. If pelvic pathology (especially gynecological) suspects, they place one on each side.
(Gastroduodenal perforation) the surgeon stands on the perineum and the assistant on the patient’s left; if pelvic pathology (especially gynecological) suspects, they place one on each side. gastroduodenal perforation) the surgeon stands on the perineum and the assistant on the patient’s left; if pelvic pathology (especially gynecological) suspects, they place one on each side. Laparoscopic Trainer.
The monitor will always place on the opposite side of the surgeon. It is very convenient that there are two monitors. (And even better that they are hanging monitors with a movable arm to place them in the precise place). Since the pathology can affect any location of the abdomen. If the surgeon and the assistant are on both sides of the patient then two monitors are necessary.
Unless there is a very clear diagnostic suspicion of a specific process, it is always advisable to perform a first open entry with a Hasson trocar in the umbilical position. Initially, 10 mm optics and frontal vision uses. However, it is very useful to have 30º optics for cases of more difficult exposure.
For cases of pure diagnostic laparoscopy, in those who do not have a surgical pathology (pure exploratory laparoscopy). And in whom it is possible to consider the patient incurable (intestinal ischemia). Also, mini-laparoscopy, with optics and 2- or 5-mm trocars, may be useful. If something more than pure diagnostic laparoscopy is going to do. At least 2 more entries of 5 mm used, unless an endo-cutter (12 mm sheath in that case) or a clip holder (10-11 mm sheath) is necessary. mm in that case). For minimally invasive surgery technique, several of them have not received practical training with simulators similar to Laparoscopic Trainer.
Through the umbilical entrance, the optics reach all the abdominal spaces. And in many cases the diagnosis already makes; the position of the rest of the entrances. And the placement of the surgeons will depend on the specific diagnosis (see following sections). The only common caution that makes is that areas close to the course of the epigastric vessels avoided.
Potential Risk of Emergency Laparoscopy
This is due to the potential risk of injuring them and causing serious bleeding. The emergency laparoscopy unit must be especially well equipped, since it should allow laparoscopic diagnosis and treatment of any possible diagnosis.
In this sense, it is especially important that there is no lack of a laparoscopic portal and contra-portal (for laparoscopic suture with intracorporeal tying). At least one atraumatic intestinal grasping forceps (to mobilize the stomach, small intestine, and colon). A forceps with large jaw teeth (to hold vesicles under tension) and high-pressure irrigation-aspiration system (for peritoneal lavage in peritonitis).
Unless the diagnosis is obvious from the outset, it will be necessary to use the force of gravity. Changing the position of the table in the appropriate direction. And using at least two instruments to mobilize the liver, stomach, small intestine, colon, appendix, and pelvic organs. Until the diagnosis makes after exploring the entire peritoneal cavity.
A common contraindication is the state of instability in patients and critically ill patients and many abdominal diseases that require urgent surgery performed laparoscopically.
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