Basic Laparoscopic Surgery

Learn Basic Laparoscopic Surgery, the components of a laparoscopic surgical setup, optimal positioning and ergonomics in laparoscopic surgery, and much more. Check out the full course for free here: https://www.incision.care/free-trial

What is Laparoscopic Surgery:
Laparoscopic surgery describes procedures performed using one or multiple small incisions in the abdominal wall in contrast to the larger, normally singular incision of laparotomy. The technique is based around principles of minimally invasive surgery (or minimal access surgery): a large group of modern surgical procedures carried out by entering the body with the smallest possible damage to tissues. In abdominopelvic surgery, minimally invasive surgery is generally treated as synonymous with laparoscopic surgery as are procedures not technically within the peritoneal cavity, such as totally extraperitoneal hernia repair, or extending beyond the abdomen, such as thoraco-laparoscopic esophagectomy. The term laparoscopy is sometimes used interchangeably, although this is often reserved to describe a visual examination of the peritoneal cavity or the purely scopic component of a laparoscopic procedure. The colloquial keyhole surgery is common in non-medical usage.

Surgical Objective of Laparoscopic Surgery:
The objective of a laparoscopic approach is to minimize surgical trauma when operating on abdominal or pelvic structures. When correctly indicated and performed, this can result in smaller scars, reduced postoperative morbidity, shorter inpatient durations, and a faster return to normal activity. For a number of abdominopelvic procedures, a laparoscopic approach is now generally considered to be the gold-standard treatment option.
Definitions

Developments of Laparoscopic Surgery:
Following a number of smaller-scale applications of minimally invasive techniques to abdominopelvic surgery, laparoscopic surgery became a major part of general surgical practice with the introduction of laparoscopic cholecystectomy in the 1980s and the subsequent pioneering of endoscopic camera technology. This led to the widespread adoption of the technique by the early- to mid-1990s. The portfolio of procedures that can be performed laparoscopically has rapidly expanded with improvements in instruments, imaging, techniques and training — forming a central component of modern surgical practice and cross-specialty curricula [2]. Techniques such as laparoscopically assisted surgery and hand-assisted laparoscopic surgery have allowed the application of laparoscopic techniques to a greater variety of pathology. Single-incision laparoscopic surgery, natural orifice transluminal endoscopic surgery, and minilaparoscopy-assisted natural orifice surgery continue to push forward the applications of minimally invasive abdominopelvic techniques; however, the widespread practice and specific indications for these remain to be fully established. More recently, robotic surgery has been able to build on laparoscopic principles through developments in visualization, ergonomics, and instrumentation.

This Basic Laparoscopic Surgery Course Will Teach You:
Abdominal access techniques and the different ways of establishing a pneumoperitoneum
Principles of port placement and organization of the operative field
Key elements of laparoscopic suturing, basic knotting and clip application

Specific attention is paid to the following hazards you may encounter:
Fire hazard and thermal injury
Lens fogging
Contamination of insufflation system
Complications from trocar introduction
Limitations of Veress needle technique
Limitations of open introduction technique
Complications of the pneumoperitoneum
Gas embolism
Mirroring and scaling of instrument movements
Firing clip applier without a loaded clip

The following tips are designed to improve your understanding and performance:
Anatomy of a laparoscope
Checking for optic fiber damage
"White balance" of camera
Checking integrity of electrosurgical insulation
Access at Palmer's point
Lifting abdominal wall before introduction
Confirming position of Veress needle
Umbilical anatomy
Identification of inferior epigastric vessels under direct vision
Translumination of superficial epigastric vessels
Selection of trocar size
Aiming of trocar
Working angles in laparoscopic surgery
Choice of suture material
Instruments for suturing
Optimal ergonomics for suturing
Extracorporeal needle positioning
Optimal suture lengths
"Backloading" needle
Intracorporeal needle positioning
Hand movements when suturing
Optimal positioning of scissors
Extracorporeal knot tying
Visualization of clip applier around target structure
Common clip configurations