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Safe Laparoscopy Reducing Complications Jonathan Frappell FRCS.FRCOG.

Safe Laparoscopy Reducing Complications Jonathan Frappell FRCS.FRCOG. Driving without due care and attention. Equipment. Stack system Camera/TV Light source Light lead High speed insufflator

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Safe Laparoscopy Reducing Complications Jonathan Frappell FRCS.FRCOG.

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  1. Safe LaparoscopyReducing ComplicationsJonathan Frappell FRCS.FRCOG.

  2. Driving without due care and attention

  3. Equipment • Stack system Camera/TV Light source Light lead High speed insufflator Video/Still recorder

  4. Equipment • Grasping forceps Johannes Manhes • Scissors • Diathermy monopolar/bipolar • Suction/irrigation 5/ 10cms

  5. Consent Risk of serious complication requiring LAPAROTOMY 3-5 per 1000 3 per 1000 intestinal injury 1 per 1000 vascular injury

  6. Safe Entry • RCOG GreentopGuideline No.48(Oct.2007) • SratOG Module 2 Perioperative care in gynaecology

  7. Safe entry • Primary trocar Veressneedle technique Hasson open entry Alternative entry site “Safety” trocars optical Ternamian screw ‘Step’ system

  8. Safe Entry • Veressneedle Patient flat Sharp Intra-umbilical vertical incision Tests of correct placement Maximum of two attempts Insufflate to 25mmHg

  9. Safe Entry HIGH RISK Patients Very thinHassonopen entry Previous Laparotomy Avoid scars Consider a)Hassonentry b)Alternative entry site Palmer’s point Obese Hasson Optical ports

  10. Major Vascular Injury • Immediate MidineLaparotomy Apply pressure • Call for help Surgical/Anaesthetic • O Neg Blood • X match 6 units/FFP • Written protocol in theatre

  11. Safe Entry • After insertion of primary trocar Reduce pressure to 15mmHg Visual check Head down tilt • Secondary trocars inserted under direct vision

  12. 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

  13. Electrical Energy • Bipolar Current flows only between tips of the forceps “blades” Excellent for haemostasis No risk of stray current damage

  14. Electrical Energy • Monopolar Risk of stray current Cutting current has lower voltage than coagulating current

  15. Post-op Recovery • Suspect bowel damage if condition deteriorates 24-48 hrs post-op • <50% bowel injuries recognised at time of op. • Av.time to diagnosis 1.7 days Delay can be fatal

  16. Port Closure

  17. Fundamental Attributesof a Safe Surgeon • Communication • Decision making • Judgment • Leadership “the strength of simulation is as an adjunct rather than as an alternative to clinical experience”

  18. Thank You

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