FROM HERE, HEALTH

Introduction to
Laparoscopic Surgery
Basic Surgical Skills Course

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Terms
• Endoscopy – to ‘look inside’ (usually a lumen)
• Laparoscopy – to look inside the abdomen/pelvis. Not to be
confused with…
• Laparotomy – where a much larger incision is made in the
abdominal wall
• Laparoscopy and Endoscopy are types of Minimal Access Surgery
(MAS). Other types include:
• Arthroscopy
• Thoracoscopy
• MIS is also known as Minimally Invasive Surgery (MIS) or
‘Keyhole’ Surgery
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History

• 1911 – First laparoscopy performed on a human (Sweden)

• 1975 – First laparoscopic organ resection (Brazil)
• 1981 – First laparoscopic appendectomy (Germany)
• 1990 – automatic clip applicators invented.
Before 1990, laparoscopy was only in widespread use for
gynaecological/gastroenterological procedures
• Laparoscopic cholecystectomy is now the most common
laparoscopic procedure
• New advances – disposables; robotics

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Uses for Laparoscopy

Abdominal/Pelvic Pain Gastrectomy Prolapse Repair
Bowel Resection Gastric Bypass Nephrectomy
Prostatectomy Splenectomy Appendectomy
Cholecystectomy Closure of Perforation Hernia
Repair Anterior Resection/APR Division of Adhesions
Left/Sigmoid Colectomy Right Hemicolectomy
Oesophagogastrectomy Whipple Cancer diagnosis Ectopic
Pregnancy Endometriosis Ovarian Cyst Fibroids
Hysterectomy Pelvic Inflammatory Disease Etc…
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Laparoscopy vs. Open Procedure

• Less post-operative pain
• Less tissue trauma
• Faster recovery time
• Shorter hospital stay

• 2-dimensional view – depth perception

• Different operating technique (longer instruments etc.)

• Basic principles of good surgery still apply

• Nature of disease is unchanged!

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Possible Complications
• Shoulder pain (an indirect effect of CO2 in the abdomen irritating
the phrenic nerve)
• Damage to organ/blood vessel
• Infection
• Bruising
• Complications from anaesthesia
• Hernia at entry site

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Basic Equipment
• Camera
• Light Source and cable
• Telescopes – 0
– 30
• Ports – 5mm
– 10mm
• Monitor
• Insufflator

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Axis to Target view angle

0 Scope
Angle of the optical axis
(created by the scope)
relative to the view of the
target is 90
Altering the inclination of the
scope alters this optical axis-to-
target view angle...

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Scope viewing angle

30 Scope
An angled scope alters the
angle of view

Rotating the scope

increases the viewable area…

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Ergonomics – Visual and Motor Considerations

• Errors increase as optical angle increases
• Altered view angle increases accessible field
• Beware of blind areas – if you can’t see it, don’t do it!

• Demand on cerebral processing

• mental fatigue
• forgetting the non-dominant hand
• Lack of tactile feedback
• Motion translation
• Comfort

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Ergonomics – Port Positions

• Azimuth angle – between the optical (scope) axis and the
instrument
• Manipulation angle – between instruments
• Elevation angle – between the instrument and the horizontal
plane of the target

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Ergonomics – Port Positions

Azimuth – between
the optical (scope)
axis and the
instrument

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Ergonomics – Port Positions

Azimuth – between
the optical (scope)
axis and the
instrument

Ideally should be equal

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Ergonomics – Port Positions

Manipulation –
between instruments

Ideally should be approx. 60

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Ergonomics – Port Positions

Elevation – between
the instrument and
the horizontal plane

Ideally should be
45-60

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Practical Aims for this session

• Familiarise yourself with the laparoscopic
stack and instruments
• Manipulation exercises

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