Laparoscopic Surgery

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Laparoscopic Surgery
Brian Nguyen University of California - Irvine
Medical Center, Orange, CA
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Laparoscopic Surgery

• Minimally invasive technique
• Introduced in 1987
• Utilizes 3 small incisions in abdomen
• Trochar placed in ports
• Laparoscope passed through trochar
• Key tool is laparoscope
• Transmit images from cavity to monitors
• Surgeons eyes

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Laparoscope
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Laparoscopic Surgery
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Laparoscopic Surgery
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Laparoscopic View
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Procedures

• Gastrointestinal surgery
• Gynecologic surgery
• Urology
• Hand-access device
• Allows for pancreatic, liver and biliary
  procedures

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Benefits

• Less pain
• Faster return to function
• Shorter hospital stay (1-3 days)
• Less scarring
• Less post-operative complications
• SSI reduced

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Benefits
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Benefits
No large midline abdominal incision
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Comparison of Colectomy for Diverticulitis  Comparison of Colectomy for Diverticulitis  Comparison of Colectomy for Diverticulitis  Comparison of Colectomy for Diverticulitis 
  Laparoscopic Open
Typical operative time (h) Typical operative time (h) 3 2.5
Typical length of stay (d) Typical length of stay (d) 34 7
Typical return to work (wks) Typical return to work (wks) 2 6
OR cost OR cost Higher Lower
Wound infection rate () Wound infection rate () 5 10
Incisional hernia rate () Incisional hernia rate () 2 5
Risk of postoperative small bowel obstruction Risk of postoperative small bowel obstruction Low Moderate
Applicability in urgent setting Applicability in urgent setting Unknown Yes
Importance of surgeon (procedure-specific experience) Importance of surgeon (procedure-specific experience) Critical Routine
Bordeianou L, Rattner D. 2010. Is laparoscopic sigmoid colectomy for diverticulitis the new gold standard? Gastroenterology. 138(7) 2213-6. Bordeianou L, Rattner D. 2010. Is laparoscopic sigmoid colectomy for diverticulitis the new gold standard? Gastroenterology. 138(7) 2213-6. Bordeianou L, Rattner D. 2010. Is laparoscopic sigmoid colectomy for diverticulitis the new gold standard? Gastroenterology. 138(7) 2213-6. Bordeianou L, Rattner D. 2010. Is laparoscopic sigmoid colectomy for diverticulitis the new gold standard? Gastroenterology. 138(7) 2213-6.
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Challenges

• Requires more technical experience
• Learning curve gt 40 cases
• Adhesions
• Risk of puncture, injury
• Risk of conversion
• Bleeding, leakage