Introduction to Basic Laparoscopic Surgery

 


Overview

Laparoscopy is a seductive minimally invasive surgical technique, more and more widespread in the practice of veterinary medicine, making it possible to make diagnoses (exploration of the abdomen, biopsies) or conventional surgeries (oophorectomy).

For minimally invasive surgery technique many of them have not received practical training with simulators Laparoscopic Endo Trainer.

Introduction to Laparoscopy

This technique is associated with reduced postoperative pain, rapid postoperative recovery and a low rate of complications. To get started, specific training and the acquisition of the appropriate equipment are necessary. Building on advances in human medicine, veterinary surgeons quickly gained access to laparoscopic surgery, also known as laparoscopy. This enabled a major breakthrough in the rapidly expanding field of minimally invasive surgery. The aim of this article is to describe the general principles inherent in laparoscopy as well as the necessary equipment.

What Is Laparoscopy?

Text Laparoscopy, also called laparoscopy, is a minimally invasive technique that involves the insertion of an optic connected to a camera in the abdomen in order to visualize all the abdominal organs. Laparoscopy can be used as a diagnostic tool (eg: biopsies) or as a surgical technique. Instruments are inserted through additional ports, also called cannulas.

Delimit a workspace

The sine qua non for performing a laparoscopy in good conditions is the creation of a pneumoperitoneum obtained by blowing gas into the abdominal cavity. The induced abdominal distension allows visualization of the abdominal organs and the establishment of a workspace. It is recommended to work with carbon dioxide because it is the safest gas to prevent the risk of air emboli and spark during cauterization.

Insufflation pressure should be a maximum of 15 mmHg, although a pressure of 8-10 mmHg is usually sufficient to maintain adequate abdominal distension and limit the pain that may be caused by dilation of the abdominal cavity. Beyond this value, there is a risk of vascular collapse. The major defect of CO2 is the induction of hypercapnia following resorption of gas through the peritoneum. It is recommended to put a filter at the gas outlet to filter out impurities.

How to perform a pneumoperitoneum?

Two techniques are possible for gas insufflation: Veress needle and direct trocar (Hasson technique or “open coelioscopy”). Veress needle: This is the technique initially described. The needle is inserted blindly into the abdomen and allows the supply of CO2. The needle has a blunt inner cannula which limits the risk of damage to the abdominal organs when it is inserted (Photo 1).

This makes it possible to obtain abdominal distension prior to insertion of the cannulas, which reduces the risk of trauma to the abdominal organs during their insertion. Complications of this technique are the puncture of an organ or the insufflation of gas into an organ, a mass or subcutaneously.

“Open laparoscopy” - Hasson technique: This technique is currently preferred by many surgeons because it is easier to perform. The first cannula inserted has an insufflation valve. It is put in place by a minilaparotomy which is barely larger than the diameter of the cannula. This involves placing the first cannula through an undistended abdominal wall. The risk is to damage an organ (spleen, bladder) when inserting this cannula.

If the incision in the abdominal wall is larger than the size of the cannula, there is a risk of leakage and therefore gas leakage, which affects the quality of the pneumoperitoneum. This is the major drawback of this technique, but the placement of a suture in purse around the cannula most often makes it possible to remedy a loss of tightness.

The following cannulas are placed under visual control after insufflation, orienting the optic in the abdomen towards the point of penetration, previously identified by pushing the wall with the finger.

Operator Channels to Work

The instruments are inserted through the abdominal wall using cannulas. They are implanted, after the formation of a pneumoperitoneum, to move the abdominal wall away from the abdominal viscera and limit the risk of injury. A micro-incision is made at the point of penetration and the cannula is forcefully inserted using a trocar. The instruments used must be specifically designed for laparoscopy (see below).

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