1.
BASIC PRINCIPLES OF
LAPROSCOPY
Dr Dhara Pandya
G.M.C, NAGPUR

2.
Principle Differences between
Laparoscopic and Open Surgery
FOR THE PATIENT
 Post operative pain related to size of incision- smaller
incisions =less pain.
 Less Handling of intestines results in little or no
disturbance of normal function.
 Avoidance of the trauma of abdominal wall injury by
the incision allows rapid return to normal activity
 No incision allows early return to more strenuous
activities: driving, lifting, sport etc.

3.
Principle Differences between
laparoscopic and open surgery
For the Surgeon
 Magnified view often better than obtained via
an incision allows precise dissection.
 Altered (but not absent) tactile response
 Two dimensional (flat screen) view.
 Usually (but not always) longer operating time
 Need to develop entirely different operating
technique
 Adaptation of principles of open surgery to
laparoscopic surgery.

4.
Laparoscopic Trolly
Lahore Laparoscopic Surgery Training
Center
5
• The Optical Chain
– Endoscope
– Light Cable
– Light Source
– Camera System
– Monitor
• Gas Insufflation Apparatus
– Insufflator
– Carbon Dioxide Cylinder

5.
CAMERA & LIGHT SOURCE

6.
CAMERA SYSTEM

7.
INSUFFULATOR

8.
LIGHT SOURCE

9.
OPTIC CABLES

10.
Straight Line Principle
Surgeon
Pathology
Monitor

11.
Visual Axis and Motor Axis

12.
Co Axial alignment

13.
Surgeon’s Stance
Ideal relaxed stature Tiring

14.
Ideal Relaxed Position
-straight head, in the axis of the trunk,
without rotation or extension of the cervical spine;
- shoulders in a relaxed and neutral position;
- arms alongside the body
- elbows bent to 70 to 90 degrees
- forearms in an horizontal or slightly descending axis-
-hands pronated (physiological resting position);
- hands and fingers lightly grip the handles/handpiece
•Waist line table
•Gaze down view of monitor
•Straight line principle
•Triangulation

15.
Working against the
camera and ‘blind
spots’
“Dueling swords”
phenomenon
(scissoring effect)
Avoid competing
for the same space:

16.
What operations can we do
Laparoscopically
DIAGNOSIS
Gallstone
Appendicitis
Hernia
Adhesions
Perforated ulcer
Hiatus Hernia
OPERATION
Cholecystectomy
Appendicectomy
Hernia repair
Division of adhesions
Closure of perforation
Hiatus hernia repair.

17.
What operations can we do
Laparoscopically
DIAGNOSIS
Colorectal
carcinoma
Caecal carcinoma
Colonic carcinoma
Gastric carcinoma
Oesophageal
carcinoma
OPERATION
Anterior resection/ APR
Right Hemicolectomy
Left/Sigmoid Colectomy
Gastrectomy
Oesophagogastrectomy

18.
What operations can we do
laparoscopically?
Diagnosis
Crohn’s Disease
Diverticulitis
Rectal Prolapse
Benign renal disease
Gastric Obstruction
Some Splenic
disorders
The list is endless!!!
Operation
Bowel resection
Bowel resection
Repair of Prolapse
Nephrectomy
Bypass
Spleenectomy

19.
PORT PLACEMENTS
LAP APPENDICETOMY LAP CHOLECYSTECTOMY

20.
SCAR COMPARISION

21.
Laparoscopic Instruments
• Operative instruments
• Energy sources

22.
• Hand grip types

23.
TROCHARS

24.
Operative instruments
• Dissectors
• Scissors
• Retractors
• Forceps

25.
DISSECTORS

26.
1) MARYLAND
2)CURVED DISSECTOR WITH
LONG BLADES
3) BLUNT DISSECTOR

27.
• Bullet nose grasper • Dorsey intestinal
grasper
GRASPERS

28.
• Hunter bowel grasper • Crocodile graspers

29.
SCISSORS

30.
1) CURVED METZENBAUM
2) STRAIGHT
3) NON INSULATED SCISSORS

31.
BOWEL CLAMPS

32.
1) ALLIS
2) BABCOCK( reusable)
3) BABCOCK(disposable)

33.
SPATULA

34.
1) SPATULA
2) BOWEL HOLDING
SPATULA( SHORT)
3) BOWEL HOLDING SPATULA
(LONG)
4) CLAW FORCEPS

35.
FORCEPS

36.
1)STONE HOLDING FORCEPS
2)BIOPSY FORCEPS
3)CHOLANGIOGRAM FORCEPS

37.
RETRACTORS

38.
1)10mm DISPOSABLE
2)5mm STAINLESS STEEL
Hook

39.
SUCTION NOZZLE
HYDATID TROCAR
NEEDLE HOLDER
a)Ethicon type 5 mm
b)Ethicon type 3mm
c) conventional needle
holder , coaxial ring handle

40.
1) VERESS NEEDLE
2)CLIP APPLICATOR
a)10 mm reusable
b)5mm reusable
3) LOOP APPLICATOR

41.
Energy sources
• Electro surgery
• Ligasure
• Argon beam coagulation
• Ultrasonic dissection
• Cavitational ultrasonic surgical aspirator
(CUSA)

42.
HARMONIC SCALPEL

43.
COMPLICATIONS OF
LAPAROSCOPIC SURGERIES
1. Anaesthetics Complications
2. Complications due to pneumoperitonium
3. Surgical complications
4. Diathermy related injuries
5. Patients factors related complications
6. Post operative complications

44.
CONTRAINDICATIONS
Absolute :
• Generalized peritonitis
• Intestinal obstruction
• Clotting abnormalities
• Liver cirrhosis
• Failure to tolerate general anesthesia
• Uncontrolled shock
Relative :
• Multiple abdominal adhesions
• Organomegaly
• Abdominal aortic aneurysm

45.
Emerging Technologies
• Robotics
• SILS
• NOTES
• Trocarless laparoscopy
• ENDOBARRIER

46.
ROBOTIC SURGERY

47.
SILS (Single Incision
Laproscopy surgery)

48.
N.O.T.E.S.
Natural Orifice Transluminal Endoscopic Surgery

49.
Scarless surgery!

50.
THANK YOU!!!