The Role of the Assistant in Laparoscopic Surgery: Important Considerations for the Apprentice-in-Training
The Assistant In Laparoscopic Surgery <ul><li>Aid and facilitate the surgeon in performing a safe and efficient operation ...
The Assistant In Laparoscopic Surgery <ul><li>Preoperative evaluation and preparation </li></ul><ul><li>Patient positionin...
The Assistant In Laparoscopic Surgery <ul><li>Majority of laparoscopic assistants are surgeons-in-training </li></ul><ul><...
The Assistant In Laparoscopic Surgery <ul><li>Team approach to perform safe and sound operations </li></ul><ul><li>Require...
The Assistant In Laparoscopic Surgery <ul><li>The assistant must play a vital role in order to become a proficient laparos...
The Learning Curve <ul><li>Didactic teaching  </li></ul><ul><ul><li>Essential to improving safety and efficacy of ever-evo...
The Learning Curve <ul><li>Should we ignore the assistant’s role in simulation labs? </li></ul><ul><li>What can we learn o...
Preoperative Assessment <ul><li>Comorbidities </li></ul><ul><li>Patient anatomy </li></ul><ul><ul><li>Panniculus </li></ul...
Preparing the Operative Suite <ul><li>Patient and surgeon positioning </li></ul><ul><li>Location of monitors and foot peda...
Intraoperative Role of the Assistant <ul><li>Should be familiar with different techniques of achieving pneumoperitoneum </...
Trocar Placement <ul><li>Size of incision respective to each trocar </li></ul><ul><li>Controlled insertion </li></ul><ul><...
Driving the Camera <ul><li>The camera assistant plays a vital role to the success of any laparoscopic procedure </li></ul>...
Driving the Camera <ul><li>Each hurdle can be conquered based on the skill of the assistant </li></ul><ul><ul><li>‘ Touchi...
Advanced Skills of the Assistant <ul><li>Requires detailed knowledge of laparoscopic instruments </li></ul><ul><ul><li>Ret...
Module for Learning <ul><li>The resident experience: assistant, surgeon, or both? </li></ul><ul><ul><li>Perceptive </li></...
Tutorials for training <ul><li>Simulators and instructional videos are now standard at most institutions </li></ul><ul><li...
Conclusion <ul><li>The role of the laparoscopic assistant is vital </li></ul><ul><li>Allows the surgeon to focus on crucia...
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The Role of the Assistant in Laparoscopic Surgery: Important Considerations for the Apprentice in Training

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The Role of the Assistant in Laparoscopic Surgery: Important Considerations for the Apprentice in Training

  1. 1. The Role of the Assistant in Laparoscopic Surgery: Important Considerations for the Apprentice-in-Training
  2. 2. The Assistant In Laparoscopic Surgery <ul><li>Aid and facilitate the surgeon in performing a safe and efficient operation </li></ul>
  3. 3. The Assistant In Laparoscopic Surgery <ul><li>Preoperative evaluation and preparation </li></ul><ul><li>Patient positioning </li></ul><ul><li>Operative suite arrangement </li></ul><ul><li>Trocar placement </li></ul><ul><li>Intraoperative maneuvers </li></ul>
  4. 4. The Assistant In Laparoscopic Surgery <ul><li>Majority of laparoscopic assistants are surgeons-in-training </li></ul><ul><li>The resident experience: assistant, surgeon, or both? </li></ul><ul><li>Inevitably, the role changes as the apprentice become the mentor </li></ul>
  5. 5. The Assistant In Laparoscopic Surgery <ul><li>Team approach to perform safe and sound operations </li></ul><ul><li>Requires fundamental knowledge of laparoscopic techniques </li></ul><ul><li>Familiarity with the details and nuances of each procedure </li></ul>
  6. 6. The Assistant In Laparoscopic Surgery <ul><li>The assistant must play a vital role in order to become a proficient laparoscopic surgeon </li></ul><ul><li>As the assistant gains experience, anticipation and precision become key elements </li></ul><ul><li>Focus of learning shifts from assisting to operating </li></ul>
  7. 7. The Learning Curve <ul><li>Didactic teaching </li></ul><ul><ul><li>Essential to improving safety and efficacy of ever-evolving laparoscopic procedures </li></ul></ul><ul><li>Peg board transfers and intracorporeal knot tying develop required skill sets </li></ul>
  8. 8. The Learning Curve <ul><li>Should we ignore the assistant’s role in simulation labs? </li></ul><ul><li>What can we learn outside of the OR? </li></ul><ul><ul><li>Utilizing an angled scope </li></ul></ul><ul><ul><li>Centering and zooming on the surgical field </li></ul></ul><ul><ul><li>Retraction with various instruments </li></ul></ul>
  9. 9. Preoperative Assessment <ul><li>Comorbidities </li></ul><ul><li>Patient anatomy </li></ul><ul><ul><li>Panniculus </li></ul></ul><ul><ul><li>Hernias </li></ul></ul><ul><ul><li>Scars </li></ul></ul><ul><ul><li>Central obesity </li></ul></ul>
  10. 10. Preparing the Operative Suite <ul><li>Patient and surgeon positioning </li></ul><ul><li>Location of monitors and foot pedals </li></ul><ul><li>Strategic organization of cables </li></ul><ul><li>“Stocking” appropriate instruments </li></ul>
  11. 11. Intraoperative Role of the Assistant <ul><li>Should be familiar with different techniques of achieving pneumoperitoneum </li></ul><ul><li>Monitor and understand flow rate and intraabdominal pressure during insufflation </li></ul><ul><li>Recognize pitfalls and react quickly </li></ul><ul><ul><li>Incomplete abdominal wall penetration </li></ul></ul><ul><ul><li>Adhesions </li></ul></ul><ul><ul><li>Visceral injury </li></ul></ul>
  12. 12. Trocar Placement <ul><li>Size of incision respective to each trocar </li></ul><ul><li>Controlled insertion </li></ul><ul><li>Optimal positioning </li></ul><ul><ul><li>Maximal access </li></ul></ul><ul><ul><li>Ergometrics </li></ul></ul><ul><ul><li>Visualization </li></ul></ul><ul><ul><li>Avoid “dueling swords” </li></ul></ul>
  13. 13. Driving the Camera <ul><li>The camera assistant plays a vital role to the success of any laparoscopic procedure </li></ul><ul><li>Hurdles </li></ul><ul><ul><li>Camera fogging </li></ul></ul><ul><ul><li>Trocar displacement </li></ul></ul><ul><ul><li>Optical dynamics </li></ul></ul>
  14. 14. Driving the Camera <ul><li>Each hurdle can be conquered based on the skill of the assistant </li></ul><ul><ul><li>‘ Touching the liver” technique </li></ul></ul><ul><ul><li>Maintaining visualization as well as the angle of the trocar during egress and ingress of instruments </li></ul></ul><ul><ul><li>Momentary camera adjustments to accommodate operative maneuvers </li></ul></ul>
  15. 15. Advanced Skills of the Assistant <ul><li>Requires detailed knowledge of laparoscopic instruments </li></ul><ul><ul><li>Retraction </li></ul></ul><ul><ul><li>Cutting </li></ul></ul><ul><ul><li>Suction/irrigation </li></ul></ul><ul><ul><li>Suturing </li></ul></ul>
  16. 16. Module for Learning <ul><li>The resident experience: assistant, surgeon, or both? </li></ul><ul><ul><li>Perceptive </li></ul></ul><ul><ul><li>Integrative </li></ul></ul><ul><ul><li>Autonomous </li></ul></ul>
  17. 17. Tutorials for training <ul><li>Simulators and instructional videos are now standard at most institutions </li></ul><ul><li>Goal directed tasks improve resident’s skills </li></ul><ul><li>Incorporation of assistant roles </li></ul>
  18. 18. Conclusion <ul><li>The role of the laparoscopic assistant is vital </li></ul><ul><li>Allows the surgeon to focus on crucial elements of the operation </li></ul><ul><li>Provides safety and efficacy for the patient </li></ul><ul><li>Part of a continuum in becoming a skilled laparoscopic surgeon </li></ul>

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