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N325 Laproscopic Surgery Presentation

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N325 Laproscopic Surgery Presentation

  1. 1. <ul><li>Lichele Palmer </li></ul><ul><li>Andrea Stubbs </li></ul><ul><li>Christy Scritchfield </li></ul><ul><li>Randi Bonnell </li></ul>
  2. 2. <ul><li>Laparoscopic surgery, also referred to as minimally invasive surgery, describes the performance of surgical procedures with the assistance of a video camera and several thin instruments. During the surgical procedure, small incisions of up to half an inch are made and plastic tubes called ports are placed through these incisions. The camera and the instruments are then introduced through the ports which allow access to the inside of the patient. </li></ul>
  3. 3. <ul><li>The camera transmits an image of the organs inside the abdomen onto a television monitor. The surgeon is not able to see directly into the patient without the traditional large incision. The video camera becomes the surgeon’s eyes in laparoscopy surgery, since the surgeon uses the image from the video camera positioned inside the patient’s body to perform the procedure. </li></ul>
  4. 5. <ul><li>1980s: First combined with video cameras, Laparoscopy allowed surgeons to free their hands to work better with instruments. </li></ul><ul><li>Initially used for tubaligations   </li></ul><ul><li>1985, First gallbladder removal in France   </li></ul><ul><li>Then used for the appendix and beyond </li></ul>
  5. 6. <ul><li>Used for exploratory surgery in abdominal or pelvic pain or injury </li></ul><ul><li>Check for tumors, find conditions that make pregnancy difficult for women (cysts, adhesions, fibroids, infection), cancer that may have spread to the abdomen, damage to internal organs  </li></ul><ul><li>Check and treat for endometriosis, ectopic pregnancy, pelvic inflammatory disease </li></ul><ul><li>Biopsy </li></ul><ul><li>Removal of the colon and kidney during live donor transplants </li></ul><ul><li>Removal of uterus, spleen, gallbladder, ovaries, appendix, partial colon resection </li></ul><ul><li>Gastric Bypass, vertical banding gastroplasty </li></ul><ul><li>Tubal ligation </li></ul><ul><li>Hiatal hernia, inguinal hernia </li></ul>
  6. 7. <ul><li>Gastric Bypass Surgery </li></ul><ul><ul><li>Stomach is stapled and bowel are rerouted </li></ul></ul><ul><li>Hysterectomy </li></ul><ul><ul><li>Surgical removal of the Uterus </li></ul></ul><ul><li>Cholecystectomy </li></ul><ul><ul><li>Surgical removal of the Gallbladder </li></ul></ul><ul><li>Appendectomy </li></ul><ul><ul><li>Surgical removal of the Appendix </li></ul></ul><ul><li>Hernia Repair </li></ul>
  7. 12. <ul><li>Less post operative discomfort since the incisions are much smaller </li></ul><ul><li>Cosmetic appeal – much smaller scars </li></ul><ul><li>Reduced blood loss, less likely to need transfusion </li></ul><ul><li>Quicker recovery times </li></ul><ul><li>Shorter hospital stays </li></ul><ul><li>Earlier return to full activities </li></ul><ul><li>There may be less internal scarring because laparoscopy is minimally invasive compared to standard open surgery. </li></ul><ul><li>Decreased risk for infection </li></ul><ul><li>Decreased risk for incisional hernias </li></ul>
  8. 13. <ul><li>Contraindicated for patients who have adhesions from previous abdominal procedure, or coagulation disorders </li></ul><ul><li>Higher risk for vascular injury, which is not recognized as quickly as it is during open surgery </li></ul><ul><li>Gas embolism from CO2 with a vascular injury </li></ul><ul><li>Increased intra abdominal pressure from CO2 can cause pooling of blood in legs, decreased venous return, hypotension, increased risk for DVT </li></ul><ul><li>Bowel injuries: stomach, small bowel, colon, spleen </li></ul><ul><li>Pneumothorax from misplaced Veress needle </li></ul><ul><li>Electrical burns from electrodes used to maintain hemostasis – can perforate organs and cause peritonitis </li></ul>
  9. 14. <ul><li>Use disposable laparoscopes, which are usually sharper and require less force to insert; lessens risk of compressing trocar against bowel or blood vessels. </li></ul><ul><li>Use ultrasounds to “map” abdominal wall </li></ul><ul><li>Some trocars have plastic sheaths that spring to cover sharp edge after insertion </li></ul><ul><li>Unsurprisingly, surgeons who have performed more Laparoscopic surgeries had less complications during their procedures </li></ul>
  10. 15. <ul><li>1 hour before surgery patient should empty their bladder </li></ul><ul><li>IV fluids are given: LR or NS </li></ul><ul><li>Medicine may be given IV to help patient relax (Versed) </li></ul>Pre-Op
  11. 16. <ul><li>An airway will be placed to help patient breathe if given general anesthesia. </li></ul><ul><li>Urinary catheter may be placed (depending on surgery). </li></ul><ul><li>Hair may be shaved. </li></ul><ul><li>Abdomen and pelvic area will be washed and sanitized. </li></ul>In The OR
  12. 17. <ul><li>During laparoscopy, a small incision is made in the belly. More than one incision may be made if other tools will be used during the surgery. A hollow needle is put through the first incision and gas (carbon dioxide or nitrous oxide) is slowly put through the needle to inflate the abdomen. The gas lifts the abdominal wall away from the organs inside so the doctor can see clearly. </li></ul>In The OR
  13. 18. <ul><li>A thin, lighted tube (laparoscope) is then put through the incision to look at the organs. Other tools can be used to take tissue samples, fix damage, or drain cysts. A laser may be attached to the laparoscope to help with the surgery. </li></ul>In The OR
  14. 19. <ul><li>After the surgery, all the tools will be removed and the gas will be released. The incisions will be closed with stitches and covered with a bandage. </li></ul><ul><li>Laparoscopy takes 30 to 90 minutes, depending on what is done, but can take longer if a condition (such as endometriosis) is found and treated. </li></ul>In The OR
  15. 21. <ul><li>After the laparoscopy, patient will go to the recovery room for 2 to 4 hours. </li></ul><ul><li>Monitor vital signs and overall patient recovery from surgery. </li></ul><ul><li>Monitor I/O’s </li></ul><ul><li>Patients are encouraged to get up and move around (the sooner the better). </li></ul><ul><li>Patient teaching about compliance of post-surgery instructions and medications </li></ul>After Surgery
  16. 22. <ul><li>Explain any special instructions from the doctor. </li></ul><ul><li>Patient may have some bloating from the CO 2 , as well as bruising and pain around incisions for a few days. </li></ul><ul><li>Advise against drinking carbonated beverages for 1 to 2 days after the laparoscopy to lower chance of gas pains and vomiting. </li></ul>
  17. 23. <ul><li>The gas used during the laparoscopy can irritate the diaphragm for a few days. Patient may experience some pain or achiness in the site for several hours after the laparoscopy. </li></ul><ul><li>Some of the gas in the abdomen may leak into the skin and cause a crackling sound if patient rubs the skin surrounding the stitches. This is not serious and will go away in a few days. </li></ul>
  18. 24. <ul><li>The patient can usually do normal activities the next day, but should avoid any strenuous activity or exercise for about a week depending on type of surgery. </li></ul><ul><li>Patient may be tired and have some pain for a few days after a laparoscopy. Patient may have a mild sore throat from the tube in the throat. Have patient use throat lozenges and gargle with warm salt water to help sore throat. </li></ul>

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