laparoscopy lecture

1. Laparoscopy in
Gynaecology
Yazid Jibrel

2. History of
laparoscopy

3. Georg Kelling
1901
 Dresden, Germany
 First laparoscopy on a dog

4. Hans Christian
Jacobaeus
 Sweeden
 First laparoscopy in human

5. Hans Jacob

6. Patrick Steptoe
 Oxford, UK
 1977
 First diagnostic laparoscopy
 First IVF baby using laparoscopy
to collect the eggs

7. Raul palmer
 France
 1947
 First publication of modern
diagnostic laparoscopy

8. Kurt Semm
 Kiel, Germany
 “The mad scientist” Der spigel
 First cold light source
 First gas insufoltor
 Laparoscopic suturing
 First lap appaendectomy
 1981

9. Knowledge checks

11. • What proportion of uretretric injuries are recognised intraoperatively
during laparoscopic surgery?
• A. 10%
• B. 25%
• C. 33 %
• D. 50%
• E. 67%

13. A. 15% of bowel injury might not be diagnosed at time of laparoscopy
B. 25% of bowel injury might not be diagnosed at time of laparoscopy
C. 35% of bowel injury might not be diagnosed at time of laparoscopy
D. 45% of bowel injury might not be diagnosed at time of laparoscopy
E. 55% of bowel injury might not be diagnosed at time of laparoscopy

21. Think SAFETY!

23. • 250,000 women undergo laparoscopic surgery in the UK each year.
• Serious complications rate 1 in 1000

24. Entry
techniques
• Closed technique
• Open technique (Hasson)
• Closed tech 4 in 10,000 bowel damage
• 2 in 10,000 major vessel injury

26. Alternative sites for primary trocar or veress
• The preferred point of entry is 3 cm below the left costal margin in
the mid-clavicular line (Palmer’s point)

29. Serious risks with laparoscopy

33. • Clinical evidence of a bladder injury includes suprapubic pain,
haematuria, leakage of urine per vagina and oliguria.Sterile urine
does irritate the peritoneum, causing a form of chemical peritonitis
(uroperitoneum). Symptoms and signs are misleading and subtle
compared to peritonitis caused by contaminated material such as
bowel content or infected urine. Uroperitoneum can present with
diffuse abdominal pain, distension and ileus.
• Symptoms and signs usually appear in first 48 hours, unless thermal
injury has occurred which present 10-14 days later.

39. • What proportion of uretretric injuries are recognised intraoperatively
during laparoscopic surgery?
• A. 10%
• B. 25%
• C. 33 %
• D. 50%
• E. 67%

41. A. 15% of bowel injury might not be diagnosed at time of laparoscopy
B. 25% of bowel injury might not be diagnosed at time of laparoscopy
C. 35% of bowel injury might not be diagnosed at time of laparoscopy
D. 45% of bowel injury might not be diagnosed at time of laparoscopy
E. 55% of bowel injury might not be diagnosed at time of laparoscopy

48. Thank you