CHAPTER 9

Laparoscopy

Additional images are available at: evolve.elsevier.com/Tighe/instrumentation/

Laparoscopy is visualization within the abdominal cavity. The structures have to be moved away from the abdominal wall so the scope can be inserted safely. Pneumoperitoneum is accomplished by insufflation of carbon dioxide.

Laparoscopes, like arthroscopes, cystoscopes, hysteroscopes, nephroscopes, sigmoidoscopes, sinusoscopes, thoracoscopes, and urethroscopes, are types of endoscopes. Endoscopy is the introduction of a small tube to visualize inside a body cavity or structure. The tube (endoscope) has a lens and a light source for vision. The lens angle determines the area that will be seen inside the patient. The most common lens angles are 0 degrees, 30 degrees, and 70 degrees.

Many of the endoscopic instruments can be used interchangeably within the various endoscopic specialties. Interchangeable terms include “obturator/trocar” and “cannula/port” or “sleeve.” The addition of instruments either through attachments to the scope or through another port into the cavity or structure allows the surgeon to perform operative procedures. The light source is usually a fiberoptic cable, or cold light, that prevents injury to internal structures.

Minimally invasive surgery (MIS) incorporates all the fields of endoscopic surgery (orthopedic; genitourinary; gynecological; and ear, nose, and throat) using small incisions or no incisions, such as when using an endoscope rather than using traditional open methods. The advantages of MIS include: (1) decreased size of the incision sites; (2) decreased postoperative pain; (3) decreased recovery period; and (4) quicker return to work and family. Almost all surgical specialties now perform MIS procedures on most anatomical areas.

In laparoscopy, the mayo stand is set up to include a Bard-Parker scalpel handle #3 with a #11 blade; 2 Backhaus towel forceps; a Verres needle for insufflation; Silastic tubing; trocars with sleeves; a laparoscope; and a fiberoptic light cable.

A brief description of the laparoscopic procedure follows:

1. The abdominal wall is elevated with 2 Backhaus towel clips.

2. A stab wound is made near the umbilicus with a Bard-Parker scalpel.

3. The Verres needle is inserted at a 45-degree angle.

4. The Silastic tubing is attached to the needle and the CO₂ is insufflated to create the pneumoperitoneum. At 12 to 15 mm Hg pressure, the needle is removed.

5. A trocar with sleeve is introduced.

6. The trocar is removed and the laparoscope is inserted.

7. The fiberoptic cable is attached.

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