Book contents
- Frontmatter
- Contents
- Contributing Authors
- Forewords
- Preface
- 1 HISTORY OF MODERN OPERATIVE LAPAROSCOPY
- 2 EQUIPMENT
- 3 ANESTHESIA
- 4 LAPAROSCOPIC ACCESS
- 5 LAPAROSCOPIC SUTURING
- 6 INTRAPERITONEAL AND RETROPERITONEAL ANATOMY
- 7 FERTILITY
- 8 HYSTEROSCOPY
- 9 MANAGEMENT OF ADNEXAL MASSES
- 10 ENDOMETRIOSIS
- 11 LAPAROSCOPIC ADHESIOLYSIS AND ADHESION PREVENTION
- 12 LEIOMYOMAS
- 13 HYSTERECTOMY
- 14 PELVIC FLOOR
- 15 LAPAROSCOPIC TREATMENT OF CHRONIC PELVIC PAIN
- 16 GYNECOLOGIC MALIGNANCY
- 17 LAPAROSCOPY IN THE PREGNANT PATIENT
- 18 MINIMAL ACCESS PEDIATRIC SURGERY
- 19 LAPAROSCOPIC VASCULAR SURGERY IN 2007
- 20 COMPLICATIONS IN LAPAROSCOPY
- 21 ADDITIONAL PROCEDURES FOR PELVIC SURGEONS
- 22 LAPAROSCOPY SIMULATORS FOR TRAINING BASIC SURGICAL SKILLS, TASKS, AND PROCEDURES
- 23 ROBOT-ASSISTED LAPAROSCOPY
- 24 HYSTEROSCOPY AND ENDOMETRIAL CANCER
- 25 OVERVIEW OF COMPLICATIONS
- Appendix
- Atlas
- Index
4 - LAPAROSCOPIC ACCESS
Published online by Cambridge University Press: 23 December 2009
- Frontmatter
- Contents
- Contributing Authors
- Forewords
- Preface
- 1 HISTORY OF MODERN OPERATIVE LAPAROSCOPY
- 2 EQUIPMENT
- 3 ANESTHESIA
- 4 LAPAROSCOPIC ACCESS
- 5 LAPAROSCOPIC SUTURING
- 6 INTRAPERITONEAL AND RETROPERITONEAL ANATOMY
- 7 FERTILITY
- 8 HYSTEROSCOPY
- 9 MANAGEMENT OF ADNEXAL MASSES
- 10 ENDOMETRIOSIS
- 11 LAPAROSCOPIC ADHESIOLYSIS AND ADHESION PREVENTION
- 12 LEIOMYOMAS
- 13 HYSTERECTOMY
- 14 PELVIC FLOOR
- 15 LAPAROSCOPIC TREATMENT OF CHRONIC PELVIC PAIN
- 16 GYNECOLOGIC MALIGNANCY
- 17 LAPAROSCOPY IN THE PREGNANT PATIENT
- 18 MINIMAL ACCESS PEDIATRIC SURGERY
- 19 LAPAROSCOPIC VASCULAR SURGERY IN 2007
- 20 COMPLICATIONS IN LAPAROSCOPY
- 21 ADDITIONAL PROCEDURES FOR PELVIC SURGEONS
- 22 LAPAROSCOPY SIMULATORS FOR TRAINING BASIC SURGICAL SKILLS, TASKS, AND PROCEDURES
- 23 ROBOT-ASSISTED LAPAROSCOPY
- 24 HYSTEROSCOPY AND ENDOMETRIAL CANCER
- 25 OVERVIEW OF COMPLICATIONS
- Appendix
- Atlas
- Index
Summary
The modern era of laparoscopy began in 1954, when Palmer [1] reported the results of endoscopic procedures in 250 patients without sequelae. He produced a pneumoperitoneum with CO2 at a rate of 300 to 500 mL/min and cautioned that the intraabdominal pressure should not exceed 25 mm Hg. The claimed advantages of laparoscopy over culdoscopy were a decreased chance of infection, a better view of the pelvis, improved access to the pelvic organs and cul-de-sac, and easier application of surgical techniques.
Although the basic principles of laparoscopy are the same, the instruments and the complexity of operative procedures have changed significantly since 1954. This chapter presents information for residents learning laparoscopic operations and clinicians who are updating their knowledge of operative laparoscopy.
PREOPERATIVE EVALUATION
Advanced operative laparoscopy is a major intra-abdominal procedure. Careful preoperative evaluation optimizes the operative outcome and decreases the incidence of injuries and complications. Preoperative consultations with surgeons in other disciplines (colorectal, urologic, oncologic) sometimes are necessary. The patient is informed about the possible outcome and results of the planned operation, possible complications, and the surgeon's experience in doing the particular procedure. The following preoperative work-up is suggested:
History and physical
Complete blood count (CBC) with differential
Serum electrolytes
Urinalysis
Papanicolaou smear
Thrombin time, partial thrombin time, bleeding time
Transvaginal sonography (TVS)
In special situations, an endometrial biopsy, cervical culture, hysterosalpingogram, barium enema, intravenous pyelogram, blood type and screen or type and crossmatch, and bowel preparation are indicated.
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- Publisher: Cambridge University PressPrint publication year: 2008
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