Before Your First: Laparoscopy

Review anatomy– you’ll be able to see well!

Pimped- Youtube Channel videos for laparoscopic anatomy

What case are you doing and why?

Review common indications, steps to procedure and potential risks/complications

Saying hi to the patient first

Being helpful setting up — yellowfins or stirrups for lithotomy

Scrubbing in — ask to grab your gown/gloves for the scrub, open carefully or get help if unsure

Abx: If entering uterus or vagina ie hyst

Prep: infection prevention with chloraprep or something

EtOH based, needs to evaporate before draping or risk fire!

Vaginal prep — betadine or chlorhexidine

Then everyone scrubs

Let resident/attending drape unless asked.

You may be asked to help with foley/manipulator

Uterine manipulators: Many sizes/shapes/types

Vagina is dirty– can’t go from vagina to abdomen

Abdomen:

Entry: Typically in umbilicus or just above. Can use Palmer’s Point if needed.

Direct visualization with Hassan

Visiport

Veres needle

Insufflate with CO2

Port placement: Typically middle ⅓ of distance between ASIS and umbilicus. Avoid obvious superficial vessels and inferior epigastric –watch from below

Common procedures:

Dx LSC– endometriosis, adhesions

Tubal ligation or bilateral salpingectomy

Cystectomy

BSO

Hysterectomy

Closing ports: Close fascia on ports >5mm due to increased risk of hernia

Post-op checks: Many LSC cases are same-day, meaning patients go home

-Nausea/vomiting, eating/drinking, voiding, passing flatus, ambulating

-UOP, BPs,