Procedure Ready: Ob/Gyn

Before Your First: Laparoscopy


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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,

    ...more
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    Procedure Ready: Ob/GynBy Jennifer Doorey, MD, MS

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