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,