Laparoscopic Course: General Principles of Laparoscopy: Specific Aspects of Transperitoneal Access (R.Bollens)
Laparoscopic Course: General Principles of Laparoscopy: Specific Aspects of Transperitoneal Access (R.Bollens)
Laparoscopic Course: General Principles of Laparoscopy: Specific Aspects of Transperitoneal Access (R.Bollens)
Veress needle or of the first port. Veress needle can be reusable or disposable.
Disposable is more expensive but the sharpness is perfect for each procedures.
completely free of friction and sharp part is completely covered after release.
mm. Shorter skin incision increase risk of injury during the port introduction. In
this situation, the abdominal wall move down and the blade of the port can
injure intra abdominal organs. A naso gastric tube must be placed before any
pressure in the abdomen. One click is classically eared on the midline and two
clicks somewhere else. Sometimes peritoneum adds one more click in fatty
space
Veress needle is connected and the insufflator starts on low gas flow.
Abdominal wall is lifted up to help insufflation. High peak pressure occurs when
needle is closed to the omentum. In this case, you must mobilised needle in its
axis. In the field of the liver, Veress can be placed trough this organ without any
impact on the creation of the pneumoperitoneum. For this reason the needle
give enough resistance to introduce the port without risk to push down the
abdominal wall. Port is introduced in 90° from the skin or slightly in direction of
increase abdominal wall injury. When first port is placed the valve is opened
perform to exclude any injury occurred during this blind part of the installation.
use grasping forceps (Kocher). Skin is incised classically and fatty tissue is
opened to see the aponevrosis. The aponevrosis is grasped between two Kocher
and incised. Muscular fibres are dissected to show the next plan (Douglas arch
or peritoneum for ex.). The next plan is grasped between two others Kochers
and incised. The Two first Kocher are removed. All successive plans are opened
using the same principles. When the peritoneum is opened, a purse spring suture
the optic, inside the abdomen, and the purse spring suture is closed to avoid gas
leakage. Never introduce the port alone because its tip is sharp. Insufflation can
be finally installed.
Gasless laparoscopy:
but more a trapezoid volume due to the lifting system. Main disadvantage is
think that this approach is certainly not perfect and in most cases we can
mm hg).