Sun. Oct 20th, 2019

WHAT IS LAPAROSCOPY ? OPERATING PROCEDURE , INSTRUMENT’S AND ITS ADVANTAGE..

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WHAT IS LAPAROSCOPY ? 

Diagnostic laparoscopy is a minimally invasive surgical procedure that allows the visual examination of intra abdominal organs in order to detect pathology Laparoscopy is a type of surgical procedure in which a small cut is made through the navel (tummy button) through which a viewing tube (laparoscope) is inserted. The video image of the liver, stomach, intestines, gallbladder, spleen, peritoneum, and pelvic organs can be viewed on a monitor after insertion of a telescope into the abdomen.  Other small cuts can be made to insert instruments to perform procedures (keyhole surgery). Manipulation and biopsy of the viscera is also possible through additional ports..

INSTRUMENT 

This is kind of special surgical tools that the surgeon uses to work on the patient. These tools allow the surgeon to move, cut, and stitch organs during the operation. The laparoscopic instrument used during the previous activity is much different from the instrument used during a real surgical procedure. The instrument is assemble with other components to aid Surgeon see clear pictures of image of an internal organs of human system.

 

OPERATIVE PROCEDURE

Laparoscopy is a surgical procedure performed in the hospital under general anaesthesia. Before starting the procedure the bladder is emptied with a small catheter and the skin of the abdomen cleaned.
After the patient is given anaesthesia a hollow needle is inserted into the abdomen through a small cut through the navel (tummy button), and carbon dioxide gas pumped through the needle to expand the abdomen. This allows the surgeon a better view of the internal organs the monitor. The laparoscope is then inserted through this cut to look at the internal organs on the video monitor. Usually one or two additional small cuts are made along the ‘bikini line’ to insert other instruments which are used to lift the tubes and ovaries for examination or to perform surgical procedures.

USES

Laparoscopy can be carried out to diagnose certain conditions or to perform certain types of operations which include: 
lap Sterilization.
Pelvic pain
Ectopic pregnancy.
Infertility.
Endometriosis.
Hysterectomy
Ovarian cysts.
Adhesiolysis.
Fibroids. etc

COMPONENT

Camera Head 
Coupler
Camera Head Cable
Camera Processor
Video Monitor 
Light source
Light cable /fiber optic cable
Rotation Knob
Trigger+ Handle 
Scissor Insert



ADVANTAGES

Small incision
Minimal pain
Attenuated stress response
Earlier return to ambulation
Reduced hospital stay
Fast recovery
Reduced blood loss

 BIOMEDICAL TROUBLESHOOTING
Poor Insufflation

The possible cause be as result of Empty CO2 tank, Accessory port stopcock(s) not properly adjusted Leak in sealing cap or stop cock Excessive suctioning, loose connection of insufflator tubing at source or at port, Tubing disconnection from insufflators or Flow rate set too low. 

Check and change the CO2 tank if it’s empty. Inspect all accessory ports. Open or close stopcock(s)  as needed. Change cap or cannula and Allow time to reinsufflate. Re-tighten all lose connections, Replace or secure sutures. Connect tubing And Adjust flow rate. 

Excessive pressure required for insufflations

The problem may be as a result of Veress needle or cannula tip not in free peritoneal cavity. Occlusion of tubing (kinking, table joints, etc.), Port stopcock turned off, Patient is “light” Cannula tip not in peritoneal space. 

Reinsert needle or cannula. Inspect full length of tubing. Replace with proper size as necessary. Fully open stopcock, Give more muscle relaxant, Advance cannula under visual control.

Inadequate lighting (partial/complete loss): 

The cause can be as result of loose connection at source or scope Light is on “manual-minimum”,Bulb is burned out, Fiber optics are damaged,  Monitor brightness turned down Room brightness floods monitors.
Adjust connector, Go to “automatic” Replace bulb Replace light cable Readjust setting Dim room lights

Lighting too bright.

This may be due to Light is on “manual-maximum” “Boost“ on light source is activated or Monitor brightness turned up.
Go to “automatic” deactivate “boost” And Re adjust setting

No picture display on monitor 
This may be that Camera control or other components (V.C.R., printer, light source, monitor)
Are not “on”, or Cable connector between camera control unit and monitors not attached properly or Cable between monitors not connected Input select button on monitor doesn’t match “video in” choice

Make sure all power sources are plugged in and turned on. Cable should run from “video out” on camera control unit to “video in” on primary monitor. Use compatible cables for camera unit and light Source. Cable should run from “video out” on primary monitor to “video in” on secondary monitor, Assure matching selections.

Poor quality fogging/haze picture: 
The problem may occur when there is Condensation on lens from cold scope entering warm abdomen Condensation on scope eyepiece, camera lens, coupler lens.

Gently wipe lens on viscera; use anti-fog solution, or warm water Detach camera from scope (or camera from coupler), inspect and clean lens as needed.

Flickering, Electrical interference:
May be there is a  moisture in camera cable connecting plug or Poor cable shielding or  Insecure connection of video cable between monitors. 

Use suction or compressed air to dry out moisture (don’t use cotton tip applicators on muti-pronged plug. Also move electrosurgical unit to different circuit or away from video equipment and reattach video cable at each monitor.

Blurring distortion image: 
There is Cracked on the lens, or internal moisture content, Incorrect focus too grainy

Adjust camera focus ring Inspect scope/camera, replace if needed, Adjust enhancement and/or grain settings for units with this option

Poor or Inadequate suction/irrigation: 
This can occur if there is Occlusion of tubing (blood clot). Occlusion of valves in suction/irrigator
Device, not attached to wall suction, Irrigation fluid container not pressurized.

Inspect full length of tubing. If necessary, detach from instrument and flush tubing with sterile saline. Detach tubing, flush device with sterile saline. Inspect and secure suction & wall source connector. Inspect compressed gas source, connector, pressure dial setting.

Absent or “weak” cauterization: 
If the Patient is not grounded properly or there is no Connection between electro-surgical unit and instrument loose or Foot pedal or hand switch not connected to electrosurgical unit or wrong output selected or Connected to the wrong socket on the electrosurgical unit. Instrument insulation failure outside of surgeon’s view.

Make sure there is adequate grounding pad contact. Inspect both connecting points, correct output choice, Check that cable is attached to endoscopic socket, and also Use new instrument and inspect insulation.

2 thoughts on “WHAT IS LAPAROSCOPY ? OPERATING PROCEDURE , INSTRUMENT’S AND ITS ADVANTAGE..

  1. Good Job Vishnu. The article is made in an orderly fashion. Also the pictorial representation with labelled parts is very useful so that even a beginner can understand clearly.

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