Laparoscopy and entry RCOG Basic Practical Skills Course

Position • • Supine Stirrups/Lloyd Davis Non slip mattress Trendelenberg after ports © Royal College of Obstetricians and Gynaecologists

Primary port closed entry The greater the gas bubble & abdominal wall tension the less the risk of bowel injury Abdominal pressure= 8 mm. Hg Abdominal pressure=25 mm. Hg © Royal College of Obstetricians and Gynaecologists

Primary port closed entry Commonest problem - failed entry Insertion of subumbilical Veress needle © Royal College of Obstetricians and Gynaecologists

Primary port closed entry Complications: – Vascular injury – Retroperitoneal haemorrhage – Bladder injury – Injury to over inflated stomach © Royal College of Obstetricians and Gynaecologists

Secondary ports are inserted under direct vision Principles Avoid inferior epigastric vessels Avoid bowel/vascular injury Minimise hernia risk © Royal College of Obstetricians and Gynaecologists

Secondary ports - Anatomy Mid-line Rectus muscles Obliterated umbilical artery Round ligament © Royal College of Obstetricians and Gynaecologists

Secondary ports - Anatomy Inf epigastric artery © Royal College of Obstetricians and Gynaecologists

Exit techniques • under direct view to identify: bleeding, injury to bowel/omentum Wound closure: avoid hernia risk by closing sheath: - midline port sites > 7 mm - lateral port sites > 5 mm prevent wound dehiscence © Royal College of Obstetricians and Gynaecologists

Now show the Video: Closed laparoscopic entry technique Now show the video: Open laparoscopic entry techniques © Royal College of Obstetricians and Gynaecologists