basics skills for laparoscopic colon surgery n.
Download
Skip this Video
Loading SlideShow in 5 Seconds..
Basics Skills for Laparoscopic Colon Surgery PowerPoint Presentation
Download Presentation
Basics Skills for Laparoscopic Colon Surgery

Loading in 2 Seconds...

play fullscreen
1 / 28

Basics Skills for Laparoscopic Colon Surgery - PowerPoint PPT Presentation


  • 204 Views
  • Uploaded on

Basics Skills for Laparoscopic Colon Surgery. Bradley R. Davis, MD, FACS, FASCRS Associate Professor of Surgery University of Cincinnati Program Director Residency in General Surgery Director of Minimally Invasive Colorectal Surgery, University Hospital.

loader
I am the owner, or an agent authorized to act on behalf of the owner, of the copyrighted work described.
capcha
Download Presentation

PowerPoint Slideshow about 'Basics Skills for Laparoscopic Colon Surgery' - briar-harvey


An Image/Link below is provided (as is) to download presentation

Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author.While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server.


- - - - - - - - - - - - - - - - - - - - - - - - - - E N D - - - - - - - - - - - - - - - - - - - - - - - - - -
Presentation Transcript
basics skills for laparoscopic colon surgery

Basics Skills for Laparoscopic Colon Surgery

Bradley R. Davis, MD, FACS, FASCRS

Associate Professor of Surgery

University of Cincinnati

Program Director Residency in General Surgery

Director of Minimally Invasive Colorectal Surgery, University Hospital

laparoscopic colectomy you ve come a long way baby
Laparoscopic Colectomy:You’ve Come a Long Way Baby!
  • Improved instrumentation
  • Improved techniques
  • Standardized approach
  • Large experience by a few surgeons
  • Still not routine
barriers to implementation
Barriers to Implementation
  • Access to cases
  • Technique often differs from open approach
    • Medial vs. lateral
    • Comfort in major pedicle ligation (aortic branches)
  • Requirements for more than one skilled surgeon
  • Time
skill sets
Skill Sets
  • Multi quadrant surgery
    • Skilled camera operator
    • Ability to work against the camera
  • Colon not always fixed
    • Tension created by two operators – both skilled
  • Knowledge of energy devices and endo staplers
other considerations
Other Considerations
  • Loss of tactile feedback
    • Diverticulitis
    • Crohn’s disease
    • Location of tumor/polyp
  • Learning curve
    • Surgeon
    • Surgical Team
    • Referring Docs
preparation the patient
Preparation - The Patient
  • Preoperative evaluation
    • few additional studies necessary
    • additional invasive monitoring unusual
  • Flexibility of hips and legs
room setup
Room Setup

What we get…

What we hope for…

set up the bed
Set Up: The Bed
  • Electric bed
  • Bean bag
  • Velcro bag to bed
  • Bottom of bag at break
set up the patient
Set Up: The Patient
  • Modified lithotomy
  • Minimize hip flexure
  • Arms tucked
  • Padding for shoulder
set up the patient1
Set Up: The Patient
  • Minimize hip flexion
  • 10o at most
  • More flexion may limit access to transverse colon
set up the patient2
Set Up: The Patient
  • Padding for neck and shoulder
  • 3” silk around chest to prevent lateral slippage
preparation surgeon general recommendations
Preparation - Surgeon: General Recommendations
  • Be prepared for the day
  • Don’t book too many cases
  • Keep your cool
  • Pick the easy lay-up
  • Find some good help
preparation surgeon learning curve
Preparation - Surgeon: Learning Curve
  • Steep (20-50 cases)
    • Depth perception
    • Multiple quadrants
    • Reverse angles
    • Coordination of team

Operative times

Conversion rates

slide19

Convert

Alternate

conversions does it matter
Conversions – Does it matter
  • Conversion – an ugly word
  • Increased operative times
  • Increase length of stay
  • Increase 30 day readmission/morbidity
  • Increase cost
conversions1
Conversions
  • No difference in outcomes when compared to an open cohort of similar patient
  • KEY is to make a decision to ALTERNATE the approach early

Dis Colon Rectum. 2004 Oct;47(10):1680-5

alternatives to conversion
Alternatives to Conversion
  • Pfannenstiel incision after:
    • mobilization of splenic flexure
    • division of vascular pedicle
  • Hand-assisted

laparoscopy

    • allows tactile sensation
    • blunt separation
preparation surgeon developing a systematic approach
Preparation - Surgeon: Developing a Systematic Approach
  • Develop an approach and stick with it
  • Initial survey
  • Port placement
  • Vascular ligation and medial mobilization
  • Lateral mobilization
  • Extraction and anastomosis
laparoscopes
Laparoscopes
  • 10mm 0o
    • Easy orientation
    • May be inadequate at the flexures
  • 10mm 30o
    • Better visualization at flexure and pelvis
    • Disorientation
  • Flexible tip lens
conclusion
Conclusion
  • Don’t wait for the perfect case
  • Be prepared
  • If you are going to alternate – do it quickly
  • Have fun