By A. Smamsa
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Extra info for Advanced Laparoscopy
Clavien, PA. (2004). Classification of surgical complications: a new proposal with evaluation in a cohort of 6336 patients and results of a survey. Ann. Surg, Vol. 240, No. 2, (Aug 2004), pp. 205–13, ISSN 0003-4932 Dumont, L; Mattys, M; Mardirosoff, C; Vervloesem, N; Allé, JL. & Massaut, J. (1997) Changes in pulmonary mechanics during laparoscopic gastroplasty in morbidly obese patients. Acta Anaesthesiol Scand Vol. 3, (Mar 1997), pp. 408 –13, ISSN 0001-5172 Dunham, CM; Sosnowski, C; Porter, JM; Siegal, J.
4 Positioning Careful positioning of the equipment and staff to achieve optimal access to the patient is crucial to successful laparoscopy. Examples are given in Figures 1 and 2. The position must allow adequate exposure of the patient and safe access to the operating field. The recommended alignment is to have the monitor, operating surgeon and the patient or target organ in a straight line. It is preferable to have two monitors to serve the operating surgeon and his or her assistant separately; this is standard for most operating rooms today.
1 Preoperative assessment This is crucial in all children in preparation for a laparoscopic procedure. This can be as a formal assessment in a dedicated preoperative assessment clinic led by experienced paediatric surgeons with easy access to paediatric anaesthetist and paediatrician or informally in the outpatients’ clinic when the decision to undertake the procedure is made. The anaesthetic team would need to be informed if any potential cardiovascular/ respiratory problems are anticipated. The child’s suitability for laparoscopy by way of respiratory and cardiovascular status as well as suitability regarding skin condition at proposed site of access and situations which may make access to the abdominal cavity greatly limited.