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Why would you do a diagnostic lap of the anterior
abdominal wall?
What area should you enter the abdomen?
What degree scope should you use? - Answers-To look for
evidence of post-op bleeding, adhesions, hernia or tumor.
Left upper quadrant, unless the area of interest is in the
LUQ.
30 degree scope
Best position and port placement for diagnostic pelvic
laparoscopy - Answers-- Tucked arms so surgeon can be
ergonomically favorable.
- Trendelenburg
- Ports at or above the umbilicus
- Retract uterus with manipulator or suture retraction to the
abdominal wall.
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Diagnostic lap for suspected appendicitis - Answers-- Left
arm tucked, allowing surgeon and assistant to stand on
left side.
- T-burg
- Rotate slightly to a "right side up" orientation
- Secure patient adequately to table
What are the anatomic landmarks or the beginning and
end of the small bowel? - Answers-LUQ at ligament of
Treitz to RLQ at ileocecal valve
Why would you want to have 2 monitors for a diagnostic
laparoscopy of the small bowel - Answers-Because the
small bowel spans the entire abdomen both LUQ and RLQ
so surgeon and assistant need to stand on both sides of
the table (as opposed to some surgeries like appy where
both surgeons stand on patient's left and operate on
patient's right).
In reference to the location next to the patient, what are
the best positions for the monitors in laparoscopy? -
Answers-Best monitor positions are by patient's left
shoulder and right hip.
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- Answers-Ports all on left side of abdomen in a line
How do you "run the bowel" laparoscopically? - Answers--
Systematically
- Start at cecum and work proximally, keep track of where
you are to ensure complete examination.
- Usually requires changing camera angle several times.
What are some of the newest developments in
laparoscopic surgery? - Answers-Robotic assistance,
single port site procedures, Natural Orifice Translumenal
Endoscopic Surgery (NOTES), and intrauterine fetal
surgery
List 5 laparoscopic procedures that are performed on
newborn infants - Answers-appendectomy, undescended
testes, anti-reflux surgery, pectus repair, PDA, intestinal
atresia, pyloromyotomy, and surgery for Hirschsprung's
disease
Indications for diagnostic laparoscopy - Answers-elective -
cancer staging, chronic abdominal pain
urgent - small bowel obstruction, vs ileus