By Namir Katkhouda
This moment version of complex Laparoscopic surgical procedure, ideas and Tips represents a complete description of the present laparoscopic concepts. It offers surgeons with the entire info essential to effectively accomplish laparoscopic surgery. it's a hands-on handbook that is helping the doctor keep away from pitfalls and procure the mandatory laparoscopic abilities fast and successfully. it's a prepared resource of functional aid while trouble-shooting is critical. complex laparoscopic surgical procedure is a wonderful merger of a textbook and atlas for the healthcare professional who desires to expand and refine his laparoscopic thoughts.
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Additional resources for Advanced Laparoscopic Surgery: Techniques and Tips, Second Edition
Acute Gangrenous Cholecystitis In acute gangrenous cholecystitis, removal of the inflammatory adhesions from the fundus of the gallbladder is the first step. This is accomplished by applying high-pressure hydro-irrigation through the irrigation suction cannula to the edge of the gallbladder to open up planes, which are then further dissected using a grasper and scissors with cautery, staying away from the duodenum at all times. 1). When the fundus of the gallbladder has been identified, it is possible 29 Impacted Stone (Hydrops, Empyema, Early Mirizzi) to make a small opening using electrical scissors and insert an irrigation suction device into the fundus to aspirate the contents of the gallbladder.
The author personally uses the closed technique with a Veress needle, and in more than 20 years of advanced laparoscopy performing several thousand procedures, the author has experienced only one injury (on a distended stomach on his third laparoscopic case in 1989). When a Veress needle is used, the author recommends that a nasogastric tube be inserted into the stomach and the stomach deflated so as to avoid puncture. When performing lower abdominal surgery it is also important to insert a urinary catheter.
This may be attempted without fluoroscopic guidance because the stones have already been located by intraoperative cholangiography. However, if retrieval of the stones proves difficult, then fluoroscopic guidance can be called upon before resorting to a choledochoscope. If the choledochoscope is needed to locate the stones, they can be removed using a wire basket introduced through the choledochoscope operating channel. If all these techniques are not successful, it will be necessary to revert to a laparoscopic choledochotomy.
Advanced Laparoscopic Surgery: Techniques and Tips, Second Edition by Namir Katkhouda