By Daniel B. Jones
Accelerated through 30% to discover the most recent surgical ways, strategies, apparatus, and views, this moment version leads surgeons via new functions in minimally invasive surgical procedure, gynecology, urology, endoscopically-assisted cosmetic surgery, pediatric surgical procedure, and video-assisted thoracoscopic tactics.
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Extra info for Laparoscopic Surgery: Principles and Procedures, Second Edition, Revised and Expanded
If this occurs, the surgeon should establish a different viewing axis by moving the laparoscope to a position at which the angle between the camera and the instrument port is wider. Occasionally this may require placement of an additional access port if satisfactory arrangement is not possible using the existing port locations. When a monitor is used, the video is always opposite the surgeon. In this arrangement, hand-eye coordination is extremely difficult for the assistant, for whom the view is a mirror image.
Maneuvers to correct hypoxemia include increasing inspired oxygen concentration, releasing the pneumoperitoneum, and changing the patient from the Trendelenburg to the supine position. The chest should also be auscultated to verify the position of the endotracheal tube and to rule out a pneumothorax. Hypercarbia represents an imbalance between CO 2 absorption, production, and elimination. During laparoscopy, hypercarbia often results either from systemic absorption of insufflated CO 2 or hypoventilation.
Positioning of the tracheal tube is best confirmed with a fiberoptic bronchoscope. Arterial line placement may be indicated for continuous blood pressure monitoring and assessment of adequacy of oxygenation and ventilation. Dysrhythmias occur frequently, especially if CO 2 insufflation is used, because CO 2 is absorbed more rapidly from the pleural cavity. Mediastinal compression may cause hypotension. VII. CONCLUSION A major advantage of laparoscopy is the potential for less postoperative pain and faster recovery.
Laparoscopic Surgery: Principles and Procedures, Second Edition, Revised and Expanded by Daniel B. Jones