Preparing the patient for laparoscopic surgery

I have been doing laparoscopic surgery for about 25 years. I have visited many famous laparoscopic surgeons and learnt from them. There are many tips and tricks I have learnt over the years. I wanted to write a book on athis topic but that will take a long time. I have decided to blog all my thoughts. In this was it could be always updated. The aim of these series of blogs is to educate young doctors keen on learning laparoscopic surgery. My plan is to make videos to accompany this blog so that learning will be more fun. I will be grateful if experts in laparoscopic surgery could give me pointers on improving these blogs as well as give other tips that will benefit everyone. You can follow all the videos and blogs by clicking #laparoscopytips.

Bowel preparation

There is controversy as to whether bowel preparation should be done before laparoscopic gynaecological. My personal policy is that, I don’t give bowel preparation for minor case like diagnostic laparoscopy, laparoscopic tubal ligation or laparoscopic salpingectomy for ectopic pregnany.  I will give a bowel preparation before all major cases. This will oral laxative the night before the surgery. As for cases where there will be a potential for bowel excision, then low fibre diet for 3 days followed by  full course of cathartic as recommended by my colorectal surgeon. The  advantage of bowel preparation is that the small and large intestines will collapse and can be moved away from the pelvis so that surgery can be done easily.

Placing a roll under the back of the patient

This is a trick that I learnt from Dr. Shailesh Puntambaker when I visited his centre several years ago.. When you place a roll or sandbag at the back just at the level of the anterior superior iliac spine, there will be a tilt between the pelvis and the abdomen. This helps to shift the small bowel away from the pelvis with much lesser Trendelenburg position for the patient. Many doctors ask me whether this will cause more backache postoperatively. From my experience of doing this routinely for the last 8 years, this is not a problem. 

Draping

Some of us are still using reusable cloth drapes. If you are using such drapes, the easiest way to drape is to use a large drape and cover the legs and then tie them together across the leg so as to cover the legs. I have used preprepared sleeves for the legs. It is ok but it tears easily and laundry services will have difficulty washing and preparing such drapes. I learned this from Dr Shailesh.

Suturing a gauze at the perineum

One of the problem that I face when doing laparoscopic surgery is that feces may contaminate the vagina. To overcome this I learned a trick from Dr. Ando of Japan. A gauze is sutured to a drape on the fourchette of the perineum. This will prevent soiling of the vagina. One can also place a stitch on the labia minora and suture it to the side of the drape. This will also make vaginal access easier. The only problem will be to ensure that the labia minora is not torn during the manipulation that may occur during surgery especially when large tissues are removed from the vagina. 

Please watch the video at

https://youtu.be/AZpNJReabGw

https://vimeo.com/user31343866/review/402450180/54c4f16b1a  

Dr. Selva
Sevellaraja Supermaniam
31/3/2020

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Dr. Selva

Dr. Selva

Dr S. Selva (Sevellaraja Supermaniam) is a Consultant Obstetrician and Gynaecologist and a subspecialist in Reproductive Medicine at a private hospital in Melaka, Malaysia. He heads the O&G unit and the IVF Centre at the hospital.

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