3. Intracranial pathology (hydrocele, AV malformation, tumor, hx of CVA/cerebral
aneurysm, increased ICP)
What are the techniques to laparoscopic procedures? - ANSWER An artificial
pneumoperitoneum is established to
1. Provide visibility
, 2. Access the surgical site
3. Provides room to safely manipulate instruments
There are 2 primary techniques to establish a pneumoperitoneum:
1. Closed technique
2. Open technique
What is the closed technique? - ANSWER A veress needle pierces the abdominal
wall @ the thinnest point (usually the umbilicus). A pneumoperitoneum is then
established, then the trocars are placed
What risks to the closed technique? - ANSWER No visualization of the needle, so
there is an increased risk for puncture of organs
What is the open technique? - ANSWER A 1-2 mm incision is made and the
abdominal wall is separated from underlying tissue under direct visualization. The
trocars are then inserted, then the pneumoperitoneum is established
What are the drawbacks of an open technique? - ANSWER Takes longer
What is the intra-abdominal pressure used for insufflation? - ANSWER 15 mmHg
or less
Why do we use CO2 for insufflation? - ANSWER 1. Diffuses faster
2. Non-flammable
3. Inexpensive
4. Most hemodynamically stable source
What are alternatives to CO2 for insufflation? - ANSWER 1. Gasless
2. Helium/Argon
3. Nitrous oxide
How does the gasless technique work? - ANSWER Devices lift the abdominal wall
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