Laparoscopy

Laparoscopy & Details

1. LAPAROSCOPY Samha Ahmed Ibrahim Didi Fathimath Aleefa DN – 37 th Batch

2. Objectives At the end of this presentation you should be able to understand and explain: - What laparoscopy is A brief history of laparoscopy How laparoscopy is done Who needs surgery and what laparoscopic surgery will be done Benefits of laparoscopy Perioperative nursing care for laparoscopy

3. LAPAROSCOPY Laparoscopy is also known as: - “KEYHOLE SURGERY” MINIMALLY INVASIVE SURGERY MINIMAL ACCESS SURGERY

4. LAPAROSCOPY Word origin: Greek Lapara - "the soft parts of the body between the rib margins and hips Skopein , which means "to see or view or examine." L aparoscope - endoscope inserted through an incision in the abdominal wall in order to examine the abdominal organs or to perform minor surgery

5. WHAT IS LAPAROSCOPY? Laparoscopic surgery (minimally invasive surgery) is the performance of surgical procedures with the assistance of a video camera and several thin instruments.

6. HISTORY 11th century - Abulkasim , Arab physician, used a speculum illuminated by a set of light reflectors and candles - limited applications because the heat produced by candles and other artificial lights resulted in burns. 1901- George Kelling did the first laparoscopy on a dog 1911- The first laparoscopy in a human was done by a Swedish physician H. C. Jacobeus . Hans Christian Jacobaeus

7. HOW IT IS DONE? Small incisions of up to half an inch are made and plastic tubes called ports are placed through these incisions. A camera and instruments are put into the ports and this allows access to the inside of a patient. The video camera serves as the eyes of the surgeon.

8. WHO & WHAT? DIAGNOSIS SURGERY Diverticulitis Bowel resection Gastric Obstruction Bypass Splenic disorders Splenectomy Gallstone Cholecystectomy Appendicitis Appendectomy Hernia Hernia Repair Perforated Ulcer Closure of Perforation

9. BENEFITS OF LAPAROSCOPY Shortens hospital stay - Quick recovery times Less post operative discomfort - smaller incisions = less pain. Smaller scars Less internal scarring - Less Handling of intestines results in little or no disturbance of normal function. Quicker return to activities of daily living - Avoidance of the trauma of abdominal wall injury by the incision.

10. Perioperative Nursing Care Preoperative Phase Nursing History Medical History Previous surgeries Medication History Physical assessment Clinical manifestations Laboratory & Diagnostic Studies

11. Perioperative Nursing Care Preoperative Phase Assess and enquire: Age Allergies - to medications, topical agents used to prepare the skin for surgery, and latex can create significant risks. Smoking Habits Alcohol and drug use Emotional Status Family Support Occupation Cultural and Spiritual Factors

12. Perioperative Nursing Care Preoperative Nursing Diagnosis & Interventions Knowledge deficit – Health education Anxiety – Reassurance & family involvement in patient care. Risk for ineffective airway clearance – Maintain a patent airway and monitor for complications Risk for ineffective peripheral tissue perfusion – Check capillary refill, note skin colour and check temperature.

13. Perioperative Nursing Care Final Preparation for surgery All personal belongings are identified and secured . Jewelry is removed & handed over to relatives . Dentures are removed, labeled and placed in a denture cup . Give preop medications as per physicians orders

14. Perioperative Nursing Care Postoperative Phase Maintain a patent airway Stabilize vital signs - Presence of artificial airway, O 2 saturation, BP , pulse, temperature. Provide pain relief Recognize & manage complications

15. Perioperative Nursing Care Postoperative Phase Check LOC - ability to follow command, pupillary response Urinary output Skin integrity Condition of surgical wound Presence of IV lines Position of patient to ensure safety

16. Perioperative Nursing Care Postoperative Nursing Diagnosis & Interventions Ineffective airway clearance because of increased secretions due to anesthesia, ineffective cough, pain - maintain adequate, patent airway Acute pain – Relieve pain Urinary retention – Catheterization Risk for infection – Maintain aseptic techniques during wound dressing.

17. Appendectomy

18. Cholecystectomy

19. Inguinal Hernia Repair

20. SUMMARY Laparoscopy is the performance of surgical procedures using a video camera and several thin instruments. To perform laparoscopy, small incisions are made and ports are placed through these incisions through which camera and instruments allow access to the inside of a patient. Laparoscopy is used for surgeries of the abdominopelvic cavity. (appendectomy, cholecystectomy etc.) Laparoscopy causes less pain, less discomfort, decreases recovery time and less scarring on the inside and out than an open surgery. Perioperative nursing care for laparoscopy includes history, assessment, relieving anxiety, preparation for surgery, pain relief, aseptic techniques etc.