Principles of SurgeryLaparoscopic Skills 2

D. Trottier

MIS Fellow

March 31 2009

Why should I care?

• Laparoscopy is the Standard of Care for many procedures

o Pt expectations

o Improved post-operative outcomes

• Fundamentals of Evolving Technologies

o Robotics

o TeleSurgery

o Single Port Surgery

o NOTES

Why am I here?

• To familiarize yourself with the challenges of videoscopic surgery in a controlled environmento Skills learned in the lab can then be transferred to the OR

• Challenges of Laparoscopyo 2D field of vision instead of 3Do Loss of normal degrees of freedom for manipulation of

surgical instruments / loss of tactile feedbacko Unstable video camera positioningo Operative ergonomics / working angles

o Laparoscopy is gentler on the patient but tougher on the surgeon!

The SKILLS StudyBalaa et al.

• Validation of the GOALS model in a Lap Box Trainer (Fried et al.)

• Model Design – made possible by this study

• Laparoscopic cholecystectomy: porcine model– Instructions:

• Groups of 2 / 20 minutes

• Use desiccation instead of fulgaration

• Technical problems

Lab Objectives

1] Depth Perception• Develop comfort level working with monocular optical

system (2D)

• Use Small, Precise movements (avoid overshooting, wide swings)

• Stay in correct plane

Lab Objectives

1] Depth Perception

2] Bimanual Dexterity• Optimize use of both hands (principles of ambidexterity)

• Countertraction

Lab Objectives

1] Depth Perception

2] Bimanual Dexterity

3] Tissue Handling• Adapt to a certain loss of tactile feedback (“Surgery of the

Eyes”)

• Learn to properly handle tissues (no excessive traction, tearing)

• Avoid dissecting into liver

Lab Objectives

1] Depth Perception

2] Bimanual Dexterity

3] Tissue Handling

4] Instrument Handling• Minimize recoil

• Avoid “off-screen” injuries

• Optical port: more important than you would think!• Maximize exposure/field of vision

Lab Objectives

1] Depth Perception

2] Bimanual Dexterity

3] Tissue Handling

4] Instrument Handling

ENJOY!