Laparoscopic access

The modern era of laparoscopy began in 1954, when Palmer [1] reported the results of endoscopic procedures in 250 patients without sequelae. He produced a pneumoperitoneum with CO2 at a rate of 300 to 500 mL/min and cautioned that the intraabdominal pressure should not exceed 25 mm Hg. The claimed advantages of laparoscopy over culdoscopy were a decreased chance of infection, a better view of the pelvis, improved access to the pelvic organs and cul-de-sac, and easier application of surgical techniques. Although the basic principles of laparoscopy are the same, the instruments and the complexity of operative procedures have changed significantly since 1954. This chapter presents information for residents learning laparoscopic operations and clinicians who are updating their knowledge of operative laparoscopy. Preoperative Evaluation: Advanced operative laparoscopy is a major intra-abdominal procedure. Careful preoperative evaluation optimizes the operative outcome and decreases the incidence of injuries and complications. Preoperative consultations with surgeons in other disciplines (colorectal, urologic, oncologic) sometimes are necessary. The patient is informed about the possible outcome and results of the planned operation, possible complications, and the surgeon's experience in doing the particular procedure. The following preoperative work-up is suggested: History and physical. Complete blood count (CBC) with differential. Serum electrolytes. Urinalysis. Papanicolaou smear Thrombin time, partial thrombin time, bleeding time Transvaginal sonography (TVS) In special situations, an endometrial biopsy, cervical culture, hysterosalpingogram, barium enema, intravenous pyelogram, blood type and screen or type and crossmatch, and bowel preparation are indicated.