LAPAROSCOPY

Samha Ahmed Ibrahim Didi

Fathimath Aleefa

DN – 37th Batch

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

LAPAROSCOPY

Laparoscopy is also known as: -

“KEYHOLE SURGERY”

MINIMALLY INVASIVE SURGERY

MINIMAL ACCESS SURGERY

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."

• Laparoscope - endoscope inserted through an incision in the abdominal wall in order to examine the abdominal organs or to perform minor surgery

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.

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

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.

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

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.

Perioperative Nursing Care

Preoperative Phase

• Nursing History• Medical History • Previous surgeries • Medication History• Physical assessment• Clinical manifestations• Laboratory & Diagnostic Studies

Perioperative Nursing CarePreoperative 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

Perioperative Nursing CarePreoperative 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.

Perioperative Nursing CareFinal 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

Perioperative Nursing CarePostoperative Phase

• Maintain a patent airway

• Stabilize vital signs - Presence of artificial airway, O2 saturation, BP , pulse, temperature.

• Provide pain relief

• Recognize & manage complications

Perioperative Nursing CarePostoperative 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

Perioperative Nursing CarePostoperative 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.

Appendectomy

Cholecystectomy

Inguinal Hernia Repair

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.