Laparoscopic do’s & don’ts
The readiness of a surgeon to convert a laparoscopic procedure could mean averting a major lifethreatening situation and is an option that requires decisive thinking from all practicing laparoscopic surgeons. This was stressed by Prof. Dr. Jens Rassweiler during the 5th Winter Meeting held in Tenerife, Spain last December 10 to 14.
“During the procedure a surgeon should have a low threshold for conversion such as when severe bleeding occurs or in cases of unclear anatomy. Do not hesitate to opt for conversion as proceeding with the laparoscopic procedure could eventually result to or end in more serious complications,” says
Rassweiler, one of Germany’s pioneering and reputed laparoscopic surgeons. Rassweiler also emphasised that after a laparoscopic procedure, a surgeon should also have a low threshold for re-intervention. “Do not take any risks,” advises Rassweiler as he points out that some surgeons may hesitate in performing re-intervention in order not to waste the perceived advantages of laparoscopy.
“It is worth ‘losing’ the advantages of laparoscopy. You will have secondary problems if you do not perform timely re-intervention,” according to Rassweiler.
He also gave several helpful tips such as the careful selection of cases. Although most patients with gross obesity are among the ideal candidates and normally benefit the most from laparoscopic procedures, Rassweiler notes that a surgeon has to have extensive laparascopic experience in such cases before attempting to perform one.
Another essential tip is a comprehensive checklist for surgical instrumentation. “Check your armamentarium. Check needles and inform yourself even on details such as the power adjustment of the HF-generator,” says Rassweiler. He recommends surgeons to not only use a single clip for the renal artery but take extra precautions. Sufficient stocks of staplers (i.e, Endo-GIA) should also be at hand, Rassweiler adds as he mentions that such minute details can often mean the success or failure of a laparoscopic procedure.
Experienced surgeons practicing laparoscopy also perform a careful check of the anatomy, Rassweiler says as he notes that even experienced surgeons may perform or adopt incorrect decisions due to aberrations in anatomy. Another key element is the working environment. “Carefully consider the ergonomic features of your working environment. A good chair could prove to be of great advantage and can be used to avoid the socalled ‘right knee’ syndrome that is a problem to many surgeons,” says Rassweiler.
He suggests that laparoscopists also acquire a camera holder as this would help in achieving a more comfortable environment during surgery. For beginners in laparoscopy, he advises a comprehensive training complete with valid models. Practising or devoting a specific amount of time regularly to improve one’s skills and dexterity in laparoscopic procedures is also recommended rather than practising intermittently or in irregular periods.