Technical Aspects of Laparoscopic Surgery

Laparoscopic surgery is now an integral part of general surgery and is used in almost all known surgical procedures. There are many advantages to laparoscopic surgery, including faster patient recovery, shorter hospital stay, decreased pain and analgesic requirements, and faster return to work. A thorough understanding of the different technical aspects of laparoscopic surgery is necessary to perform procedures correctly, as well as to avoid certain predictable difficulties and complications that can occur. This review details operating room setup and patient and surgery team positioning; the laparoscope and instruments used; laparoscopic suturing; laparoscopic training and simulators; when and why to convert to open surgery; and the use of single-port or single-incision laparoscopic surgery. Figures show a schematic representation of a ceiling-mounted articulated boom for laparoscopic surgery; blueprints and photographs of the first endoscope; images of an articulated 5 mm scope and high-definition camera head, assorted laparoscopic instruments, 10 and 5 mm LigaSure sealing devices and a 5 mm Harmonic scalpel, an Endoloop ligature with a 2-0 polyglactin tie, various sizes of the 5 mm Nathanson retractor and the round Snake retractor, and 5 mm needle drivers and a 10 mm Endo Stitch suturing device; and an illustration of laparoscopic suturing (using a square knot). Tables list patient positions used for laparoscopic surgical procedures, guidelines for optimal laparoscopic surgery suites, and staple heights and colors. This review contains 9 figures, 2 tables, and 78 references.