The exposure method of laparoscopic surgery is different from that of open surgery. Due to the limitations of techniques, instruments, space, perspective and field of vision, the ideal exposure of the operative field can be achieved only in the close cooperation of the whole team of laparoscopic laparoscopes, anesthesiologists, surgeons, surgical assistants and circuit nurses.
Rationale of field exposure in laparoscopic surgery：
In laparoscopic surgery, the doctor completes the operation under the supervision and guidance of the laparoscope.Due to the magnifying effect of the laparoscope, the picture is clear, and the Angle of view and field of view can be changed by the rotation, advance and retreat of the laparoscope, and real-time exposure can be more fully realized.Therefore, the basic principle of laparoscopic surgical exposure is to use the puncture device to make the laparoscope and surgical instruments more smoothly into the ground and more clearly expose the operative field space.For example, the operative field is fully exposed by means of changing body position and tension traction, and then the target tissues and structures are exposed through surgical techniques.
In laparoscopic surgery, it is often said that the lens holder is the "golden eyes" of the team, and the assistant is the "golden left hand" of the master. Indeed, in the process of surgery, the master expects the assistant to be able to predict in advance and accurately expose the field of vision (especially in the ionizing stage).So, can we get good surgical fields in a controlled way?
No.2 Adjust the lens
Laparoscopy is the guiding light in the dark and the eye of the surgeon. The doctor must operate under the supervision of the laparoscope.The hand should keep up with the thought of the surgeon, master the skills of holding the lens, so that the operative field exposure can reach the best state.
Some people will help the mirror skills summed up as "bubble, wipe, flat, in, into, back, spin, with" the eight words formula.
"Bubbling" refers to the lens soaked in warm water at 60-70° C, which can make the lens adapt to the relatively high temperature in the abdominal cavity and display clearly;
"Wipe" means to wipe the lens clean and eliminate the lens.Water drops on the objective lens to ensure clear display;
"Flat" refers to the flat of the laparoscopic base to make the field of vision conform to the habit of laparotomy. Generally, the lower edge of the liver and the pancreas are taken as the horizontal reference.
"Center" means that the operation target is located in the center of the visual field and the operation field is always placed in the center of the display to ensure exposure;
"Forward" means to move forward, making the target area more visible but the field of view smaller;
"Retreat" refers to retreating, making the visual field larger but the definition of the target area decreased. It is generally used to understand the relationship between the operative field and the surrounding structures；
"Rotation" refers to rotation. The 30-degree mirror rotation can observe the organizational structure of the target from different sides；
"Follow" means to follow the thoughts of the surgeon;
Progression, regression, rotation and heel essentially require real-time adjustment of the laparoscopic perspective and field of vision according to the operation needs to ensure clear exposure to the operative field.