Today we are going to continue our discussion of laparoscopic field exposure.
No.3 Helper effective pull
In order to obtain a good surgical field, in addition to using gravity to shift and expose the surgical field, pulling and pushing the obstructing structure is necessary, and this active pulling method is the king.As mentioned earlier, the two "troublers" of the small intestine and the omentum greater are the most noteworthy in abdominal colorectal surgery.
Because they often slide into various areas of the abdomen, when the omentum greater or small intestine glides into the surgical field, it can cause a lot of trouble. Small trouble may interfere with the operation, while big trouble may increase the risk of the operation, or even cause off-screen effects.
During surgery, non-invasive grippers can be used to gently pull these structures to the opposite side of the lesion. Two points need to be paid attention to when pulling: force and direction.
First, strength is the core to ensure effective traction
The pulling force should not be too large or too small, as too large a force may damage organs or tissues;Too small a force can not provide effective tension, which is not conducive to the surgeon entering the correct level of disassociation accurately. Such unreasonable tension may prolong the operation time of separation operation in a small way, or increase the side injury of operation in a large way, foreseering postoperative complications for patients!
Second, pay attention to the direction when pulling
In the right hemicolectomy, the assistant can pull the omentum to the superior transverse colon and push the loop of the small intestine into the pelvic cavity.During the left hemicolectomy, an assistant's two manipulators pull the fixed sigmoid to the left and cephalally.
In the two examples above, the purpose of the pull is not only to assist in exposing the field of vision, but also to provide the master surgeon with effective layer-cutting tension.
So, a word that the doctor often says is: tension the first, plane the 2nd, blood vessel the 3rd, area lymphatic the 4th.This order is to pay attention to the operation order of the operation should be, there is no tension on the blind operation, is tantamount to a blind horse in the pool, the emergence of more serious consequences.
The gallbladder bed, colonic peritoneum, hepatogastric ligament, gastrocolonic ligament and mesenteric attachment are all inherent attachment points. In laparoscopic surgery, the inherent attachment points of organs should be used to assist exposure in combination with posture adjustment as much as possible.For example, during the separation of ligaments of liver and kidney by hepatectomy, the assistant lifts the liver upward with the suction tube rod, and the master pulls the transverse colon downward to fully expose the space between liver and kidney.During the endoscopic resection of the pancreatic body and tail, the assistant pulled the gastrocolonic ligament to the right and the master pulled the stomach forward, which was beneficial to the incision of the aperitivo colonic ligament to open the lesser omentum sac and expose the pancreatic body and tail.During laparoscopic splenectomy, an assistant lifts the spleen upward with blunt rod-shaped instruments such as intestinal forceps or aspirators, and the master pulls the colon and spleen downward to the right to expose and cut off the spleen-colon ligament.