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This moment variation of complicated Laparoscopic surgical procedure, suggestions and Tips represents a entire description of the present laparoscopic suggestions. It provides surgeons with all of the details essential to effectively accomplish laparoscopic surgery. it's a hands-on guide that is helping the health practitioner keep away from pitfalls and procure the required laparoscopic abilities speedy and successfully. it's a prepared resource of useful support whilst trouble-shooting is important. complicated laparoscopic surgical procedure is a superb merger of a textbook and atlas for the health care provider who desires to expand and refine his laparoscopic thoughts.
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Additional info for Advanced Laparoscopic Surgery: Techniques and Tips, Second Edition
The mesentery defect is closed with nonabsorbable running suture. The Roux limb is then brought up and approximated to the end of the CBD. An enterotomy is performed, followed by creation of an anastomosis using a continuous suture on the posterior aspect of the jejunal wall. An interrupted 3–0 PDS is used on the anterior jejunal wall, ensuring the avoidance of the stricture of the hepatic duct.
3a). This is performed with the left hand of the surgeon pulling laterally and inferiorly (towards the right Anterior Superior Iliac Spine) on Hartmann’s pouch while the first assistant retracts the fundus of the gallbladder towards the lateral right hemidiaphragm. This will open up the triangle of Calot and the risk of a common bile duct (CBD) injury will be minimized. 3b. If the anterior peritoneum overlying the cystic duct and artery is scarred, it is very important to retract the cystic duct in a cephalad direction and incise the posterior peritoneum as closely as possible to the neck of the gallbladder.
At this point, the Maryland forceps are placed in the 10 mm operating port to retract Hartmann’s pouch laterally. The assistant now holds these forceps to free the surgeon’s two hands allowing him to focus on the introduction of the cholangiogram clamp. This description is based on the use of the Olsen cholangiogram clamp with a smooth ureteral catheter no. 4, which must be checked before insertion. This catheter should be introduced from the left lateral grasper port into the cystic duct. It is not necessary to introduce more than 1 cm of the catheter into the cystic duct, or no more than one black dot on the tip of the catheter.