Operative Techniques in Single Incision Laparoscopic Colorectal Surgery by Daniel P. Geisler Deborah S. Keller & Eric M. Haas

Author:Daniel P. Geisler, Deborah S. Keller & Eric M. Haas
Language: eng
Format: epub
Publisher: Springer International Publishing, Cham

Optimize External Working Space

Several techniques can be employed to optimize external working space and minimize instrument collisions. The use of a 90 ° light cord adapter, differing length instruments (i.e., bariatric instruments), and instruments with reticulating handles will allow the surgeons hands to be offset from each other and from the camera operator. It is also important to understand that the angles required to optimize exposure of the hepatic flexure from a single entry site will differ significantly from the traditional laparoscopic approach and may be counterintuitive in some instances. Internal crossing of instruments is essential at times and should be embraced, to provide external freedom of movement for the operator, especially when significant retraction is required. However, both the surgeon and assistant should understand that there will inevitably be collisions that will require some problem solving to overcome.

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