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Ergonomics and Technical Aspects of Minimal Access Surgery in Acute Surgery

  • Focus on Laparoscopic and Abdominal Emergencies
  • Published:
European Journal of Trauma and Emergency Surgery Aims and scope Submit manuscript

Abstract

Background:

Following the general trend in the evolution of minimal access surgery (MAS), the place of laparoscopy for diagnostic and therapeutic procedures in the emergency setting is well defined. As for all laparoscopic procedures, the ergonomic and technical aspects of MAS in acute surgery are important issues.

Methods:

Review of the literature.

Results:

The ergonomic and technical aspects of emergency laparoscopy include the surgeon’s and the patient’s position; the operating room setup, including the table, the monitor, and the specific equipment; patient preparation adapted as required to potential changes necessary as adapted to the pathology and conversion; the trocar setup, also adapted to the organ and pathology. Specific needs and variations can be necessary, dependent on the patient status, body build, and the pathology being treated. The operating room used for acute surgery should be adapted to evolving laparoscopic techniques, as well as new intraoperative diagnostic and therapeutic modalities.

Conclusion:

High-tech equipment and associated procedures have modified the needs for a modern operating room setup. Laparoscopic procedures for emergency surgery must make use of well-known ergonomic principles and be adapted to the patient and the pathology.

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References

  1. O’Leary DP, Collins CD. Analysis of a year’s general surgical activity in a District General Hospital. Ann R Coll Surg Engl 1994;76:176–81.

    PubMed  Google Scholar 

  2. Mai-Phan TA, Patel B, Walsh M, Abraham AT, Kocher HM. Emergency room surgical workload in an inner city UK teaching hospital. World J Emerg Surg 2008;3:19.

    Article  PubMed  Google Scholar 

  3. Kenyon TA, Urbach DR, Speer JB, Waterman-Hukari B, Foraker GF, Hansen PD, Swanström LL. Dedicated minimally invasive surgery suites increase operating room efficiency. Surg Endosc 2001;15:1140–43.

    Article  CAS  PubMed  Google Scholar 

  4. Greenwald JA, McMullen HF, Coppa GF, Newman RM. Standardization of surgeon-controlled variables: impact on outcome in patients with acute cholecystitis. Ann Surg 2000;231:339–44.

    Article  CAS  PubMed  Google Scholar 

  5. Cuschieri A. Whither minimal access surgery: tribulations and expectations. Am J Surg 1995;169:6–19.

    Article  Google Scholar 

  6. Hanna GB, Shimi SM, Cuschieri A. Task performance in endoscopic surgery is influenced by location of the image display. Ann Surg 1998;227:481–4.

    Article  CAS  PubMed  Google Scholar 

  7. Chiu A, Bowne WB, Sookraj KA, Zenilman ME, Fingerhut A, Ferzli GS. The role of the assistant in laparoscopic surgery: important considerations for the apprentice-in-training. Surg Innov 2008;15:229–36.

    Article  PubMed  Google Scholar 

  8. Baker LW, Thomson SR, Chadwick SJD. Colon wound management and prograde colonic lavage in large bowel trauma. Br J Surg 1990;77:872–6.

    Article  CAS  PubMed  Google Scholar 

  9. Lau H. Laparoscopic repair of perforated peptic ulcer: a metaanalysis. Surg Endosc 2004;18:1013–21.

    CAS  PubMed  Google Scholar 

  10. Chung RS, Rowland DY, Li P, Diaz J. A meta-analysis of randomized controlled trials of laparoscopic versus conventional appendectomy. Am J Surg 1999;177:250–6.

    Article  CAS  PubMed  Google Scholar 

  11. Garbutt JM, Soper NJ, Shannon WD, Botero A, Littenberg B. Meta-analysis of randomized controlled trials comparing laparoscopic and open appendectomy. Surg Laparosc Endosc 1999;9:17–26.

    Article  CAS  PubMed  Google Scholar 

  12. Sauerland S, Lefering R, Holthausen U, Neugebauer EA. Laparoscopic vs conventional appendectomy - a meta-analysis of randomised controlled trials. Langenbecks Arch Surg 1998;383:289–95.

    Article  CAS  PubMed  Google Scholar 

  13. Temple LK, Litwin DE, McLeod RS. A meta-analysis of laparoscopic versus open appendectomy in patients suspected of having acute appendicitis. Can J Surg 1999;42:377–83.

    CAS  PubMed  Google Scholar 

  14. Lai PB, Kwong KH, Leung KL, Kwok SP, Chan AC, Chung SC, Lau WY. Randomized trial of early versus delayed laparoscopic cholecystectomy for acute cholecystitis. Br J Surg 1998;85:764–7.

    Article  CAS  PubMed  Google Scholar 

  15. Lo CM, Liu CL, Fan ST, Lai EC, Wong J. Prospective randomized study of early versus delayed laparoscopic cholecystectomy for acute cholecystitis. Ann Surg 1998;227:461–7.

    Article  CAS  PubMed  Google Scholar 

  16. Liu SI, Siewert B, Raptopoulos V, Hodin RA. Factors associated with conversion to laparotomy in patients undergoing laparoscopic appendectomy. J Am Coll Surg 2002;194:298–305.

    Article  PubMed  Google Scholar 

  17. Wullstein C, Barkhausen S, Gross E. Results of laparoscopic vs. conventional appendectomy in complicated appendicitis. Dis Colon Rectum 2001;44:1700–5.

    Article  CAS  PubMed  Google Scholar 

  18. Sanna A, Adani GL, Anania G, Donini A. The role of laparoscopy in patients with suspected peritonitis: experience of a single institution. J Laparoendosc Adv Surg Tech A 2003;13:17–9.

    Article  CAS  PubMed  Google Scholar 

  19. Navez B, Tassetti V, Scohy JJ, Mutter D, Guiot P, Evrard S, Marescaux J. Laparoscopic management of acute peritonitis. Br J Surg 1998;85:32–6.

    Article  CAS  PubMed  Google Scholar 

  20. Rosen M, Brody F, Ponsky J. Predictive factors for conversion of laparoscopic cholecystectomy. Am J Surg 2002;184:254–58.

    Article  PubMed  Google Scholar 

  21. Kum CK, Goh PM, Isaac JR, Tekant Y, Ngoi SS. Laparoscopic cholecystectomy for acute cholecystitis. Br J Surg 1994;81:1651–4.

    Article  CAS  PubMed  Google Scholar 

  22. Chosidow D, Johanet H, Montariol T, Kielt R, Manceau C, Marmuse JP, Benhamou G. Laparoscopy for acute small-bowel obstruction secondary to adhesions. J Laparoendosc Adv Surg Tech A 2000;10:155–9.

    Article  CAS  PubMed  Google Scholar 

  23. Levard H, Boudet MJ, Msika S, Molkhou JM, Hay JM, Laborde Y, Gillet M, Fingerhut A. Laparoscopic treatment of acute small bowel obstruction: a multicentre retrospective study. ANZ J Surg 2001;71:641–6.

    Article  CAS  PubMed  Google Scholar 

  24. de Visser H, Heijnsdijk EAM, Herder JL, Pistecky PV. Forces and displacements in colon surgery. Surg Endosc 2002;16:1426–30.

    Article  PubMed  Google Scholar 

  25. Fingerhut A, Millat B, Borie F. Preventions of complications in laparoscopic surgery. In: Eubanks WS, Swanström LL, Soper NJ, eds. Mastery of endoscopic and laparoscopic surgery. Lippincott Williams & Wilkins: Philadelphia.

  26. Neudecker J, Sauerland S, Neugebauer E, Bergamaschi R, Bonjer HJ, Cuschieri A, Fuchs KH, Jacobi Ch, Jansen FW, Koivusalo AM, Lacy A, McMahon MJ, Millat B, Schwenk W. The European Association for Endoscopic Surgery clinical practice guideline on the pneumoperitoneum for laparoscopic surgery. Surg Endosc 2002;16:1121–43.

    Article  CAS  PubMed  Google Scholar 

  27. Merlin TL, Hiller JE, Maddern GJ, Jamieson GG, Brown AR, Kolbe A. Systematic review of the safety and effectiveness of methods used to establish pneumoperitoneum in laparoscopic surgery. Br J Surg 2003;90:668–79.

    Article  CAS  PubMed  Google Scholar 

  28. Ferzli GS, Fingerhut A. Trocar placement for laparoscopic abdominal procedures: a simple standardized method. J Am Coll Surg 2004;198:163–73.

    Article  PubMed  Google Scholar 

  29. Sackier JM. Emergency Laparoscopy. In: Scott-Conner CEH, ed. The SAGES manual: fundamentals in laparoscopy and GI endoscopy. Springer: Berlin, 1999.

    Google Scholar 

  30. Forde KA, Ganepola GA. Is mandatory exploration for penetrating abdominal trauma extinct? The morbidity and mortality of negative exploration in a large municipal hospital. J Trauma 1974;14:764–66.

    Article  CAS  PubMed  Google Scholar 

  31. Lowe RJ, Boyd DR, Folk FA, Baker RJ. The negative laparotomy for abdominal trauma. J Trauma 1972;12:853–61.

    Article  CAS  PubMed  Google Scholar 

  32. Petersen SR, Sheldon GF. Morbidity of a negative finding at laparotomy in abdominal trauma. Surg Gynecol Obstet 1979;148:23–6.

    CAS  PubMed  Google Scholar 

  33. Sosa JL, Baker M, Puente I, Sims D, Sleeman D, Ginzburg E, Martin L. Negative laparotomy in abdominal gunshot wounds: potential impact of laparoscopy. J Trauma 1995;38:194–7.

    Article  CAS  PubMed  Google Scholar 

  34. Sugarbaker PH, Sanders JH, Bloom BS, Wilson RE. Preoperative laparoscopy in diagnosis of acute abdominal pain. Lancet 1975;1:442–5.

    Article  CAS  PubMed  Google Scholar 

  35. Weigelt JA, Kingman RG. Complications of negative laparotomy for trauma. Am J Surg 1988;156:544–7.

    Article  CAS  PubMed  Google Scholar 

  36. Giger U, Michel JM, Vonlanthen R, Becker K, Kocher T, Krähenbühl L. Laparoscopic cholecystectomy in acute cholecystitis: indication, technique, risk and outcome. Langenbecks Arch Surg 2005;390:373–80.

    Article  CAS  PubMed  Google Scholar 

  37. Krähenbühl L, Sclabas G, Wente MN, Schäfer M, Schlumpf R, Büchler MW. Incidence, risk factors, and prevention of biliary tract injuries during laparoscopic cholecystectomy in Switzerland. World J Surg 2001;25:1325–30.

    Article  PubMed  Google Scholar 

  38. Kum CK, Eypasch E, Lefering R, Paul A, Neugebauer E, Troidl H. Laparoscopic cholecystectomy for acute cholecystitis: is it really safe? World J Surg 1996;20:43–8.

    Article  CAS  PubMed  Google Scholar 

  39. Fletcher DR, Hobbs MST, Tan P, Valinsky LJ, Hockey RL, Pikora TJ, Knuiman MW, Sheiner HJ, Edis A. Complications of cholecystectomy: risks of the laparoscopic approach and protective effects of operative cholangiography: a population-based study. Ann Surg 1999;229:449–57.

    Article  CAS  PubMed  Google Scholar 

  40. Millat B, Borie F, Fingerhut A. Prospective trials in laparoscopic bile duct exploration. Semin Laparosc Surg 2000;7:279–87.

    Article  CAS  PubMed  Google Scholar 

  41. Millat B, Decker G, Fingerhut A. Imaging of cholelithiasis: what does the surgeon need? Abdom Imaging 2001;26:3–6.

    Article  CAS  PubMed  Google Scholar 

  42. Flum DR, Dellinger EP, Cheadle A, Chan L, Koepsell T. Intraoperative cholangiography and risk of common bile duct injury during cholecystectomy. JAMA 2003;289:1639–44.

    Article  PubMed  Google Scholar 

  43. Nathanson LK, Easter DW, Cuschieri A. Laparoscopic repair/peritoneal toilet of perforated duodenal ulcer. Surg Endosc 1990;4:232–3.

    Article  CAS  PubMed  Google Scholar 

  44. Platell C, Papadimitriou JM, Hall JC. The influence of lavage on peritonitis. J Am Coll Surg 2000;191:672–80.

    Article  CAS  PubMed  Google Scholar 

  45. Sugimoto K, Hirata M, Takishima T, Ohwada T, Shimazu S, Kakita A. Mechanically assisted intraoperative peritoneal lavage for generalized peritonitis as a result of perforation of the upper part of the gastrointestinal tract. J Am Coll Surg 1994;179:443–8.

    CAS  PubMed  Google Scholar 

  46. Lau WY, Leung KL, Kwong KH, Davey IC, Robertson C, Dawson JJ, Chung SC, Li AK. A randomized study comparing laparoscopic versus open repair of perforated peptic ulcer using suture or sutureless technique. Ann Surg 1996;224:131–8.

    Article  CAS  PubMed  Google Scholar 

  47. Boey J, Choi SK, Poon A, Alagaratnam TT. Risk stratification in perforated duodenal ulcers. A prospective validation of predictive factors. Ann Surg 1987;205:22–6.

    Article  CAS  PubMed  Google Scholar 

  48. Fingerhut A, Chouillard E. Ergonomic and technical aspects of laparoscopy for trauma and non-trauma emergencies. Eur Surg 2005;37:8–14.

    Article  Google Scholar 

  49. Fingerhut A, Millat B, Borrie F. Laparoscopic versus open appendectomy: time to decide. World J Surg 1999;23:835–45.

    Article  CAS  PubMed  Google Scholar 

  50. Hellberg A, Rudberg C, Enochsson L, Gudbjartson T, Wenner J, Kullman E, Fenyö G, Ringqvist I, Sörensen S. Conversion from laparoscopic to open appendicectomy: a possible drawback of the laparoscopic technique? Eur J Surg 2001;167:209–13.

    Article  CAS  PubMed  Google Scholar 

  51. Garbarino S, Shimi SM. Routine diagnostic laparoscopy reduces the rate of unnecessary appendicectomies in young women. Surg Endosc 2009;23:527–33.

    Article  CAS  PubMed  Google Scholar 

  52. Navez B, Delgadillo X, Cambier E, Richir C, Guiot P. Laparoscopic approach for acute appendicular peritonitis: efficacy and safety: a report of 96 consecutive cases. Surg Laparosc Endosc Percutan Tech 2001;11:313–6.

    Article  CAS  PubMed  Google Scholar 

  53. Sauerland S, Agresta F, Bergamaschi R, Borzellino G, Budzynski A, Champault G, Fingerhut A, Isla A, Johansson M, Lundorff P, Navez B, Saad S, Neugebauer EA. Laparoscopy for abdominal mergencies: evidence-based guidelines of the European Association for Endoscopic Surgery. Surg Endosc 2006;20:14–29.

    Article  CAS  PubMed  Google Scholar 

  54. Navez B, Therasse A. Should every patient undergoing laparoscopy for clinical diagnosis of appendicitis have an appendicectomy? Acta Chir Belg 2003;103:87–9.

    CAS  PubMed  Google Scholar 

  55. Sauerland S, Lefering R, Neugebauer EA. Laparoscopic versus open surgery for suspected appendicitis. Cochrane Database Syst Rev 2004;18:CD001546.

    Google Scholar 

  56. Schrenk P, Rieger R, Shamiyeh A, Wayand W. Diagnostic laparoscopy through the right lower abdominal incision following open appendectomy. Surg Endosc 1999;13:133–5.

    Article  CAS  PubMed  Google Scholar 

  57. Hau T, Ahrenholz DH, Simmons RL. Secondary bacterial peritonitis: the biological basis of treatment. Curr Probl Surg 1979;16:1–65.

    Article  CAS  PubMed  Google Scholar 

  58. Bosscha K, van Vroonhoven TJMV, van der Werken C. Surgical management of severe secondary peritonitis. Br J Surg 1999;86:1371–7.

    Article  CAS  PubMed  Google Scholar 

  59. Schein M, Gecelter G, Freinkel W, Gerding H, Becker PJ. Peritoneal lavage in abdominal sepsis. A controlled clinical study. Arch Surg 1990;125:1132–5.

    CAS  PubMed  Google Scholar 

  60. Schein M, Saadia R, Decker G. Intraoperative peritoneal lavage. Surg Gynecol Obstet 1988;166:187–95.

    CAS  PubMed  Google Scholar 

  61. Myers E, Hurley M, O’sullivan GC, Kavanagh D, Wilson I, Winter DC. Laparoscopic peritoneal lavage for generalized peritonitis due to perforated diverticulitis. Br J Surg 2008;95:97–101.

    Article  CAS  PubMed  Google Scholar 

  62. Nathens AB, Rotstein OD. Therapeutic options in peritonitis. Surg Clin North Am 1994;74:677–92.

    CAS  PubMed  Google Scholar 

  63. Sugimoto K, Hirata M, Kikuno T, Takishima T, Maekawa K, Ohwada T. Large-volumeintraoperative peritoneal lavage with an assistant device for treatment of peritonitis caused by blunt traumatic rupture of the small bowel. J Trauma 1995;39:689–92.

    Article  CAS  PubMed  Google Scholar 

  64. Tan HL, Shankar KR, Ade-Ajayi N, Guelfand M, Kiely EM, Drake DP, De Bruyn R, McHugh K, Smith AJ, Morris L, Gent R. Reduction in visceral slide is a good sign of underlying postoperative visceroparietal adhesions in children. J Pediatr Surg 2003;38:714–6.

    Article  CAS  PubMed  Google Scholar 

  65. Zamir G, Reissman P. Diagnostic laparoscopy in mesenteric ischemia. Surg Endosc 1998;12:390–3.

    Article  CAS  PubMed  Google Scholar 

  66. Eypasch E, Troidl H, Mennigen R, Spangenberger W, Barlow AP. Laparoscopy via an indwelling cannula: an alternative to planned relaparotomy. Br J Surg 1992;79:1368.

    Article  CAS  PubMed  Google Scholar 

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Authors and Affiliations

  1. Department of Gastrointestinal and Hepato-Pancreato-Biliary Surgical Oncology, Tata Memorial Hospital, Mumbai, India

    Parul J. Shukla MS, FRCS & Ravi Maharaj

  2. Department of Gastrointestinal Surgery, Department of Surgery, University of Athens, Hippokration Hospital, Athens, Greece

    Abe Fingerhut

  3. Department of Gastrointestinal and Hepato-Pancreato-Biliary Surgical Oncology, Tata Memorial Hospital, Mumbai, India

    Parul J. Shukla MS, FRCS

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  1. Parul J. Shukla MS, FRCS
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  2. Ravi Maharaj
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Correspondence to Parul J. Shukla MS, FRCS.

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Shukla, P.J., Maharaj, R. & Fingerhut, A. Ergonomics and Technical Aspects of Minimal Access Surgery in Acute Surgery. Eur J Trauma 36, 3–9 (2010). https://doi.org/10.1007/s00068-010-9226-6

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  • DOI: https://doi.org/10.1007/s00068-010-9226-6

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