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2 results

  • Chapter 25 - Anaesthesia for Minimally Invasive Surgery

  • from Section 3 - Passing the Gas
  • William Fawcett, Royal Surrey County Hospital, Guildford and University of Surrey, Olivia Dow, Guy's and St Thomas' NHS Foundation Trust, London, Judith Dinsmore, St George's Hospital, London
  • Book:
    Robinson and Hall's How to Survive in Anaesthesia
    Published online:
    09 June 2025
    Print publication:
    26 June 2025, pp 149-152

  • Summary

    Minimally invasive surgery (laparoscopic and robotic procedures) are increasingly common in gynaecological surgery, general surgery and urology. Whilst significantly reducing tissue damage and improving patient recovery they are not without risk.

    Most cases require carbon dioxide insufflation into the peritoneum to form a pneumoperitoneum. This can cause a multitude of problems including poor cardiac output, arrythmias, lung compression, barotrauma, hypercapnia and gas embolism. There can also be haemorrhage, intestinal perforation and other visceral trauma flowing insertion of the trochar.

    In addition, patient positioning can cause further physiological changes with the head up positioning (for upper abdominal surgeries) and the head down (Trendelenburg) position for pelvic procedures.

    The anaesthetist must be prepared for these physiological changes and complications as well as the possibility of conversion to open surgery.

  • Pete's bar: alternative use of the laryngoscopy suspension bar to improve surgical exposure during small incision cochlear implantation

  • S A C MacKeith, P Sleeman-Barker, J D Ramsden
  • Journal:
    The Journal of Laryngology & Otology / Volume 128 / Issue 1 / January 2014
    Published online by Cambridge University Press:
    17 December 2013, pp. 96-97
    Print publication:
    January 2014
  • Background:

    Cochlear implant surgery is increasingly being performed through a small incision because of the benefits associated with this technique, such as fewer wound complications. Efforts have been made to maximise surgical exposure in order to improve this evolving technique; this includes the development and use of new retractors. For instance, elasticated stay hooks can retract skin in a radial fashion and they are less bulky than traditional retractors. These hooks are usually attached directly to surgical drapes or to a disposable retractor ring; there are disadvantages to both of these methods.

    Method:

    This paper describes a technique using a laryngeal suspension bar in which the bar acts as a fixed structure to which these elasticated stay hooks can be attached.

    Conclusion:

    This technique was found to be safer, cheaper and more effective for obtaining optimal surgical exposure compared with a technique whereby the stay hooks are attached directly to the drapes or to a disposable retractor ring.