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Oral fluids There is no significant ileus after minimal access surgery , except in abdominal resectional procedures, such as colectomy or small bowel resection. Patients may resume oral fluids as soon as they are conscious; they usually do so 4–6 hours after the ...

Orogastric or nasogastric tube An orogastric or nasogastric tube may be placed for some abdominal surgery if the stomach is distended and obscuring the view . It is not necessary in all cases and is very rarely used in other minimal access surgery . Where pos...

PERIOPERATIVE PLANNING FOR MINIMAL ACCESS SURGERY PERIOPERATIVE PLANNING FOR MINIMAL ACCESS SURGERY PERIOPERATIVE PLANNING FOR MINIMAL ACCESS SURGERY

POSTOPERATIVE CARE The postoperative care of patients after minimal access surgery - is generally straightforward, with a low incidence of pain or other problems when compared with their open counterparts. It is a good general rule that if the patient deve...

Perivisceral endoscopy Body planes can be accessed even in the absence of a natural cavity . Examples are mediastinoscopy , retroperitoneoscopy and retroperitoneal approaches to the kidney , aorta and lumbar sympathetic chain. Some of these approaches have b...

Port site pain and numbness Pain in one or other of the port site wounds is not uncommon and is worse if there is haematoma formation. It usually settles very rapidly . In the case of thoracoscopy , intercostal nerve pain may be more common in those with sm...

Preparation of the patient Although the patient may be in hospital for a shorter period, - careful preoperative management is essential to minimise morbidity . Recognition of patient- or procedure-related factors that may in turn complicate a minimal access a...

Principles of electrosurgery during laparoscopic surgery Inadvertent electrosurgical injuries during minimal access surgery are potentially serious and are often unrecognised at the time. The vast majority occur following the use of monopolar diathermy . For ...

Principles of electrosurgery during laparoscopic surgery Inadvertent electrosurgical injuries during minimal access surgery are potentially serious and are often unrecognised at the time. The vast majority occur following the use of monopolar diathermy . For ...

ROBOTIC SURGERY A robot is a mechanical device that performs automated phys - ical tasks according to direct human supervision, a predefined program or a set of general guidelines, using artificial intel - ligence (AI) technology . In surgery , robots can be us...

SURGICAL TRAUMA IN OPEN, MINIMALL Y INVASIVE AND ROBOTIC SURGERY Most of the trauma of an open procedure is inflicted because the surgeon must have a wound that is large enough to give adequate exposure for safe dissection at a target site. The wound is often t...

SURGICAL TRAUMA IN OPEN, MINIMALL Y INVASIVE AND ROBOTIC SURGERY Most of the trauma of an open procedure is inflicted because the surgeon must have a wound that is large enough to give adequate exposure for safe dissection at a target site. The wound is often t...

Shoulder tip pain Patients should be warned about this preoperatively and informed that the pain is referred from the diaphragm and that it is not due to a local problem in the shoulders. It can be at its worst 24 hours after the operation. It usually settles ...

Single-incision minimal access surgery Single-incision minimal access surgery has varied in popularity with both strong advocates and others who are sceptical of any advantages. Single-incision laparoscopic surgery (SILS) involves insertion of all instrumen...

Skin sutures If non-absorbable sutures or skin staples have been used, they can be removed from the port sites after 7–10 days. Skin sutures If non-absorbable sutures or skin staples have been used, they can be removed from the port sites after 7–10 days. Sk...

THE FUTURE Minimal access surgery has changed surgical practice; however, it has not changed the nature of disease. The basic principles of good surgery still apply , including appropriate case selection, excellent exposure, adequate retraction and a high lev...

THEATRE SET-UP AND TOOLS Operating theatre design is key to e ffi ciency . Modern theatres are designed with moveable booms for video, diathermy and laparoscopic equipment with at least two high-resolution, high-definition (HD) or ultra-high-definition (4K) monito...

Thoracoscopy A rigid endoscope is introduced through an incision placed - between the ribs to gain access to the thorax. In the majority of cases, specialist anaesthetic support is required to ensure isolation of the lung on the side of surgery , enabling t...