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FUNDAMENTALS of GEOMETRIC LAPAROSCOPY and SUTURING FUNDAMENTALS of GEOMETRIC LAPAROSCOPY and SUTURING of GEOMETRIC LAPAROSCOPY FUNDAMENTALS Resad P

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FUNDAMENTALS of GEOMETRIC LAPAROSCOPY and SUTURING FUNDAMENTALS of GEOMETRIC LAPAROSCOPY and SUTURING of GEOMETRIC LAPAROSCOPY FUNDAMENTALS Resad P ® FUNDAMENTALS OF GEOMETRIC LAPAROSCOPY AND SUTURING FUNDAMENTALS OF GEOMETRIC LAPAROSCOPY AND SUTURING OF GEOMETRIC LAPAROSCOPY FUNDAMENTALS Resad P. PASIC Resad P. | Joseph L. HUDGENS Resad P. PASIC Joseph L. HUDGENS FUNDAMENTALS OF GEOMETRIC LAPAROSCOPY AND SUTURING JOSEPH L. HUDGENS1 RESAD P. PASIC2 1 | M.D., Assistant Professor – Department of Obstetrics and Gynecology, Director of Minimally Invasive Surgery at Wiser Women’s Hospital, University of Mississippi Medical Center, Jackson, MS, USA 2 | M.D., Professor of OB/GYN, Fellowship Director in Minimally Invasive Gynecology – Department of OB/GYN and Women’s Health University of Louisville School of Medicine, Louisville, KY, USA 4 Fundamentals of Geometric Laparoscopy and Suturing Illustrations by: Fundamentals of Geometric Laparoscopy and Suturing Katja Dalkowski, MD Joseph L. Hudgens and Resad P. Pasic Hauptstraße 64 91054 Erlangen, Germany Email: [email protected] Correspondence addresses of the authors: Joseph (Jay) Hudgens, M.D. Wiser Hospital for Women & Infants 2500 N. State St., Jackson, MS 39216, USA Email: [email protected] Resad P. Pasic, M.D., Ph.D. Department of Obstetrics, Gynecology and Women’s Health University of Louisville School of Medicine Ambulatory Care Building 550 South Jackson Street, 3rd Floor Louisville, KY 40202, USA Email: [email protected] www.gynlaparoscopy.com All rights reserved. 1st Edition © 2015 ® GmbH Important notes: P.O. Box, 78503 Tuttlingen, Germany Medical knowledge is ever changing. As new research and clinical Phone: +49 (0) 74 61/1 45 90 experience broaden our knowledge, changes in treat ment and therapy Fax: +49 (0) 74 61/708-529 may be required. 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ISBN 978-3-89756-455-8 5 Contents 1 Laparoscopic and Geometric Principles – 6 Contralateral Suturing� � � � � � � � � � � � � � � � � � � � � � � � � � � 43 Understanding Visualization, Angles, and Planes � � � � � � 9 Joseph L� Hudgens Joseph L� Hudgens 6�1 With the Needle (Smiley) Knot Tying Technique � � � � � � � � � � 43 1�1 Obstacles to Laparoscopic Suturing and Surgery � � � � � � � � � 9 6�1�1 Setting the Needle � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � 43 1�2 Visualization and Understanding Visual Angle � � � � � � � � � � � � 9 6�1�2 Tissue Re-approximation � � � � � � � � � � � � � � � � � � � � � � � � � � 44 1�3 Depth Perception and the Use of Monocular Cues � � � � � � � 11 6�1�3 Knot Tying � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � 45 1�4 Planes Determined by Port Placement � � � � � � � � � � � � � � � � 12 6�2 Without the Needle (Expert) Knot Tying Technique � � � � � � � � 49 1.5 Understanding Angles, Planes, and Efficiency � � � � � � � � � � � 13 6�2�1 Setting the Needle � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � 49 References � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � 13 6�2�2 Tissue Re-approximation � � � � � � � � � � � � � � � � � � � � � � � � � � 50 6�2�3 Knot Tying � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � 51 2 Equipment � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � 15 Joseph L� Hudgens 7 Midline Port Placement � � � � � � � � � � � � � � � � � � � � � � � � � � 55 2�1 Video Imaging System and Laparoscope � � � � � � � � � � � � � � � 15 Joseph L� Hudgens 2�2 Ports � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � 16 7�1 With the Needle (Smiley) Knot Tying Technique � � � � � � � � � � 55 2�3 Needle Drivers � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � 16 7�1�1 Setting the Needle � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � 55 2�4 Receivers and Assisting Instruments � � � � � � � � � � � � � � � � � � 17 7�1�2 Tissue Re-approximation � � � � � � � � � � � � � � � � � � � � � � � � � � 56 2�5 Suture Material � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � 17 7�1�3 Knot Tying � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � 57 7�2 Without the Needle (Expert) Knot Tying Technique � � � � � � � � 61 2�6 Knot Pushers � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � 18 7�2�1 Setting the Needle � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � 61 2�7 Laparoscopic Scissors � � � � � � � � � � � � � � � � � � � � � � � � � � � � 18 7�2�2 Tissue Re-approximation � � � � � � � � � � � � � � � � � � � � � � � � � � 62 7�2�3 Knot Tying � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � 63 3 Port Configuration and Triangulation � � � � � � � � � � � � � � � 19 Joseph L� Hudgens 8 Ipsilateral Right Port Placement � � � � � � � � � � � � � � � � � � � 67 3�1 Triangulation � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � 19 Joseph L� Hudgens 3�2 Contralateral Port Placement� � � � � � � � � � � � � � � � � � � � � � � � 20 8�1 With the Needle (Smiley) Knot Tying Technique � � � � � � � � � � 67 3�3 Ipsilateral Port Placement � � � � � � � � � � � � � � � � � � � � � � � � � � 21 8�1�1 Setting the Needle � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � 67 3�4 Midline Port Placement � � � � � � � � � � � � � � � � � � � � � � � � � � � � 22 8�1�2 Tissue Re-approximation � � � � � � � � � � � � � � � � � � � � � � � � � � 68 8�1�3 Knot Tying � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � 69 4 Systematic Method � � � � � � � � � � � � � � � � � � � � � � � � � � � � � 25 8�2 Without the Needle (Expert) Knot Tying Technique � � � � � � � � 73 Joseph L� Hudgens 8�2�1 Setting the Needle � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � 73 4�1 Introduction: Rationale for Systematic Approach � � � � � � � � � 25 8�2�2 Tissue Re-approximation � � � � � � � � � � � � � � � � � � � � � � � � � � 74 4�2 Setting of the Needle � � � � � � � � � � � � � � � � � � � � � � � � � � � � � 26 8�2�3 Knot Tying � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � 75 4�2�1 Introduction of the Needle � � � � � � � � � � � � � � � � � � � � � � � � � � 26 4�2�2 Advanced
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