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Chapter-04 Laparoscopic Cutting and Hemostasis

BOOK TITLE: State of the Art Atlas of Endoscopic Surgery in Infertility and Gynecology

Author
1. Munro Malcolm G
ISBN
9788184489903
DOI
10.5005/jp/books/11190_4
Edition
2/e
Publishing Year
2010
Pages
24
Author Affiliations
1. David Geffen School of Medicine at UCLA Kaiser-Permanente Los Angeles, California, David Geffen School of Medicine at UCLA, Kaiser-Permanente Los Angeles, Los Angeles, California
Chapter keywords

Abstract

Laparoscopic cutting and hemostasis can be safely achieved with relatively simple instrumentation provided the surgeon have a sound understanding both of pelvic anatomy and of the techniques or energy modalities and their impact on dissected tissue. Cutting and the maintenance or establishment of hemostasis are critical components of any surgical procedure. This is especially true in the performance of laparoscopically directed surgery, where, because of the visual, tactile and mechanical limitations, prevention of bleeding is preferable to searching for bleeding vessels. Laparoscopic surgery has posed unique challenges that have resulted in a variety of creative solutions, each of which has particular advantages and disadvantages. Cutting can be achieved using: (i) mechanical means, including scissors and other linear incising devices, (ii) concentrated radio-frequency (RF) electricity, (iii) focused laser light and (iv) ultrasonic energy. The methods for maintaining or securing hemostasis could be generally classified into mechanical, energy-based and chemical. Mechanical occlusion techniques include sutures, clips and linear stapling devices while energy based tissue sealing are achieved using ultrasonic or RF sources to coapt the vessel. Chemical hemostasis can be achieved by accelerating or enhancing vasoconstriction or components of the clotting process including platelet aggregation of the internal and/or external clotting cascade.

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