Alternative to the conversion - Forum


Alternative to the conversion - Ärzteforum

Post#1 »

A few days ago, I operated a patient, male, 43, cholelithiasis, with previous op, (diffusse peritonitis), we suspected adherences in the preop. We could do the pneumoperitoneum, but we couldn't introduce the camera, trough the umbilical hole, so I changed the place to the left hole (I do french approach). After this I did the upper hole, through this I introduced the hook and could release the adherences, especially in the right side, so it was possible to do the fourth hole. Once released the adherences, put the camera as usually through the umbilical hole. It was an alternative to the conversion. Cholecystectomy was no difficult, with no complication.


Re: Alternative to the conversion - Ärzteforum

Post#2 »

The operating laparoscope (the one with the 5 mm instrument channel) and the long scissors (preferrably disposable, because we at least can't seem to keep the long reusable scissors sharp (just back from sharpening and still dull)) works well for this also. You can take down your adhesions through one trocar site.

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Lady Surgeon

Re: Alternative to the conversion - Ärzteforum

Post#3 »

I believe that the method that you described, gaining entry at a safe site, and lysing adhesions, in order to do a lap chole, would be standard now. Much has changed, and contraindications to laparoscopy, such as adhesions, are fewer in number. Do you use a Hasson cannula?


Re: Alternative to the conversion - Ärzteforum

Post#4 »

I presume many of us who practice lap. surgery solve such problems more or less the same way.

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Re: Alternative to the conversion - Ärzteforum

Post#5 »

I believe this is a good approach. I like to gain the first entry with a Hasson cannula in all cases, and I believe it adds to the safety of the procedure. It is surprizing how often the cholecystectomy itself is very simple, after the adhesions are lysed.

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