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By A. Smamsa

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Pasetto, A. (1996). The effect of laparoscopic cholecystectomy on cardiovascular function and pulmonary gas exchange. Anesth Analg, Vol:83, No. 1, (Jul 1996), pp. 134–140, ISSN 0003-2999 Gong, EM; Orvieto, MA; Lyon, MB;, Lucioni, A; Gerber, GS. & Shalhav AL. (2007). Analysis of impact of body mass index on outcomes of laparoscopic renal surgery. Urology Vol. 69, No. 1, (Jan 2007), pp. 38–43, ISSN 0090-4295 Gottumukkala, V. (2008). Positioning of Patients for Operation, In Anesthesiology, Longnecker DE, 1314-38, The McGrawHill Companies, 0-07-145984-7, New York Halliwill, JR; Hewitt, SA; Joyner, MJ.

The combination with ultrasonography adds information regarding the status of the tissue beneath the surface and increasing the diagnostic yield by 14% to 25%; core biopsies can be obtained and Doppler flow may add information about vessels and tumour-vessel interface (Conlon & Toomey, 2003). The development of coagulative equipment such as the bipolar and harmonic scalpel, coagulative gels and tissue glue have contributed significantly to the reduction in risk of bleeding as well as the safe management of bleeding complications in laparoscopy.

Rigorus pursuit of haemostasis is essential for success in laparoscopic surgery as blood in the operating field significantly reduces visibility. Adequate control of blood vessels of target organ must be achieved to minimise risk of uncontrollable blood loss this often being the reason for conversion to an open approach. Vascular injury can affect the primary target organ or secondary intra-abdominal organs. This can have dire consequences for the devascularised organ. Vascular injury to the mesenteric vessels can result in bowel ischaemia and loss resulting in feeding problems commensurate with the length of bowel 40 Advanced Laparoscopy Prolonged operative time Visceral injury Bladder injury Bleeding Shoulder tip pain Vascular injury Conversion to open procedure Pneumothorax Wound infection Port site hernia Renal impairment Adhesive Intestinal obstruction Intra-abdominal abscesses Port site recurrence of malignancy Gas embolism Gastric volvulus Table 4.

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