••• Chapter 57^ Laparoscopy and Infertility Surgery^569
❍ What are the disadvantages of using fiber-optic lasers in laparoscopy?
They do not cut as well as CO 2 lasers and are less safe because of penetration of both tissue and water.
❍ What is the depth of penetration of YAG laser?
0.6 to 4.2 mm.
❍ Why is CO 2 used preferentially over nitrous oxide for achieving pneumoperitoneum?
CO 2 is rapidly absorbed by blood and therefore less likely to lead to gas embolism.
❍ How do you confirm adequate hemostasis during operative laparoscopy?
Examine the surgical site under water or without the pneumoperitoneum.
❍ What are some of the benefits of laparoscopic surgery compared with laparotomy?
Decreased hospital utilization, recovery time, patient discomfort, and overall cost.
❍ What are the alternatives to the standard umbilical insertion sites for Verres or trocar placement?
Open laparoscopy, LUQ (beneath the costal margin of the ninth intercostal space at the edge of the lateral rectus
or anterior axillary line), posterior cul-de-sac, or transfundal.
❍ Which patients may be good candidates for port placement in the LUQ?
Patients who have undergone multiple abdominal surgeries or are known to have extensive adhesions or in whom
insufflation is not attainable in the conventional spaces.
❍ What are desired intraperitoneal pressures during laparoscopy?
Upon entry, ≤10 mmHg → after insufflation, ≤20 to 25 mmHg.
❍ Describe the “hanging drop test.”
Rapid intake of the drop of fluid as well as the inability to reaspirate the media. It suggests intraperitoneal location
of the Veress needle.
❍ Which vessels can usually be identified by transillumination?
Superficial epigastric vessels.
❍ The inferior epigastric artery is a branch of what artery?
External iliac.
❍ When viewed from the laparoscope, the landmarks used to locate the inferior epigastric vessels are?
The inferior epigastric vessels lie medial to the round ligament and lateral to the obliterated umbilical artery (lateral
umbilical ligament).
❍ What are some common complications associated with gynecologic laparoscopy?
Vascular and bowel injury, urinary tract injury, thermal injury, peripheral neuropathy due to poor positioning,
hematoma and post-op bowel herniation.