Laparoscopic gynaecological surgery in the context of maintaining normal intracranial pressure.

A nulliparous patient in her early 20s was referred to a fertility specialist for fertility preservation, before commencing chemo-radiation therapy for a recently diagnosed malignant brain tumour. Two weeks prior, she had presented with seizures and undergone emergency craniotomy and tumour resection. Taking into consideration of the tight time frame and her comorbidities, several measures were undertaken to minimise the potential increase in intracranial pressure that may lead to cerebral oedema during laparoscopy. Preoperatively, the anaesthetist administered 8 mg dexamethasone as prophylaxis. Intraoperatively, the degree of head-down tilt was minimised to 10, which was just adequate to displace bowel cranially for visualisation of pelvic structures. Finally, a shorter operative time was achieved by ensuring the most senior surgeon performed the operation, and the procedure itself was altered from the standard approach of ovarian harvesting to unilateral oophorectomy. The patient made a quick recovery and was discharged home day 1 postoperatively.

Safer laparoscopic trocar entry: it's all about pressure.

This prospective observational study aimed to assess the feasibility of adapting peritoneal hyperdistention to 25 mmHg during laparoscopy in an Australian hospital environment. A total of 1150 consecutive diagnostic or operative laparoscopies were performed. All cases were monitored for early detection of untoward physiological changes. All patients had Veress needle insufflation with distension to 25 mmHg prior to insertion of the primary trocar. No patients experienced any surgical entry complications or adverse clinical effects noted during anaesthetic. The aim of the current study is to assess the feasibility and safety of increasing the peritoneal insufflation pressure to 25 mmHg for primary trocar insertion.