Don't forget to look up: operating in the upper abdomen

Area of Science:

• Minimally Invasive Gynecologic Surgery
• Surgical Oncology
• Laparoscopic Techniques

Background:

• Laparoscopic technology advancements have increased gynecologic surgeons' comfort in pelvic surgery.
• Operating in the upper abdomen presents ergonomic challenges and a perceived "backward" operating sensation for gynecologic surgeons.
• Pathologies outside the pelvis, including benign (endometriosis, adhesions) and malignant (staging, omentectomy, debulking), necessitate upper abdominal expertise.

Purpose of the Study:

• To describe operating room modifications that enhance ergonomics and simulate pelvic cavity operating conditions for upper abdominal gynecologic surgery.
• To provide strategies for gynecologic surgeons to improve confidence and efficiency when operating in the upper abdomen.

Main Methods:

• Modifications include strategic operating room setup, repositioning monitors bilaterally at the patient's shoulders, and changing the surgeon's position to the patient's right side.
• Techniques such as port hopping and utilizing a 30-degree camera angle were implemented.
• An instructional video was developed to demonstrate these methods.

Main Results:

• The described modifications aim to improve the surgeon's experience and ability to operate effectively in the upper abdomen.
• These strategies address the loss of ergonomics and the sensation of operating backward.
• The goal is to enhance surgeon confidence and efficiency for a wider range of gynecologic pathologies.

Conclusions:

• Mastering upper abdominal laparoscopic surgery is crucial for gynecologic surgeons due to the prevalence of pathologies in this region.
• Implementing specific operating room setup and procedural techniques can significantly improve surgical ergonomics and efficiency.
• These adaptations facilitate better management of both benign and malignant gynecologic conditions located outside the pelvis.