The SAGES Manual of Perioperative Care in Minimally Invasive Surgery

Book excerpt: The second SAGES (Society of American Gastrointestinal Endoscopic S- geons) manual was intended to be a companion piece for the successful ?rst SAGES manual, edited by Carol Scott-Connor, that was published more than 4 years ago. Originally, the goal was to concentrate on tersely covered or often ignored aspects of the preoperative preparation of the patient and the operating room as well as the postoperative care of patients undergoing minimally in- sive operations. It was also our intention to include a section for each procedure where several different port placement schemes would be presented and brie?y discussed. Unique to this manual, the impact of the patient’s body habitus (short or long, narrow or wide) on port placement is also taken into account for many of the procedures. Also unique are chapters devoted to hypothermia, port wound closure, and the management of subcutaneous emphysema and abdominal wall hemorrhage caused by trocars. Naturally, the surgeon tends to focus on the technical aspects of the pro- dure, such as the operative tasks to be carried out, the order of operation, and the position of the surgeon and assistant. However, it is critical that the surgeon be aware that the CO pneumoperitoneum, far more so than laparotomy, results 2 in multiple physiologic alterations that, if not compensated for by the anest- siologist and surgeon, may endanger the patient or prevent the laparoscopic c- pletion of the procedure.