Dissection Planes

Barry Salky, MD FACS

Franz W. Sichel Professor of Surgery

Division of Laparoscopic Surgery

The Mount Sinai Hospital

New York

Dissection Planes

This type of difficult dissection occurs in inflammatory processes, endometriosis, and reoperative surgery. The principles are the same as in open surgery. The question is how can we use laparoscopic techniques to solve this problem. Can we do it better?

Dissection Planes

In general, start with the easiest part of the procedure first. This almost always means to find a “normal” embryological surgical plane first and work towards the pathology. Hemostasis if incredibly important in these dissections.

Dissection Planes

• Proper instrumentation with sharp dissection is usually the best technique, but blunt dissection has its role as well.• Atraumatic graspers• Hemostasis• Identify anatomic planes.

Dissection Planes

Inflammatory Disease

Endometriosis

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Diverticulitis

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Crohn’s Disease

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Dissection Planes

What about reoperative colon surgery? • Adhesiolysis: proper plane on the

bowel wall.• Identify and protect the retroperiteum• Sharp dissection preferred

Don’t get tripped up!

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Dissection Planes

It’s about the process. Be flexible in your technique. Know medial to lateral and lateral to medial. Know different instrumentation. Know the various energy sources. Keep it simple.

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SAGES & CAGS host the 12th

World Congress of Endoscopic

Surgery

April 14 - 17, 2010Gaylord National Resort and Convention Center

Landover, MD (just outside Washington, DC)

Registration & Program Information

will be available Summer, 2009

Program Chairs:

Daniel Herron, MD

(SAGES Co-Chair)

Barry Salky, MD

(SAGES Chair)

Christopher Schlachta, MD

(CAGS Chair)

Hosted by SAGES & CAGSSociety of American Gastrointestinal and Endoscopic Surgeonsand Canadian Association of General Surgeons