Irrigation Suction

An excellent combination of irrigation and suction systems is necessary for any laparoscopic procedure. In cases of bleeding or spilled intestinal contents, irrigation systems with a minimal flow rate of 1 L/min are essential. Adjustable suction with interchangeable 5- and 10-mm metallic suction tubes should be available to remove smoke, laser plume, fluid, clots, or other debris. Using suction tips with multiple side holes is important when irrigating and evacuating fluid or clots rapidly or in large volumes.

Intraoperative irrigation should be performed with a warmed (37°C) isotonic solution; normal saline or lactated Ringer's solution is suitable. To effectively aspirate a collection of blood or tissue fluid at the conclusion of the operation, the operating table should be rotated appropriately so that the site of collection can be positioned lowest in the abdomen (Figure 6.29). An adequate suction power should be used to avoid rapid loss of pneumoperitoneum, keeping the probe below the level of fluid to be aspirated. Often omentum, mesentery, epiploic appendages, and intestinal loops may migrate into the collection and are drawn onto the suction probe. Care must be taken to release these attached tissues before the suction probe is withdrawn through the cannula. This may be achieved by switching off the suction, transiently switching on the irrigation, and a gentle manipulation of the trapped tissue. In case of inadequate suction caused by repeated obstruction by trapped tissue structures, a surgical gauze is inserted through the 10-mm cannula, and the suction is performed upon contact with it (Figure 6.30). This technique greatly facilities the suction/irrigation procedure especially in obese patients and is of practical value in preventing tissue trauma or accidental bleeding during the withdrawal of the instrument.

In case of inadvertent bleeding, adequate irrigation/suction is necessary to precisely locate the bleeders. In contrast to the situation of the elective irrigation/suction procedure, this requires the operating table to be rotated so that the bleeding area can be positioned for optimal viewing.

Surgical Setup Operating Room
Figure 6.29. Rotating the operating table to optimize positioning for irrigation/suction.
Laparoscopic Suction
Figure 6.30. The gauze technique avoids sucking tissue into the suction cannula.

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