Laparoscopic surgery is quite dependent on specific material and instruments. This relation gets even closer in laparoscopic bariatric procedures. The characteristics of the patients associated with the complexities of the different techniques require nothing less than the best designed and properly working tools.1 The constant development of new instruments makes laparoscopic bariatric interventions easier and safer,2 minimizing complications and reducing costs.3
When considering the material part of laparoscopy in bariatrics, there is a conjunct of environments that surround the patient and relate with each other: (1) the operating room settlement; (2) the laparoscopy kit (equipments in the set); (3) the instruments that get in direct contact with the patient (trocars, graspers, etc.); and (4) the tubes and cables that interface group 2 with group 3.
The surgical room should be wide, in order to have all equipment fit comfortably, and permit easy transit of personnel. The surgical table should be able to take excess weight, as well as move in accordance with the surgeon's needs, preferably remote-controlled. In addition, the table's design ought to enable concomitant procedures, such as cholangiographies during associated cholecystectomies. For fixing the patient, comfortable and self-adhering bands should be applied around the arms, legs, and over the hips. (For material specific to anesthesia, please refer to Chapter 10.)
Electric outlets should be evenly distributed to obviate the need for crossing wires. CO2 supply coming from the wall pipes discards space-demanding gas canisters and the need to replace them when empty. In modernly designed operating rooms, most of the outlets and gas tubes come from ceiling booms; these can also accommodate the entire laparoscopic set and video recording devices (Figure 8–1). If the institution is involved with teaching programs, i.e., university hospitals, there should be video and voice live transmission for education; this feature also provides with the capability of intraoperative consultation. The nurse's desk should contain all room controls, such as lighting, video recording, video signal switchers, still-image recorder/printer, overhead boom motor controls, and sound system. Considering ergonomics, the use of additional, opposite-side placed monitors in the operating room during laparoscopic bariatric procedures facilitates the assistants’ work, mostly for the one at the same side as the laparoscopy kit (Figure 8–1). A smaller monitor dedicated to the anesthesia helps the anesthesiologist follow the procedure and perform tasks (such as bougie insertion) without leaving the head of the table.4
The use of calf-length pneumatic compression hose, along with low-weight heparin, short operative time, and early postoperative ambulation, reduces the risk of deep venous thrombosis and its consequences.5,6
After finishing the operation, the patient should be moved to the transport bed with aid of a sliding device or air mattress so as to avoid arm or ...