Quote from akor
I appreciate your detailed info....I have been out of the O.R. for 12 years and am busting my brain to keep up with all the procedures and materials. There is really no official training program....it is a sink or swim type of thing. We DO do video Nissen surgery and it is the attending doc who does it....so far so good... Thanks for the info on the splenic hemorrhage complication... I will know where the Argon Laser is when I am present....
--NOT the Argon Laser--that's an different device---(unless that's what you call your Argon Beam Coagulator, which is a type of cautery.) It has its own ground pads, hand held cautery units (one of which directs a beam of Argon gas directly onto a bleeder) etc. You can also connect a regular hand held cautery to it, and it only requires a single ground pad, even though you are using 2 hand held cauteries.
The Argon Beam Coagulator ALSO makes a handpiece to use during laparoscopic procedures. If you do this, make CERTAIN that you switch the Argon flow from "automatic" to "manual," start with a low flow rate, (ask the rep what he recommends) and make certain that all ports connected to the patient are VENTED---otherwise, you run the very real risk of filling the patient's abdomen with both CO2 from the insufflator and a possibly uncontrolled amount of Argon, both of which can't escape unless there are ports open to vent. The result can be a ruptured diaphragm, which has also occurred. This is a true surgical emergency.
Of course, any time one is doing laparoscopy, there must be at least one port open to vent, otherwise the CO2 can't escape. Don't depend on the alarms on the insufflator to tell you that intraabdominal pressure is too high--sometimes they fail.
Anybody using the Argon Beam Coagulator should make absolutely certain that he or she has had a thorough inservice about the device, and understands it completely. Always be cognizant of the fact that there are 2 flow rates--automatic and manual---and know when each is indicated.