After sterile washing and draping of the operative field, the mini-laparotomy is performed immediately below the umbilicus. Creation of the pneumoperitoneum via the Veress needle.
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Minilaparotomy
![Minilaparotomy]()
Soundsettings -
Positioning of the Trocars
![Positioning of the Trocars]()
Soundsettings Insertion of an 11-mm optical trocar; Placement of the additional 11-mm working trocars left lateral (working trocar e.g. for the scissors) and in the epigastrium (working trocar e.g. for a grasping forceps). A 5-mm trocar is placed in the right upper quadrant (working trocar for e.g. the suction device).
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Exploration
![Exploration]()
Soundsettings Visualization of the cyst, opening of the cyst with scissors through electrocoagulation. Aspiration of the cyst contents.
Tips: For the excision of the cyst wall, depending on thickness and consistency, scissors with monopolar or bipolar current, or even Ultracision can be used.
Careful hemostasis must be ensured!
Deeper cysts (e.g., in polycystic disease) may appear bluish and must be distinguished from veins; here, laparoscopic ultrasound with vascular Doppler function can be helpful! -
Circular Excision of the Cyst Wall
Inspection of the cyst base
Inspection of the cyst base for bleeding or bile leakage; if necessary, vessel coagulation, resp. c
Inspection of the cyst base for bleeding or bile leakage; if necessary, vessel coagulation, resp. c
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