Nature of recommendations

Based on clinical studies of good quality and consistency addressing the specific recommendations and including at least one randomized trial

Based on well-conducted clinical studies, but without randomized clinical trials

Made despite the absence of directly applicable clinical studies of good quality

1.3 References

Grimshaw J, Eccles M, Russell I.

Developing clinically valid practice guidelines. J Eval Clin Prac 1995; 1: 37-48.

Woolf SH.

Practice guidelines, a new reality in medicine. II. Methods of developing guidelines. (Review.) Arch Intern Med 1992; 152: 946-952.

Agency for Health Care Policy and Research.

Clinical Practice Guidelines Development, Methodological Perspectives. US Department of Health and Human Services, Public Health Service, Washington DC, 1992, pp. 115-127.

TECHNICAL ASPECTS

Introduction

Laparoscopy is a surgical technique that allows surgical procedures to be performed while minimizing trauma to the body. The following are indispensable for carrying out any laparoscopic procedure:

? Basic mandatory equipment

? Specific basic instruments

? Basic access techniques

? Complication management

? Specific training.

2.2 Equipment(1-3)

The view of the surgical field is provided by a video-camera, which represents the eye of the surgeon. It goes without saying that a proper video armamentarium is of paramount importance. The basic, indispensable equipment for videoing is as follows:

? At least one CCD (charge-coupled device), but preferaby three CCD video-cameras

? At least one, but preferably two, video-monitors

? Video-recorder cart.

In addition, equipment should also include:

? High-flow insufflator

? Xenon-light source

? High-frequency generator, both mono- and bipolar

? Suction and irrigation device. (Other devices for dissecting and for controlling bleeding may be useful,
such as an ultrasonic dissector or a radio-frequency coagulator.)

2.3 Instruments(1 -3)

As well as having instruments to enable access to, and development of, working room, the surgeon requires state-of-the-art instruments for optimal performance of laparoscopic procedures, including:

? Dissection

? Haemostasis

? Suturing

? Retrieval of specimens.

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