Loading presentation...

Present Remotely

Send the link below via email or IM

Copy

Present to your audience

Start remote presentation

  • Invited audience members will follow you as you navigate and present
  • People invited to a presentation do not need a Prezi account
  • This link expires 10 minutes after you close the presentation
  • A maximum of 30 users can follow your presentation
  • Learn more about this feature in our knowledge base article

Do you really want to delete this prezi?

Neither you, nor the coeditors you shared it with will be able to recover it again.

DeleteCancel

GENERAL PRINCIPLES OF LAPAROSCOPIC SURGERY

No description
by

muhammad adeel javed

on 18 February 2014

Comments (0)

Please log in to add your comment.

Report abuse

Transcript of GENERAL PRINCIPLES OF LAPAROSCOPIC SURGERY

Laparo-endoscopic instruments
• Video monitor
• Insufflators
• Imaging equipments: ultrasound,
fluoroscopy, optical imaging
• Electrosurgical unit
• Ultrasonic (Harmonic scalpel)
• Scope
• Ports
• Endoscopic instruments: grasping, dissecting,
cutting, suturing
GAS EFFECTS
LOCAL
• Peritoneal distension
• Vagal reaction
• Elevated diaphragm
• Altered venous return
• Pain
Port access
– Direct puncture with Veress needle
– Hasson technique
– Optical view technique
CONTRAINDICATIONS
Absolute (rare):
Unfit for general anaesthesia
Pregnancy
Relative:
Severe ischaemic or valvular heart disease
Increased intracranial pressure
Hypovolemia / shock
HISTORY
Lapro (the flank) + skopein (to examine)
Use of speculum-type intracorporeal viewing devices from the Greco-Roman period (Hippocrates 460 – 377 BCE).
Light transmission and optical clarity was a limitation.
Major breakthrough – Thomas Edison incandescent bulb and 3-lens optical system by Nitze and Reinecke (1879)
First performed by George Kelling Germany in a dog (1901)
First performed in humans by Hans Christian Jacobaeus thoracoscopy in humans (1910)


GENERAL PRINCIPLES OF LAPAROSCOPIC SURGERY
Rapid recovery time
Minimal immune response
Minimal scar tissue formation
Decreased post-operative pain
Reduction in the incidence of post-op ileus
Early mobilisation
Patient Selection and Preparation
Preoperative Evaluation:
Cardiopulmonary disease
Specific factors:
Prior incisions, umbilical abnormalities, positioning limitations, ascites, Hx of DVT
Preparation:
Pre-op antibiotics
DVT prophylaxis
Premedication
Minimally invasive team

A coordinated team approach is
mandated to ensure patient safety and
excellent outcomes.
• Team:
– Surgeon
– Assistants
– Operating room nurses
– Circulating staffs
The ‘Insufflator’

Created space
– Abdominal lifting instrument ( gasless )
– Gas insufflation: CO2, N2O, Helium, Argon, Neon,
Air
Systemic effect
• Hypercarbia
• Acidosis
• Increase after load
• Increase cathecolamines
• Myocardial stress
• Oliguria ( decrease renal blood flow, ADH secretion)
• Less immunosupression
• Higher serum cortisol than open surgery
• Rapid equilibrium of stress hormones
Veress needle
OPTICAL VIEW TROCAR
Port placement

THE DIAMOND OF SUCCESS
EXAMPLE
Access for subcutaneous and
extraperitoneal surgery
Balloon dissection
• Telescopic dissection
• Blunt dissection
Hand-assisted laparoscopic access


• Tactile advantage

• Bridging before convert to open surgery

• Difficult surgery: hepatectomy, colectomy
WHAT

IS

SILS?
Laparoscopic surgery through the umbilicus with a single incision

NO INCISION OR SCAR

OR LESS SCAR
SINGLE PORT SPLENECTOMY
1981 Semm performed first Laparoscopic
Appendectomy.
1987 Mouret performed first
Laparoscopic Cholecystectomy.
Prior to 1990, the only specialty performing laparoscopy on a widespread basis was gynecology, mostly for relatively short, simple procedures such as a diagnostic laparoscopy or tubal ligation.

• Complications related to pneumoperitoneum
– Pressure
• Cardiovascular effect ( > 15 mmHg)
• Emphysema: subcutaneous, mediastinum
• Shoulder pain
• Oliguria ( direct pressure and increase H2O resorption )
• Deep vein thrombosis ( in prolong procedure)
– Gas
• Embolism
• Shoulder pain
Complications related to access
Open – technique less major vascular injury, similar
bowel injury
– Bleeding: internal, external
– Hematoma
– Hernia
– Infection: foreign body
Deep vein thrombosis
• High risk: prolong procedure and reverse
Trenderlenberg position
• Prophylaxis: sequential compressing
stocking or heparin
COMPLICATIONS
Vaso-vagal reflex
• High risk: hypovolemic patient ( decrease
venous return and reverse Trenderlenberg position )
• Finding: arrythmia (most common: bradycardia),
hypotension
• Management: desufflation abdomen,
vagolytic agent and adequate volume
resuscitation
Complications(3)
• Complications related to energy source
Bowel, vascular, o – or solid organ injury ( particularly
monopolar)
– Heat from ultrasonic coagulation
Complications related to extreme
positions
– Muscle pain
– Burn
– Nerve injury
( compression, C-spine
• Complications related to instruments
Bowel, – vascular, or solid organ injury
An “Alternate Site” Injury
Specific complications
• Laparoscopic cholecystectomy
– Bile duct injury
– Bile leakage
• Endoscopic herniorrhaphy
– Hematoma
– Seroma
– Emphysema
EXAMPLE
Prevention of accident related to
energy-equipped instrument
• Audible sound always on
• Operated surgeon must control the energy
• The tip of electrode should be under vision
controlled
• Beware of sparking near metal
• Beware of fire in area of high O2 and fuel
Conclusions
MIS is a surgical approach which access
trauma is minimized without
compromising the quality of surgical
procedure.
• The physiological change in MIS is mostly
induced by pneumoperitoneum.
• MIS is depend on sophisticated
instrument and good surgical team
FUTURE
Trend of the future surgery is move to
minimally invasive surgery.
• Minimally invasive surgery has been
developing to the scarless surgery.
• Learning of surgery need to be change.
THANK YOU
POSITION
What is MIS ?
• A mean of performing major operations
through small incisions, often using
miniaturized, high-tech imaging systems
to minimize the trauma of surgical
exposure
• Minimal access surgery
MIS TYPES
LAPAROSCOPY
ENDOSCOPY
ENDOLUMINAL
ENDOVASCULAR
ROBOTIC
NOTES

Paradigm shift

Open surgery

Laparoscopic surgery


Endoscopic and Laparoscopic surgery
LAPAROSCOPY AND USES
1.OPTICS



2.ABDOMINAL ACCESS



3.LAPAROSCOPIC INSTRUMENTS
THEATRE SET UP
NEW ENERGY SOURCES
ARGON ENHANCED
ENDOSCOPIC USG
Full transcript