Principles of Minimally Invasive Surgery

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Principles of Minimally Invasive Surgery : 

Principles of Minimally Invasive Surgery DR. SANDEEP V. KANSAL ASSOCIATE PROFESSOR OF SURGERY GOVT. MEDICAL COLLEGE, SURAT

Introduction : 

Introduction Minimally invasive surgery may be defined as a method for performing established surgical procedures by remote manipulation in a confined anatomical space.

Slide 3: 

This leads to a reduction of access trauma, thereby reducing surgical complications, accelerating recovery, and improving cosmesis . Gain visual access to the operating site via scopes and operating access for the instruments via working ports.

Minimal access surgery has moved the focus of surgery towards reducing the morbidity of patients while maintaining quality of care : 

Minimal access surgery has moved the focus of surgery towards reducing the morbidity of patients while maintaining quality of care

TEAM WORK : 

TEAM WORK SURGEON CAMERAMAN ASSISTANT SURGEON SKILL & EXPERIENCE GOOD HAND EYE CORDINATION CAMERAMAN IS SURGEONS EYE

Slide 6: 

Minimal access techniques Established Laparoscopic cholecystectomy Diagnostic laparoscopy Laparoscopic appendicectomy Laparoscopic Nissen fundoplication Laparoscopic (or thoracoscopic) Heller's myotomy Laparoscopic adrenalectomy Laparoscopic splenectomy Thoracoscopic sympathectomy Laparoscopic rectopexy

Slide 7: 

Under evaluation Laparoscopic hernia repair Laparoscopic colectomy Laparoscopic nephrectomy for living related donor transplant Parathyroidectomy (guided with hand held gamma probe) Laparoscopic repair of duodenal perforation27 Prospects Sentinel node biopsy Hepatic resection Gastrectomy

EQUIPMENTS & INSTRUMENTATION : 

EQUIPMENTS & INSTRUMENTATION Laparoscope- Rigid instrument, Based on rod lens system of optics

VIDEO IMAGING SYSTEM : 

VIDEO IMAGING SYSTEM LIGHT SOURCE VIDEO CAMERA CAMERA CONTROL UNIT VIDEO MONITOR

INSUFFLATORS : 

INSUFFLATORS

TROCARS & INSUFLATION NEEDLES : 

TROCARS & INSUFLATION NEEDLES

SURGICAL INSTRUMENTS : 

SURGICAL INSTRUMENTS

BASIC PRINCIPLES OF LAPAROSCOPY : 

BASIC PRINCIPLES OF LAPAROSCOPY PNEUMOPERITONEUM & TROCAR PLACEMENT CLOSED & OPEN Technique Site-1. Umblicus 2. Palmer’s point in Rt. Hypochondrium Decompress stomach & U. Bladder

Pneumoperitoneum : 

Pneumoperitoneum 45* angel with pelvic cavity away from aorta & IVC Aspirate first Do saline drop test INITIALLY 1Lt/min co2 Tympanic note in four quadrents

Trocar Placement : 

Trocar Placement Metalic trocar Disposable plastic Trocar- Hasson’s trocar Preinsufflation mark port site Adequate skin incision Screw movements for trocar insertion after lifting up Ant. Abdominal wall

Anaesthesia : 

Anaesthesia G/A- Better Complete control of patient ventilation Complete relaxation of abdominal wall muscle Pulmonary & haemodynamic change in laparoscopic surgery as – peripheral resistence& C V P & entidal co2 venous return & cardiac output S/A E/A

Patients selection : 

Patients selection Absolute Contraindications- Uncorrectable Coagulopathy Frozen abdomen Intestinal Obstruction with Massive distention Haemorrhagic shock Cardiac dysfunction concomitant disease requiring laparotomy

Relative contraindications : 

Relative contraindications Not able to tolerate G/A Abdominal sepsis Intraabdominal malignency Pregnency Morbid obesity severe COPD diaphragmetic hernia

Laparoscopic Complications : 

Laparoscopic Complications Vascular injury Bowel / Bladder Injury Abdominal wall Haemorrhage Bleeding from solid organ Abdominal wall hernia Co2 embolism Hypercarbia Subcutaneous Emphysema Pneumothorax/ Pneumomediastenum Respiratory acidosis