Transcript LAPAROSCOPIC SURGERY - Dr. Patil`s Hospital

DR. PATIL’S HOSPITAL
Near Hotel Garden, Thana Naka,
Panvel – 410206, Dist – Raigad.
Phone: 27451717 / 27451217,
Telefax: 27451217,
PCO : 27491196.
ISO 9001:2000
CERTIFIED HOSPITAL
FULL-TIME DOCTORS
• DR. D. B. PATIL
M.S., F.M.A.S.; Dip A.L.S.; F.A.C.R.S.I.
• DR. MRS. J. D. PATIL
D.G.O.
We, Dr. D. B. Patil as General
Surgeon & Dr. Janki D. Patil as
Obstetrician & Gynaecologist form an
ideal team. We have a very well
equipped set-up for laparoscopic
surgery. We are performing
laparoscopic surgeries since 1995.
• We are providing advanced
laparoscopic surgeries for many
years.
• Now we are doing cancer surgery
also laparoscopically.
• We are doing diagnostic gastroscopy
& colonoscopy for many years.
• Now we are providing advanced
therapeutic endoscopy.
• We have the best set-up for
laparoscopic surgery in whole
of the Navi Mumbai & Raigad
district.
• We have two operation theaters
& one endoscopy room.
OPERATION THEATRE - 1
OPERATION THEATRE - 2
ENDOSCOPY ROOM
• We have state of the art
hightech world class
equipments.
• We have two sets of equipments
so that laparoscopic surgery
need not be converted to open
surgery for instrument failure.
TWO SETS OF EQUIPMENTS
PATIENT SAFETY FIRST!
• We have all equipments to monitor
patient’s all vital parameters which
confirms our motto “Patient’s safety
first!”
• To highlight following are the few
important equipments which speak
about our quality & care.
PHILIPS MULTIPARA CAPNOMETER
ONLY ONE OR TWO HOSPITALS HAVE
HARMONIC SCALPEL
THE ONLY ONE OF IT’S KIND IN
NAVI MUMBAI & RAIGAD
HARMONIC SCALPEL
• No electricity passes through the body. Uses
ultrasound energy, so safer than usual cautery.
• No lateral thermal damage so safer near vital
structures.
• Dissection & simultaneous cutting with coagulation
by same instrument reduces time of surgery.
• No smoke so clear visibility, & thus increased
safety.
• No charring so dissection becomes easy.
CAMERAS & XENON LIGHT SOURCE
ARE OF STORZ : THE WORLD LEADERS
These are eyes of the laparoscopic surgeon
OLYMPUS VIDEO-ENDOSCOPE
Visualises everything inside the gut.
C – ARM : Makes advanced
therapeutic endoscopy possible.
• We have
special
recording &
reporting
system.
• We have
special
softwares
for this.
ELECTRICITY SHUTDOWNS
We have two
different
back-up
systems.
• Two sets of 3KW
invertors
• 30KW Cummins
generator.
LAPAROSCOPIC SURGERY
We are proud to announce that
we introduced the laparoscopic
surgery to Panvel & Raigad
district. Laparoscopic surgery
basically encompasses two
specialities, one general surgery &
second Obstetrics & gynecology,
Laparoscopic surgery means
abdominal surgery done through
keyholes with the help of telescope.
It has many advantages over
conventional surgery & at the same
time it can be done as meticulously
as open surgery. Important
structures can be identified easily
because of magnification.
It has following advantages.
1. Post operative pain is very less.
2. Post operative recovery is very
fast.
3. Shorter hospital stay.
4. Early resumption to full work.
5.Complications such as wound
infection & incisional hernia are
virtually eliminated.
However laparoscopic
surgery is more expensive.
But in our hospital most of the
common surgeries, are
performed at concessional
charges , so that expenses are
nearly equal to conventional
surgery.
Following laparoscopic surgeries
are routinely done at our hospital.
Diagnostic: Done to know the cause
of illness in following conditions.
1. Undiagnosed Chronic abdominal
Pain.
2.Infertility.
3.Undiagnosed acute abdominal pain.
Therapeutic:
Surgeries done as treatment.
1. Tubal ligation
2. Cholecystectomy
3. Appendicectomy
4. Adhesiolysis
5. Salpingectomy
6. Oophorectomy
7. Total Laparoscopic
Hysterectomy (TLH)
8. Hernia repair
DIAGNOSTIC LAPAROSCOPY IN
CHRONIC ABDOMINAL PAIN
This is done to know the cause of
long standing abdominal pain where all
other investigations could not lead to any
conclusion. The conditions which may be
detected only on laparoscopy are, chronic
recurrent appendicitis, adhesions, chronic
ectopic, chronic pelvic inflammatomy
disease, abdominal tuberculosis etc.
DIAGNOSTIC LAPAROSCOPY IN
INFERTILITY
This is done to know the intraabdominal problems causing difficulty
in getting child. It is superior &
supplementary, to all other
investigations. You can directly
visualise internal reproductive organs
directly.
We can assess tubal patency,
condition of ovaries & tubes. We can
detect diseases such as chronic PID
leading to adhesions, &
endometriosis, which can be treated
laparoscopically. Conditions such as
abdominal tuberculosis &
genitourinary tuberculosis can be
diagnosed & treated at early stage.
DIAGNOSTIC LAPAROSCOPY IN
ACUTE ABDOMINAL PAIN
In some cases of acute
abdominal pain, some-times it is
very difficult to decide whether
immediate surgery is required or
not. This is because of atypical
presentation, in some cases of
ectopic pregnancy,
contd.
subacute
appendicitis,
blunt
abdominal trauma etc. Out of
these, many conditions can be
treated laparoscopically, through
same ports. Few conditions which
can be treated only by open
surgery, we will have an idea of
extent of surgery.
LAPAROSCOPIC TUBAL
LIGATION
This is the simplest & best
laparoscopic surgery. These surgeries
conducted on a mass scale in camps,
in the remotest of villages, which itself
indicates its simplicity, safety &
comfort. Patient can resume to full
work as rapidly as it is done.
Cosmetically very good.
However there are many misunderstandings about this surgery, because of
lack of time, where patient is not
explained fully e.g.
1. Shock is given in this surgery.
2. Failure rates are high.
No shock is given in this surgery.
Light is used to see inside of the abdomen.
Failure rates are same as open surgery.
LAPAROSCOPIC
CHOLECYSTECTOMY
Now its superiority over conventional
open cholecystectomy is proved beyond
doubt. It can be done precisely with more
comfort to the patient & cosmetically fine
results. Patient can resume to full work
very fast. Surgery can be done through
two 1cm & two 1/2cm. incisions & can be
discharged from the hospital within two
days.
LAPAROSCOPIC APPENDICECTOMY
This is also superior to open
appendicectomy in respect of post operative
comfort, wound infection, early resumption to
full work & cosmetic results. Laparoscopy is
the only method by which appendicitis can be
confirmed with certainty. At the same time
whole of the inside of the abdominal can be
visualised, so that co-existing disease if any
can be detected, & treated through the same
incisions, thus without increase in pain &
discomfort.
LAPAROSCOPIC ADHESIOLYSIS
Means division of adhesions.
Adhesions are formed following previous
open surgery or previous episodes of intraabdominal
infections. Adhesions are
detected
either
during
diagnostic
laparoscopy for chronic abdominal pain or
infertility or during laparoscopic surgery
for some other condition. Adhesiolysis
helps to relieve chronic abdominal pain or
conceive as the case may be.
LAPAROSCOPIC
SALPINGECTOMY
Here the diseased fallopian tube in
conditions such as ectopic pregnancy
hydrosalpinx or pyosalpinx is removed.
This surgery is done through one 10mm
and two 5mm incisions in laparoscopic
method, there by avoiding large incision
required in open method.
LAPAROSCOPIC OOPHORECTOMY &
OVARIAN CYSTCTOMY
Laparoscopy oophorectomy
indicated as adjuvant therapy in
carcinoma of breast, is performed
quite easily & safely. Removal of
ovarian cyst, with or without ovary
depending upon indication, can
also be done easily.
TOTAL LAPAROSCOPIC
HYSTERECTOMY (TLH)
Vaginal hysterectomy has very low
morbidity. But is easy & safe only in cases
of prolapsed, normal sized uterus. In bulky
& non-prolapsed uterus, where vaginal
hystere-ctomy is difficult, abdominal
hysterectomy is safe, but has more
morbidity. In such cases if TLH is done it
will be safe, & gives all advantages of
vaginal hysterectomy i-e
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Very less postoperative pain.
Fast post operative recovery.
Short hospital stay.
Early resumption to full work.
Cosmetically very good.
ENDOSCOPY
• We have state of the art video-endoscopes
to study upper & lower Gastrointestinal
(GI) tract.
• Upper GI tract study includes
oesophagus, stomach & duodenum (OGD
SCOPY).
• Lower GI tract study includes colon,
rectum, anal canal & terminal ileum
(COLONOSCOPY).
OGD SCOPY
Done either for diagnosis or treatment.
DIAGNOSIS :
– Diagnose or confirm acid peptic disease.
– Diagnose or confirm Gastro-oesophageal
Reflux Disease (GERD).
– Diagnose hiatus hernia, diverticuli or
stricture of oesophagus.
– Diagnose & confirm by biopsy the
nature of neoplastic lesion.
TREATMENT :
• Foreign body removal from
oesophagus, stomach & duodenum.
• Injection sclerotherapy or band
ligation for oesophageal varices &
glue injection for fundic varices.
• Dilatation of benign oesophageal
strictures, achalesia cardia etc.
• Stent insertion for cancerous
oesophageal lesion.
Continued…
• ERCP for removal of common
bile duct (CBD) & pancreatic
duct (PD) stones.
• Stenting for CBD strictures &
injuries.
• Stenting for PD strictures.
• Stenting for pancreatico-biliary
cancers.
COLONOSCOPY
Done for diagnosis & treatment.
DIAGNOSIS :
• Chronic diarrhoea
• Chronic constipation
• Change of bowel habit.
• Chronic unexplained left lower
abdominal pain.
• Unexplained rectal bleeding in elderly.
• Solitary rectal ulcer syndrome.
Continued…
• Followup study in ulcerative colitis to
assess response to treatment & early
detection of cancerous changes.
• Biopsies can be taken to ascertain the
nature of neoplastic growth.
TREATMENT :
• Polypectomy
• Controll of bleeding from vascular
lesion.
• Argon plasma coagulation.
HYSTEROSCOPY
• Shows inside of uterus.
• We can detect abnormalities like
septum, adhesions, fibroids,
polyps, tubal opening block etc.
• We can also treat above
problems.
VIDEO-CLIP OF
LAPAROSCOPIC
CHOLECYSTECTOMY
• Video-clip of
Laparoscopic
Appendicectomy.
• Video-clip of Rt.
Salpingectomy done for
twisted hydrosalpinx
(collection of fluid in the
tube).
Video-clip of laparoscopic
removal of Lt. ovarian
cyst.
Endoscopic removal of
foreign body : coin.
Video-clip of endoscopic
removal of Foreign body :
partial denture.
Video-clip of colonoscopy
: Normal findings
Video-clip of colonoscopy
: Ulcerative colitis
Video-clip of
endoscopic biopsy
from Ca-oesophagus
PORT PLACEMENT &
INITIAL DISSECTION TO
SEPARATE CYSTIC DUCT &
CYSTIC ARTERY
Applying clips &
cutting cystic duct &
cystic artery.
Dissecting out
gallbladder from liver.
Removal of gallbladder
& placement of drain.
ISO 9001:2000
CERTIFIED HOSPITAL
• For such best set-up & seniormost
experienced laparoscopic surgeons
charges are reasonable.
• Quality & care comes at the cost. It can
be made affordable but not cheap.
• Our hightech laparoscopic surgeries are
definately affordable.