Transcript Document

LAPAROSCOPY
Origin: Greek
Lapara- "the soft parts of the body between the rib
margins and hips- the "flank or loin "
Skopein, which means "to see or view or examine."
laparoscope - endoscope inserted through an incision in
the abdominal wall in order to examine the abdominal
organs or to perform minor surgery
endoscope- a long slender medical instrument for
examining the interior of a bodily organ or performing
minor surgery
LAPAROSCOPIC SURGERY
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Minimally invasive surgery -the smallest possible incisions.
Key hole surgery –the incision to enter the abdomen
Belly button surgery , scope often through umbilicus
Band-Aid surgery , because the incisions so small that they
can be covered with adhesive bandage strips.
• Endoscopic surgery , because the instrument used for
minimally invasive procedures on parts
of the body other than the abdomen is
called an endoscope
• Abdominoscopy
• peritoneoscopy
HYSTEROSCOPE
Origin: Greek
Hystero-womb. Skopeo, to view
Endoscope -- uterine cavity.
Also called metroscope, uteroscope
HISTORY
• To Reduce size of incisions - dream of surgeons for years.
• 400 BC -Hippocrates described a rectoscope.
• 11th century - Albukasim, Arab physician, - speculum
illuminated by a set of light reflectors-limited applications
because the heat produced by candles and other artificial lights
resulted in burns.
• 1901- George Kelling did the first laparoscopy on a dog
• 1911- The first laparoscopy in human by the Swedish
physician H. C. Jacobeus.
HISTORY
• Up to the 1970s, laparoscopy was mainly used by gynecologists
and gastroenterologists for diagnostic purposes.
• Therapeutic laparoscopy introduced by gynecologists in the
early 1970s.
• Rapid technical advances in miniaturized surgical tools, fiber
optics, and video systems - new developments in minimally
invasive surgery .
• methods reduced post-operative complications -laparoscopy and
other types of minimally invasive surgery became widely used by
surgeons around the world.
HISTORY
• In the 1980s, -small, high-resolution television cameras
made laparoscope more effective
• The first live broadcast of a laparoscopy via the Internet
took place in 1996.
• On March 3, 1997, a computer-enhanced robotic system
was used on a human for the first time by Dr. J. Himpens
to perform some steps of laparoscopic surgery.
GYNECOLOGICAL LAPAROSCOPY
PROCEDURES
• Pelvic pain of uncertain cause
• Ovarian cysts
• Endometriosis
• Pelvic adhesions
• Ectopic pregnancy
• Infertility
• Hysterectomy
• Tubal ligation
VERESS NEEDLE -pneumoperitoneum
ADVANTAGES OF LAPAROSCOPY
• few very small incisions about a half-inch long. Instead
of a 4-5 inch incision ,cause less damage to body tissue,
organs, and muscles so that the patient
• can go home sooner.
• recovers quickly.
• fewer post-op complications , less pain.
• has less scaring.
RISKS OF LAPAROSCOPY
• Generally safer than open operations.
• Diagnostic laparoscopy-complications 3 in 1000
• Risks greater for people who are obese, smoke
cigarettes, or have additional health problems
• Laparoscopy usually requires general
anesthesia which carries certain risks.
• Injury to blood vessels or organs, which causes
bleeding.
• Conversion to laparotomy
THE FUTURE
• Robotic Surgery
• principle of master slave manipulator.
• The da Vinci system
• The Zeus system
• These machines have interface for surgeon which
deliver information through computer to robotic arm.
MASTER SLAVE MANIPULATOR
Robotic devices to
enter the body through
its own orifices
carrying medical
instruments inside the
body, where they
would be manipulated
by simple computer
commands.
THE FUTURE
Minimal Access Surgery techniques in cardiac -The
first totally Minimal Access coronary artery bypass
operation has been performed at the Imperial College
(St. Mary’s) London.
HOLOGRAM PROJECTION SYSTEM
Laparoscopic surgery is growing in such a speed
that 3D image projection system is going to replace
the conventional monitor in near future and surgeon
will get a virtual image in air just above the body of
patient. This new projection system will abolish
all the limitation of current two dimensional image
without depth perception.
THE FUTURE
• Newer micro-laparoscopes are about one-tenth of an inch
in diameter so that some procedures can be performed
through small hollow needles
• Make greater use of local anesthesia and sedation through
an intravenous catheter. Local anesthesia will make
laparoscopy even safer by further reducing the alreadysmall number of complications that occur with general
anesthesia.
“From the inability to let well alone ,from too much zeal
for the new and contempt for what is old, from putting
knowledge before wisdom ,science before art and
cleverness before commonsense, treating patients as
cases ,from making the cure of the disease more grievous
than endurance of the same ,good lord deliver us”
– Sir Robert Hutchison