tag:blogger.com,1999:blog-55980650325850879172024-03-19T03:03:58.057-07:00Basics in Laparoscopic Surgery.chiranthiBhttp://www.blogger.com/profile/00946760717407092753noreply@blogger.comBlogger6125tag:blogger.com,1999:blog-5598065032585087917.post-54729265172838126622012-03-04T07:24:00.001-08:002012-03-04T07:24:36.853-08:00Laparoscopy in General Surgery<br />
<b><span style="font-family: 'Helvetica Neue', Arial, Helvetica, sans-serif;">Laparoscopic cholecystectomy</span></b><br />
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<span style="font-family: 'Helvetica Neue', Arial, Helvetica, sans-serif;">This is a widely used procedure in general surgery. Prior to surgery the procedure is explained to the patient and informed written consent is taken. The appropriate assessment of patient’s fitness for surgery is carried out. This includes investigation of cardiovascular and respiratory system if history suggests these to be risk factors, a full blood count and biochemical profile. Blood coagulation is checked if there is history of jaundice. </span><br />
<span style="font-family: 'Helvetica Neue', Arial, Helvetica, sans-serif;">At the operating theatre the patient is positioned in the operating table. The patient is given prophylactic antibiotics at the time of induction. The patient is anaesthetized. And pneumoperitoneum is created. Four ports are placed in the abdomen.</span><br />
<span style="font-family: 'Helvetica Neue', Arial, Helvetica, sans-serif;">The cystic duct and cystic artery are carefully defined. Then the cystic duct is clipped and divided and the gallbladder is removed from the bed then removed from the body via the umbilicus.</span><br />
<span style="font-family: 'Helvetica Neue', Arial, Helvetica, sans-serif;">Then the co2 is removed and trocars are withdrawn. The access sites are sutured. Other practices of laparoscopy in General surgery.</span><br />
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<span style="font-family: 'Helvetica Neue', Arial, Helvetica, sans-serif;"><b>•<span class="Apple-tab-span" style="white-space: pre;"> </span>Diagnostic Laparoscopy</b></span><br />
<span style="font-family: 'Helvetica Neue', Arial, Helvetica, sans-serif;"><b><br /></b></span><br />
<span style="font-family: 'Helvetica Neue', Arial, Helvetica, sans-serif;"><b>•<span class="Apple-tab-span" style="white-space: pre;"> </span>Appendectomy</b></span><br />
<span style="font-family: 'Helvetica Neue', Arial, Helvetica, sans-serif;">The surgeon typically stands on the left of the patient, and the assistant stands on the right. The standard approach is to place 3 trocars during the procedure. Two of these have a fixed position ( umbilical, suprapubic); the position of the third, which is placed in the right periumbilical region, may vary greatly depending on the patient's anatomy. After gaining access the whole abdomen is visualized and the appendix is identified.</span><br />
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<span style="font-family: 'Helvetica Neue', Arial, Helvetica, sans-serif;"><b>•<span class="Apple-tab-span" style="white-space: pre;"> </span>Hernia Repair</b>.</span><br />
<span style="font-family: 'Helvetica Neue', Arial, Helvetica, sans-serif;">The port placement differ according to the site of the hernia</span><br />
<span style="font-family: 'Helvetica Neue', Arial, Helvetica, sans-serif;"><br /></span><br />
<span style="font-family: 'Helvetica Neue', Arial, Helvetica, sans-serif;"><b>•<span class="Apple-tab-span" style="white-space: pre;"> </span>Spleenectomy</b></span><br />
<span style="font-family: 'Helvetica Neue', Arial, Helvetica, sans-serif;"><br /></span><br />
<span style="font-family: 'Helvetica Neue', Arial, Helvetica, sans-serif;">•<span class="Apple-tab-span" style="white-space: pre;"> </span><b>Anti-Reflux Procedures</b></span><br />
<span style="font-family: 'Helvetica Neue', Arial, Helvetica, sans-serif;">The most common anti-reflux surgical procedure performed for treatment of GORD is a Nissen fundoplication . The fundus of the stomach is wrapped around the lower portion of the esophagus and anchored securely below the diaphragm. If there is a hiatal hernia, the hernia will also be fixed using a laparoscope and five small incisions</span><br />
<span style="font-family: 'Helvetica Neue', Arial, Helvetica, sans-serif;"><br /></span><br />
<span style="font-family: 'Helvetica Neue', Arial, Helvetica, sans-serif;"><b>•<span class="Apple-tab-span" style="white-space: pre;"> </span>Paraesophageal Hernia Repair</b></span><br />
<span style="font-family: 'Helvetica Neue', Arial, Helvetica, sans-serif;"><br /></span><br />
<span style="font-family: 'Helvetica Neue', Arial, Helvetica, sans-serif;"><b>•<span class="Apple-tab-span" style="white-space: pre;"> </span>Gastric Procedures</b></span><br />
<span style="font-family: 'Helvetica Neue', Arial, Helvetica, sans-serif;">Since the advent of H2-receptor blockers and proton pump inhibitors elective surgery for ulcer disease is unusual, but in emergency surgery for complications such as perforation and gastric outlet obstruction, laparoscopic procedures are appropriate. These procedures include primary repair with omental patch for perforation and gastrojejunostomy bypass in cases of obstruction. Management of bleeding by laparoscopic techniques is not being done but Laparoscopic gastrectomy for benign and malignant gastric tumors has been done</span><br />
<span style="font-family: 'Helvetica Neue', Arial, Helvetica, sans-serif;"><br /></span><br />
<span style="font-family: 'Helvetica Neue', Arial, Helvetica, sans-serif;"><b>•<span class="Apple-tab-span" style="white-space: pre;"> </span>Small Bowel Procedures</b></span><br />
<span style="font-family: 'Helvetica Neue', Arial, Helvetica, sans-serif;"><br /></span><br />
<span style="font-family: 'Helvetica Neue', Arial, Helvetica, sans-serif;"><b>•<span class="Apple-tab-span" style="white-space: pre;"> </span>Colorectal Surgery</b></span><br />
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<b><br /></b></div>chiranthiBhttp://www.blogger.com/profile/00946760717407092753noreply@blogger.comtag:blogger.com,1999:blog-5598065032585087917.post-6861333619089926742012-03-04T07:24:00.000-08:002012-03-21T20:55:12.123-07:00Laparoscopic Procedure<br />
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<b><span style="font-family: 'Helvetica Neue', Arial, Helvetica, sans-serif;"> Gaining Access<o:p></o:p></span></b></div>
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<span style="font-family: 'Helvetica Neue', Arial, Helvetica, sans-serif;">Access to the peritoneal cavity
and creation of pneumoperitoneum is the initial step in laparoscopy.There are
different methods of primary access in laparoscopy. The popular ones being the
Veress needle technique and Hasson’s technique. Veress needle technique still
being used by many surgeons and gynaecologists is regarded by them as the Gold
standard. As the veress needle and the first trocar afterward are introduced
blindly, this method is called closed method contrary to the open technique
named as Hasson’s technique where peritoneum is approached by open dissection
of tissues.</span></div>
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<b><span style="font-family: 'Helvetica Neue', Arial, Helvetica, sans-serif;">The veress needle technique<o:p></o:p></span></b></div>
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<span style="font-family: 'Helvetica Neue', Arial, Helvetica, sans-serif;">Umblicus is
the site chosen as the primary access site. The reasons are it is in the
midline and <span lang="EN-GB">it is naturally a weak area due to absence of all the layers.<o:p></o:p></span></span></div>
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<span style="font-family: 'Helvetica Neue', Arial, Helvetica, sans-serif;">The anterior
abdominal wall should be lifted or stabilized before the insertion of the
needle or stabilized before the Veress needle is inserted. Only three
attempts for successful pneumoperitoneum establishment are acceptable, fourth
attempt should be made in an alternative site. One of these sites is the
Palmer’s point localized about 3 cm below the left costal margin in the
midclavicular line. This is the site especially recommended in extremely obese
and thin patients, <span lang="EN-GB"><o:p></o:p></span></span></div>
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<span style="font-family: 'Helvetica Neue', Arial, Helvetica, sans-serif;">The Veres needle should be inserted in angle from 45° in
non-obese to 90° in obese patients. There are various methods like hanging drop
of saline test, the “hiss” sound test, aspiration and syringe test, that prove
correct localization of the needle. </span></div>
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<span style="font-family: 'Helvetica Neue', Arial, Helvetica, sans-serif;">Then pneumoperitoneum is created using CO2 insufflator.</span></div>
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<span style="font-family: 'Helvetica Neue', Arial, Helvetica, sans-serif;">The last is the introduction of the first trocar, it has a
potential in damaging major vessels or organs.So it is essential to elevate the
abdominal wall.It should be introduced carefully with the rotatory motion. Just
after the insertion of the first trocar, the insufflation cord should be
connected to maintain the pneumoperitoneum.</span></div>
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<b><span style="font-family: 'Helvetica Neue', Arial, Helvetica, sans-serif;">Secondary Access<o:p></o:p></span></b></div>
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<span style="font-family: 'Helvetica Neue', Arial, Helvetica, sans-serif;">After taking the primary access secondary access of the
other trocars should take place. The site and no of placement differ according
to the procedure. Telescope should be
in the middle of instruments. Manipulation
angle of instruments usually 60 degree but can differ according to procedure.
The picture shows the placement of camera, target and instrument ports.<o:p></o:p></span></div>
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<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEh3NfntZeFRzFu4ALGT4IHhkspwoCkr2U2yky2Ewnxup2WjMrSO32DOjUUpLk2Qq3neEkcardNhtxQHx-eB_yTPLytZ8MR2R7HqEEQUVWhYReQoewU_PRnlm4YAtG6kgl76ieYlPQBo8FM/s1600/optimum-manipulation-angle-for-best-task-performance-in-laparoscopic-surgery_clip_image002.gif" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><span style="font-family: 'Helvetica Neue', Arial, Helvetica, sans-serif;"><img border="0" height="351" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEh3NfntZeFRzFu4ALGT4IHhkspwoCkr2U2yky2Ewnxup2WjMrSO32DOjUUpLk2Qq3neEkcardNhtxQHx-eB_yTPLytZ8MR2R7HqEEQUVWhYReQoewU_PRnlm4YAtG6kgl76ieYlPQBo8FM/s400/optimum-manipulation-angle-for-best-task-performance-in-laparoscopic-surgery_clip_image002.gif" width="400" /></span></a></div>
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<span style="font-family: 'Helvetica Neue', Arial, Helvetica, sans-serif;">When inserting the
ports, abdominal wall has to be pulled up and trocar inserted in a twisting
manner. This has to be stopped when the trocar enters the cavity.</span></div>
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<br /></div>chiranthiBhttp://www.blogger.com/profile/00946760717407092753noreply@blogger.comtag:blogger.com,1999:blog-5598065032585087917.post-5150849642320533022012-03-04T07:23:00.000-08:002012-03-04T07:23:59.732-08:00History of Laparoscopic Surgery<br />
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<span style="font-family: 'Helvetica Neue', Arial, Helvetica, sans-serif;"><b>1902</b>- <a href="http://en.wikipedia.org/wiki/Georg_Kelling" title="Georg Kelling"><span style="color: windowtext; text-decoration: none;">Georg
Kelling</span></a>, of <a href="http://en.wikipedia.org/wiki/Dresden" title="Dresden"><span style="color: windowtext; text-decoration: none;">Dresden,
Saxony</span></a>, performed the
first laparoscopic procedure in dogs. He used a cystoscope to peer into the
abdomen of the dog after first insufflating it with air. He also used filtered
atmospheric air to create a pneumoperitoneum, with the goal of stopping intra
abdominal bleeding.<o:p></o:p></span></div>
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<span style="font-family: 'Helvetica Neue', Arial, Helvetica, sans-serif;"><b>1910-</b> <a href="http://en.wikipedia.org/wiki/Hans_Christian_Jacobaeus" title="Hans Christian Jacobaeus"><span style="color: windowtext; text-decoration: none;">Hans Christian Jacobaeus</span></a> of Sweden reported the first laparoscopic operation
in humans. This was done in USA. The instrument used was a proctoscope of a
half inch diameter and ordinary light for illumination. The procedure was
mainly inspecting abdominal cavity. This was called “organoscopy”.<o:p></o:p></span></div>
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<tr><td class="tr-caption" style="text-align: center;">An Early Laparoscopic Surgery</td></tr>
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<span style="font-family: 'Helvetica Neue', Arial, Helvetica, sans-serif;"><b>1911-</b> H.B.Jacobaeus, again coined the term “laparothorakoscopie” after using
this procedure on the thorax and abdomen. Heused introduced the trocar inside
the body cavity directly without employing a pneumoperitoneum.<o:p></o:p></span></div>
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<span style="font-family: 'Helvetica Neue', Arial, Helvetica, sans-serif;"><b>1920</b> -Zollikofer of
Switzerland discovered the benefit of CO2 gas to use for insufflations, rather
than filtered atmospheric air or nitrogen.<o:p></o:p></span></div>
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<span style="font-family: 'Helvetica Neue', Arial, Helvetica, sans-serif;"><strong><span style="background-attachment: initial; background-clip: initial; background-color: white; background-image: initial; background-origin: initial;">1929</span></strong><span class="apple-converted-space"><b><span style="background-attachment: initial; background-clip: initial; background-color: white; background-image: initial; background-origin: initial;"> </span></b></span><span style="background-attachment: initial; background-clip: initial; background-color: white; background-image: initial; background-origin: initial;">- Heinz Kalk,<span class="apple-converted-space"> </span></span>a German gastroenterologist who is considered the founder of
the German School of Laparoscopy developed a specific lens system and a dual
trocar approach. He used laparoscopy as a diagnostic method for liver and
gallbladder disease.<o:p></o:p></span></div>
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<span style="font-family: 'Helvetica Neue', Arial, Helvetica, sans-serif;"><strong><span style="background-attachment: initial; background-clip: initial; background-color: white; background-image: initial; background-origin: initial;">1934</span></strong><span class="apple-converted-space"><span style="background-attachment: initial; background-clip: initial; background-color: white; background-image: initial; background-origin: initial;"> </span></span><span style="background-attachment: initial; background-clip: initial; background-color: white; background-image: initial; background-origin: initial;">- John C. Ruddock, M.D., F.A.C.P., pioneer in laparoscopy, an
American internist described laparoscopic as a good diagnostic method, many
times, superior than laparotomy.<span class="apple-converted-space"> <o:p></o:p></span></span></span></div>
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<span style="font-family: 'Helvetica Neue', Arial, Helvetica, sans-serif;"><b>1936</b>- Boesch ot
Switzerland is credited for doing the first laparoscopic tubal sterilization.<o:p></o:p></span></div>
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<span style="font-family: 'Helvetica Neue', Arial, Helvetica, sans-serif;"><strong><span style="background-attachment: initial; background-clip: initial; background-color: white; background-image: initial; background-origin: initial;">1938</span></strong><span class="apple-converted-space"><span style="background-attachment: initial; background-clip: initial; background-color: white; background-image: initial; background-origin: initial;"> </span></span><span style="background-attachment: initial; background-clip: initial; background-color: white; background-image: initial; background-origin: initial;">- J Veress, of Hungary, developed the spring-loaded needle.
It main purpose was to perform therapeutic pneumothorax to treat patients
suffering from tuberculosis. It current modifications make the “Veress” needle
a perfect tool to achieve pneumoperitoneum during laparoscopic surgery.</span><br />
<span style="background-attachment: initial; background-clip: initial; background-color: white; background-image: initial; background-origin: initial;"> <o:p></o:p></span></span></div>
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<span style="font-family: 'Helvetica Neue', Arial, Helvetica, sans-serif;"><strong><span style="background-attachment: initial; background-clip: initial; background-color: white; background-image: initial; background-origin: initial;">1944</span></strong><span class="apple-converted-space"><span style="background-attachment: initial; background-clip: initial; background-color: white; background-image: initial; background-origin: initial;"> </span></span><span style="background-attachment: initial; background-clip: initial; background-color: white; background-image: initial; background-origin: initial;">- Raoul Palmer, performed
gynecological examinations using laparoscopy and placing the patients in the
Trendelemburg position, so air could fill the pelvis. He also stressed the
importance of continuous intra-abdominal pressure monitoring during a
laparoscopic procedure.<span class="apple-converted-space"> <o:p></o:p></span></span></span></div>
<div class="MsoNormal" style="background: white; line-height: 14.25pt; margin-bottom: 6.0pt; margin-left: 0in; margin-right: 0in; margin-top: 4.8pt;">
<span style="font-family: 'Helvetica Neue', Arial, Helvetica, sans-serif;"><b>1950</b>- The first publication on
diagnostic laparoscopy by Raoul Palmer.<o:p></o:p></span></div>
<div class="MsoNormal" style="background: white; line-height: 14.25pt; margin-bottom: 6.0pt; margin-left: 0in; margin-right: 0in; margin-top: 4.8pt;">
<br /></div>
<div class="MsoNormal" style="background: white; line-height: 14.25pt; margin-bottom: 6.0pt; margin-left: 0in; margin-right: 0in; margin-top: 4.8pt;">
<span style="font-family: 'Helvetica Neue', Arial, Helvetica, sans-serif;"><b>1953</b>-The rigid lens
system was discovered by Professor Hopkins. By making this instrument he has
revolutionized the concept of laporoscopic surgery.<o:p></o:p></span></div>
<div class="MsoNormal" style="background: white; line-height: 14.25pt; margin-bottom: 6.0pt; margin-left: 0in; margin-right: 0in; margin-top: 4.8pt;">
<br /></div>
<div class="MsoNormal" style="background: white; line-height: 14.25pt; margin-bottom: 6.0pt; margin-left: 0in; margin-right: 0in; margin-top: 4.8pt;">
<span style="font-family: 'Helvetica Neue', Arial, Helvetica, sans-serif;"><b>1960</b>-Kurt semm a
German gynaecologist, has invented the automatic insuffator. In late 60 s this
was developed into a method which can measure the intra abdominal pressure. This
allowed safer laporoscopy. <o:p></o:p></span></div>
<div class="MsoNormal" style="background: white; line-height: 14.25pt; margin-bottom: 6.0pt; margin-left: 0in; margin-right: 0in; margin-top: 4.8pt;">
<br /></div>
<div class="MsoNormal" style="background: white; line-height: 14.25pt; margin-bottom: 6.0pt; margin-left: 0in; margin-right: 0in; margin-top: 4.8pt;">
<span style="font-family: 'Helvetica Neue', Arial, Helvetica, sans-serif;"><b>1970</b>-Laporascopy was
widely used by the gynaecologist but general surgeons remained confined to the
open surgery.<o:p></o:p></span></div>
<div class="MsoNormal" style="background: white; line-height: 14.25pt; margin-bottom: 6.0pt; margin-left: 0in; margin-right: 0in; margin-top: 4.8pt;">
<br /></div>
<div class="MsoNormal" style="background: white; line-height: 14.25pt; margin-bottom: 6.0pt; margin-left: 0in; margin-right: 0in; margin-top: 4.8pt;">
<span style="font-family: 'Helvetica Neue', Arial, Helvetica, sans-serif;"><b>1972</b>-H.Countay Clarke
first time showed laparoscopic suturing technique foe haemostasis.<o:p></o:p></span></div>
<div class="MsoNormal">
<span style="font-family: 'Helvetica Neue', Arial, Helvetica, sans-serif;"><b>1980</b> -<span class="apple-converted-space"> </span><i>Patrick Steptoe</i>, from England
started to perform laparoscopic procedures in the operating room under sterile
conditions.<o:p></o:p></span></div>
<div class="MsoNormal" style="margin-bottom: 0.0001pt;">
<span style="font-family: 'Helvetica Neue', Arial, Helvetica, sans-serif;"><b>1982</b> - First solid state camera was introduced. This is the start of
"video-laparoscopy"<o:p></o:p></span></div>
<div class="MsoNormal" style="margin-bottom: 0.0001pt;">
<br /></div>
<div class="MsoNormal" style="background: white; line-height: 14.25pt; margin-bottom: 6.0pt; margin-left: 0in; margin-right: 0in; margin-top: 4.8pt;">
<span style="font-family: 'Helvetica Neue', Arial, Helvetica, sans-serif;"><b>1983</b>- First appendicectomy
by Semm, a German gynaecologist.<o:p></o:p></span></div>
<div class="MsoNormal" style="background: white; line-height: 14.25pt; margin-bottom: 6.0pt; margin-left: 0in; margin-right: 0in; margin-top: 4.8pt;">
<br /></div>
<div class="MsoNormal" style="background: white; line-height: 14.25pt; margin-bottom: 6.0pt; margin-left: 0in; margin-right: 0in; margin-top: 4.8pt;">
<span style="font-family: 'Helvetica Neue', Arial, Helvetica, sans-serif;"><b>1985</b>- First
laparoscopic cholecystectomy.<o:p></o:p></span></div>
<div class="MsoNormal" style="background: white; line-height: 14.25pt; margin-bottom: 6.0pt; margin-left: 0in; margin-right: 0in; margin-top: 4.8pt;">
<br /></div>
<div class="MsoNormal" style="background: white; line-height: 14.25pt; margin-bottom: 6.0pt; margin-left: 0in; margin-right: 0in; margin-top: 4.8pt;">
<span style="font-family: 'Helvetica Neue', Arial, Helvetica, sans-serif;"><b>1987</b>- First
laparoscopic repair of inguinal hernia.<o:p></o:p></span></div>
<div class="MsoNormal" style="background: white; line-height: 14.25pt; margin-bottom: 6.0pt; margin-left: 0in; margin-right: 0in; margin-top: 4.8pt;">
<br /></div>
<div class="MsoNormal" style="background: white; line-height: 14.25pt; margin-bottom: 6.0pt; margin-left: 0in; margin-right: 0in; margin-top: 4.8pt;">
<span style="font-family: 'Helvetica Neue', Arial, Helvetica, sans-serif;"><b>1987</b>- First
laparoscopic cholecystectomy using video technique. This procedure has
revolutionized the general surgery.<br />
<br />
<o:p></o:p></span></div>
<div class="MsoNormal" style="background: white; line-height: 14.25pt; margin-bottom: 6.0pt; margin-left: 0in; margin-right: 0in; margin-top: 4.8pt;">
<span style="font-family: 'Helvetica Neue', Arial, Helvetica, sans-serif;"><b>1988</b>- First
laparoscopic lymphadenectomy.</span></div>
<div class="MsoNormal" style="background: white; line-height: 14.25pt; margin-bottom: 6.0pt; margin-left: 0in; margin-right: 0in; margin-top: 4.8pt;">
<br /></div>
<div class="MsoNormal" style="background: white; line-height: 14.25pt; margin-bottom: 6.0pt; margin-left: 0in; margin-right: 0in; margin-top: 4.8pt;">
<span style="font-family: 'Helvetica Neue', Arial, Helvetica, sans-serif;"><strong><span style="background-attachment: initial; background-clip: initial; background-color: white; background-image: initial; background-origin: initial;">1994</span></strong><span class="apple-converted-space"><span style="background-attachment: initial; background-clip: initial; background-color: white; background-image: initial; background-origin: initial;"> </span></span><span style="background-attachment: initial; background-clip: initial; background-color: white; background-image: initial; background-origin: initial;">- A robotic arm was designed to hold the laparoscope camera and
instruments with the goal of improving safety, reducing resource utilization
and improving efficiency and versatility for the surgeon.</span><o:p></o:p></span></div>
<div class="MsoNormal" style="background: white; line-height: 14.25pt; margin-bottom: 6.0pt; margin-left: 0in; margin-right: 0in; margin-top: 4.8pt;">
<span style="font-family: 'Helvetica Neue', Arial, Helvetica, sans-serif;"><span style="background-attachment: initial; background-clip: initial; background-color: white; background-image: initial; background-origin: initial;"><br /></span></span></div>
<div class="MsoNormal">
<span style="font-family: 'Helvetica Neue', Arial, Helvetica, sans-serif;"><b>1996
</b>-<span class="apple-converted-space"> </span>First live broadcast of laparoscopic
surgery via the Internet.<o:p></o:p></span></div>
<div class="MsoNormal">
<span style="font-family: 'Helvetica Neue', Arial, Helvetica, sans-serif;"><br /></span></div>
<div style="background: white; line-height: 19.5pt; margin-bottom: .0001pt; margin: 0in;">
<span style="font-family: 'Helvetica Neue', Arial, Helvetica, sans-serif;"><strong>1997</strong><span class="apple-converted-space"> </span>- Reconnection of the fallopian tubes operation was performed successfully
in Cleveland.<o:p></o:p></span></div>
<div style="background: white; line-height: 19.5pt; margin-bottom: .0001pt; margin: 0in;">
<br /></div>
<div style="background: white; line-height: 19.5pt; margin-bottom: .0001pt; margin: 0in;">
<span style="font-family: 'Helvetica Neue', Arial, Helvetica, sans-serif;"><strong>1998</strong><span class="apple-converted-space"> </span>- Dr. Friedrich-Wilhelm Mohr using the Da Vinci surgical robot performed
the first robotically assisted heart bypass at the Leipzig Heart Centre in
Germany.<o:p></o:p></span></div>
<div style="background: white; line-height: 19.5pt; margin-bottom: .0001pt; margin: 0in;">
<br /></div>
<div style="background: white; line-height: 19.5pt; margin-bottom: .0001pt; margin: 0in;">
<span style="font-family: 'Helvetica Neue', Arial, Helvetica, sans-serif;"><strong>2001</strong><span class="apple-converted-space"> </span>- Prof. Marescaux used the “Zeus” robot to perform a
cholecystectomy on a pig in Strasbourg, France while in New York.<o:p></o:p></span></div>
<div style="background: white; line-height: 19.5pt; margin-bottom: .0001pt; margin: 0in;">
<span style="font-family: 'Helvetica Neue', Arial, Helvetica, sans-serif;">In
September 2001, Dr. Michel Gagner used the Zeus robotic system to perform a
cholecystectomy on a woman in Strasbourg, France while in New York.<o:p></o:p></span></div>
<div style="background: white; line-height: 19.5pt; margin-bottom: .0001pt; margin: 0in;">
<span style="font-family: 'Helvetica Neue', Arial, Helvetica, sans-serif;">The
first unmanned robotic surgery took place in May <b>2006 </b>in Italy.<o:p></o:p></span></div>
<div class="MsoNormal">
<br /></div>
<table align="center" cellpadding="0" cellspacing="0" class="tr-caption-container" style="margin-left: auto; margin-right: auto; text-align: center;"><tbody>
<tr><td style="text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgPfMl3ell28o1oVW61DPd_ib7e7y919OrOv6sj_S69p9vyI7j5_bVmOlogKTQGSbQSE1ocgPhjupNr72k_c1OqtTK_QqR1xeyRK1SjKuzi45tlf8ynUY09PbGKpW7Gu2gvmIXhCW7cLr4/s1600/davincisi(1).jpg" imageanchor="1" style="margin-left: auto; margin-right: auto;"><img border="0" height="293" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgPfMl3ell28o1oVW61DPd_ib7e7y919OrOv6sj_S69p9vyI7j5_bVmOlogKTQGSbQSE1ocgPhjupNr72k_c1OqtTK_QqR1xeyRK1SjKuzi45tlf8ynUY09PbGKpW7Gu2gvmIXhCW7cLr4/s400/davincisi(1).jpg" width="400" /></a></td></tr>
<tr><td class="tr-caption" style="text-align: center;">Robot Technology in Laparoscopic Surgery.</td></tr>
</tbody></table>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
<v:shape alt="http://world.laparoscopyhospital.com/userfiles/davincisi(1).jpg" id="Picture_x0020_6" o:spid="_x0000_i1025" style="height: 203.25pt; mso-wrap-style: square; visibility: visible; width: 276.75pt;" type="#_x0000_t75">
<v:imagedata o:title="davincisi(1)" src="file:///C:\DOCUME~1\pc\LOCALS~1\Temp\msohtmlclip1\01\clip_image002.jpg">
</v:imagedata></v:shape></div>chiranthiBhttp://www.blogger.com/profile/00946760717407092753noreply@blogger.comtag:blogger.com,1999:blog-5598065032585087917.post-54756392591125385152012-03-04T07:22:00.000-08:002012-03-04T07:22:58.840-08:00Introduction<br />
<div class="MsoNormal" style="margin-left: 2.0in; mso-line-height-alt: 1.5pt; text-indent: .5in;">
<span style="font-family: 'Helvetica Neue', Arial, Helvetica, sans-serif;"><b><br /></b></span></div>
<div class="MsoNormal" style="mso-line-height-alt: 1.5pt; text-indent: .5in;">
<span style="font-family: 'Helvetica Neue', Arial, Helvetica, sans-serif;">Laparoscopic surgery which has a history of over 100
years is widely used today for pelvic and abdominal surgery. In this minimally
invasive procedure the cavity is visualized via a camera inserted in to the body
cavity.<o:p></o:p></span></div>
<div class="MsoNormal" style="mso-line-height-alt: 1.5pt; text-indent: .5in;">
<span style="font-family: 'Helvetica Neue', Arial, Helvetica, sans-serif;"><br /></span></div>
<div class="MsoNormal" style="mso-line-height-alt: 1.5pt; text-indent: .5in;">
<span style="font-family: 'Helvetica Neue', Arial, Helvetica, sans-serif;"> The first
laparoscopic surgery has taken place early in the last century and it was done
on a dog. It was about decade later the first performance on a human was
carried out. First laparoscopic surgery was done without inflating any air into
the abdominal cavity. Later filtered atmospheric air was used for this and in
1920 s co2 was first used. At the beginning the abdominal cavity was visualized
directly with lenses. Then various lens systems were introduced. However video
laparoscopy came into practice in 1980s. <span style="background-attachment: initial; background-clip: initial; background-color: white; background-image: initial; background-origin: initial;">With the widespread application of
the compact cameras, both laparoscopist and assistants could simultaneously
view the operative field on a video screen. By the end of the decade,
video-laparoscopy had become standard and operative laparoscopy became widely
accepted as a safe and effective surgical approach. A major step forward in the
development of laparoscopy was the development of a safer laparoscopic lighting
system in the 1950s. Up until that time, intra-abdominal light was produced by
a small electric light bulb at the distal tip of the laparoscope. </span>The development of this technology shows the great
thinking pattern of human being.<o:p></o:p></span></div>
<div style="background: white; margin-bottom: 9.0pt; margin-left: 0in; margin-right: 0in; margin-top: 0in; mso-line-height-alt: 1.5pt; text-indent: .5in;">
<span style="font-family: 'Helvetica Neue', Arial, Helvetica, sans-serif;"><br /></span></div>
<div style="background: white; margin-bottom: 9.0pt; margin-left: 0in; margin-right: 0in; margin-top: 0in; mso-line-height-alt: 1.5pt; text-indent: .5in;">
<span style="font-family: 'Helvetica Neue', Arial, Helvetica, sans-serif;">These were widely used in Gynaecology decades
before it was used in general surgery. During the last 35 years, gynecologic laparoscopy has evolved from a
limited surgical procedure used only for diagnosis and tubal ligations to a major
surgical tool used to treat many gynecologic conditions. For many procedures,
such as removal of an ectopic pregnancy, treatment of endometriosis, or ovarian
cystectomy, laparoscopy has become the treatment of choice.<o:p></o:p></span></div>
<div class="MsoNormal" style="mso-line-height-alt: 1.5pt; text-indent: .5in;">
<span style="font-family: 'Helvetica Neue', Arial, Helvetica, sans-serif;"><br /></span></div>
<div class="MsoNormal" style="mso-line-height-alt: 1.5pt; text-indent: .5in;">
<span style="font-family: 'Helvetica Neue', Arial, Helvetica, sans-serif;">The use of laparoscopy in general surgery widely came
into practice in last 3 decades. <span style="background-attachment: initial; background-clip: initial; background-color: white; background-image: initial; background-origin: initial;">But since then it has become
versatile. Today it is used for diagnostic and therapeutic purposes in general
surgery.</span><o:p></o:p></span></div>
<div class="MsoNormal" style="mso-line-height-alt: 1.5pt; text-indent: .5in;">
<span style="font-family: 'Helvetica Neue', Arial, Helvetica, sans-serif;"><br /></span></div>
<div class="MsoNormal" style="mso-line-height-alt: 1.5pt; text-indent: .5in;">
<span style="font-family: 'Helvetica Neue', Arial, Helvetica, sans-serif;">The procedure itself draws interest as it needs
special skill and great practice than the open surgery. <span style="background-attachment: initial; background-clip: initial; background-color: white; background-image: initial; background-origin: initial;">The basic
principle of laparoscopy is simple. A working space within the abdominal cavity
is initially established. This is usually accomplished by insufflating the
peritoneal cavity with carbon dioxide to a pressure of 10 to 15 mm Hg. The
laparoscope is inserted into the abdomen with a trocar and hollow sheath
containing a side port for continuous carbon dioxide insufflation, as well as
valves and gaskets to allow the insertion and removal of the laparoscope
without allowing the carbon dioxide to escape. In an operation, accessory
trocars are inserted to introduce laparoscopic instruments <span class="figurecaption"><span style="border-bottom-color: windowtext; border-bottom-style: none; border-bottom-width: 1pt; border-image: initial; border-left-color: windowtext; border-left-style: none; border-left-width: 1pt; border-right-color: windowtext; border-right-style: none; border-right-width: 1pt; border-top-color: windowtext; border-top-style: none; border-top-width: 1pt; padding-bottom: 0in; padding-left: 0in; padding-right: 0in; padding-top: 0in;">to the Abdomen.</span></span></span><o:p></o:p></span></div>
<div style="background: white; text-indent: .5in;">
<span style="font-family: 'Helvetica Neue', Arial, Helvetica, sans-serif;"><span style="background-attachment: initial; background-clip: initial; background-color: white; background-image: initial; background-origin: initial;"><br /></span></span></div>
<div style="background: white; text-indent: .5in;">
<span style="font-family: 'Helvetica Neue', Arial, Helvetica, sans-serif;"><span style="background-attachment: initial; background-clip: initial; background-color: white; background-image: initial; background-origin: initial;">The laparoscopic instruments are of two categories. </span>They are equipments for access and exposure
and hand instruments for the actual operative procedure. These include the
screen, the light source, the insufflater, fibro optic cable, the camera,
veress needle, Trocars and other hand instruments needed for the actual procedure.
These are graspers, scissors, needle holders and retractors, but all the
instruments are long and narrow, and have small jaws that allow the
introduction and use of the instruments through trocars. A unique instrument in
Laparoscopic surgery is a "clip applicator".<o:p></o:p></span></div>
<div class="MsoNormal" style="background: white; line-height: 14.25pt; margin-bottom: 1.2pt; mso-margin-top-alt: auto; text-indent: .5in;">
<span style="font-family: 'Helvetica Neue', Arial, Helvetica, sans-serif;"><span style="background-attachment: initial; background-clip: initial; background-color: white; background-image: initial; background-origin: initial;"><br /></span></span></div>
<div class="MsoNormal" style="background: white; line-height: 14.25pt; margin-bottom: 1.2pt; mso-margin-top-alt: auto; text-indent: .5in;">
<span style="font-family: 'Helvetica Neue', Arial, Helvetica, sans-serif;"><span style="background-attachment: initial; background-clip: initial; background-color: white; background-image: initial; background-origin: initial;">There are a number of advantages to the patient with
laparoscopic surgery than an open procedure. They include</span> Reduced<span class="apple-converted-space"> </span><a href="http://en.wikipedia.org/wiki/Hemorrhaging" title="Hemorrhaging"><span style="color: windowtext; text-decoration: none;">hemorrhaging</span></a>, so the incidence of<u> </u><a href="http://en.wikipedia.org/wiki/Blood_transfusion" title="Blood transfusion"><span style="color: windowtext;">blood transfusion</span></a> is less, smaller incision, which reduces
pain and shortens recovery time and reduce post-operative scarring. There is less
pain so less analgesia is<span class="apple-converted-space"> </span>needed;
hospital stay is less, and often with a same day discharge. Reduced exposure of
internal organs to possible external contaminants thereby reduced risk of
acquiring infections.<o:p></o:p></span></div>
<div class="MsoNormal" style="background: white; line-height: 14.25pt; margin-bottom: 1.2pt; mso-margin-top-alt: auto;">
<br /></div>
<div class="MsoNormal" style="mso-line-height-alt: 1.5pt; text-indent: .5in;">
<span style="font-family: 'Helvetica Neue', Arial, Helvetica, sans-serif;">At the same time there are some risks associated with
laparoscopic surgery. They include trauma due to trocar to major blood vessels
and major organs and the problems due to co2 insufflation .<span style="background-attachment: initial; background-clip: initial; background-color: white; background-image: initial; background-origin: initial;">Also I
increased intra-abdominal pressures associated with laparoscopy increase
anesthesia-related risks such as aspiration and increased difficulty in
ventilation.</span><o:p></o:p></span></div>
<div class="MsoNormal">
<span style="font-family: 'Helvetica Neue', Arial, Helvetica, sans-serif;"> However this technology evolves
everyday and becomes more and more versatile. In recent years robot surgery and
single incision laparoscopy has been introduced of which the robotic surgery is having
the largest impact on clinical care<o:p></o:p></span></div>
<div class="MsoNormal">
<br /></div>
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<br /></div>
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<br /></div>
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<br /></div>
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<br /></div>
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<br /></div>
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<br /></div>
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<br /></div>chiranthiBhttp://www.blogger.com/profile/00946760717407092753noreply@blogger.comtag:blogger.com,1999:blog-5598065032585087917.post-27731378189654423592012-03-04T07:16:00.000-08:002012-03-21T21:16:28.386-07:00Laparoscopic Instruments<br />
<div class="MsoNormal">
<span style="font-size: 19px; line-height: 21px;"><b><br /></b></span></div>
<div class="MsoNormal">
<b><span style="font-size: 14pt; line-height: 115%;"><br /></span></b></div>
<div class="MsoNormal">
<span style="font-family: 'Helvetica Neue', Arial, Helvetica, sans-serif;"><b><span style="font-size: 14pt; line-height: 115%;"> </span></b><span style="text-indent: -0.25in;"><span style="font-size: 7pt;"> </span><span style="font-size: 7pt;"> </span></span></span></div>
<div style="background: white;">
<br />
<div class="MsoNormal">
<span style="text-indent: -0.25in;"><span style="font-size: 7pt;"><span style="font-family: 'Helvetica Neue', Arial, Helvetica, sans-serif;"> </span></span></span><b style="text-indent: -0.25in;"><span style="font-family: 'Helvetica Neue', Arial, Helvetica, sans-serif;">Laparoscopic Tower</span></b></div>
<div class="MsoListParagraphCxSpMiddle" style="margin-left: 1in;">
<span style="font-family: 'Helvetica Neue', Arial, Helvetica, sans-serif;">Consist of</span></div>
<div class="MsoListParagraphCxSpMiddle" style="margin-left: 1.5in; text-indent: -0.25in;">
<span style="font-family: 'Helvetica Neue', Arial, Helvetica, sans-serif;">Ø<span style="font-size: 7pt;"> </span><span class="apple-converted-space">High Resolution Monitor-These are flat screen monitors. </span></span></div>
<div class="MsoListParagraphCxSpMiddle" style="margin-left: 1.5in; text-indent: -0.25in;">
<span style="font-family: 'Helvetica Neue', Arial, Helvetica, sans-serif;"><br /></span></div>
<div class="MsoListParagraphCxSpMiddle" style="margin-left: 1.5in; text-indent: -0.25in;">
<span style="font-family: 'Helvetica Neue', Arial, Helvetica, sans-serif;"><span class="apple-converted-space">Ø<span style="font-size: 7pt;"> </span></span><span class="apple-converted-space">Light source- A 300-watt xenon light source is usually used. The light is </span></span><span style="font-family: 'Helvetica Neue', Arial, Helvetica, sans-serif;">transmitted via flexible, fiber optic bundles connecting the light source to the telescope.</span></div>
<div class="MsoListParagraphCxSpMiddle" style="margin-left: 1.5in; text-indent: -0.25in;">
<span style="font-family: 'Helvetica Neue', Arial, Helvetica, sans-serif;"><br /></span></div>
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<span style="font-family: 'Helvetica Neue', Arial, Helvetica, sans-serif;"><span class="apple-converted-space">Ø<span style="font-size: 7pt;"> </span></span><span class="apple-converted-space">Viewing Optical System<o:p></o:p></span></span></div>
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<span style="font-family: 'Helvetica Neue', Arial, Helvetica, sans-serif;">Ø<span style="font-size: 7pt;"> </span><a href="http://www.laparoscopy.am/index.php?mod=pages&act=show&menu_id=192&lang=en#7"><span style="background-attachment: initial; background-clip: initial; background-color: white; background-image: initial; background-origin: initial; color: windowtext;">Electronic CO2 insufflators</span></a>-Insuflator (laparoflator) is a device used for introduction of the gas under specified volume and pressure into peritoneal cavity. The CO2 pump should be a high flow insufflation pump with both low flow and high flow settings. Generally, they are capable of delivering high gas flow of 24 L/min, which is limited by the trocar or needle to which it is attached. The insufflation tubing contains a filter that prevents bacterial and viral contamination from possible backflow of surgical smoke, protecting both equipment and health care worker.</span></div>
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<span style="font-family: 'Helvetica Neue', Arial, Helvetica, sans-serif;"><b>Fibro optic cable<o:p></o:p></b></span></div>
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<span style="font-family: 'Helvetica Neue', Arial, Helvetica, sans-serif;">This is used to connect light source with optical system. It is necessary to separately check the principles of a precise and accurate treatment with light conductors to avoid damaging thin and sensitive optical glass fibers.<o:p></o:p></span></div>
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<span style="font-family: 'Helvetica Neue', Arial, Helvetica, sans-serif;">·<span style="font-size: 7pt;"> </span><b>Endovideo Camera<o:p></o:p></b></span></div>
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<tr><td class="tr-caption" style="font-size: 13px; text-align: center;"><span style="font-family: 'Helvetica Neue', Arial, Helvetica, sans-serif;">Camera</span></td></tr>
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<tr><td class="tr-caption" style="font-size: 13px; text-align: center;"><span style="font-family: 'Helvetica Neue', Arial, Helvetica, sans-serif;">Laparoscope</span></td></tr>
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<b style="background-color: white; font-family: 'Helvetica Neue', Arial, Helvetica, sans-serif;">Veress needle</b></div>
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<span style="font-family: 'Helvetica Neue', Arial, Helvetica, sans-serif;"> A Veress needle is used to inflate air into the peritoneal cavity. This needle contains a spring-loaded inner sheath. </span></div>
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<span style="font-family: 'Helvetica Neue', Arial, Helvetica, sans-serif;">This sheath retracts as the needle is advanced through tissue exposing the needle tip. Once the needle enters the peritoneal cavity, and the majority of theresistance on the needle is released, the inner sheath springs forward. The inner sheath covers the needle tip and protects the intra-abdominal organs from being injured by the sharp end of the needle.</span></div>
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<b><span style="font-family: 'Helvetica Neue', Arial, Helvetica, sans-serif;">Trocars<o:p></o:p></span></b></div>
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<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhZWKYbw9_mcsO3FQKbbXyTZTZ1Z5J4vbXIWnBT7gK7TwBi29HCq_8spQOQkEkIA2xeuR5f_TJaKh9PBJDzi2PeMu7L8DoDlb3QSUpOtbKyr_5mfcQntWX-H6CMeaOd0bDj7YYtRd-tvnQ/s1600/IMG_8447.jpg" imageanchor="1" style="clear: left; float: left; margin-bottom: 1em; margin-right: 1em;"><img border="0" height="300" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhZWKYbw9_mcsO3FQKbbXyTZTZ1Z5J4vbXIWnBT7gK7TwBi29HCq_8spQOQkEkIA2xeuR5f_TJaKh9PBJDzi2PeMu7L8DoDlb3QSUpOtbKyr_5mfcQntWX-H6CMeaOd0bDj7YYtRd-tvnQ/s400/IMG_8447.jpg" width="400" /></a></div>
<span style="font-family: 'Helvetica Neue', Arial, Helvetica, sans-serif;">The word trocar is originally French meaning three sided. A trocar is a hollow cylinder with an access mechanism on one side which can be a blade (often three-sided), a plastic lip that is used for dilation, or a radial dilating mechanism. On the external side of the trocar is a valve mechanism which allows instruments to be passed in and out of the patient’s insufflated body cavity while maintaining the insufflated space. Trocars, also known as ports, usually have a valve to which insufflation tubing can be attached to maintain the insufflation pressure. Most trocars have an outer sheath (also called a cannula or trocar) and an inner obturator, which allows the access.</span></div>
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<span style="font-family: 'Helvetica Neue', Arial, Helvetica, sans-serif;"><b>Hand Instruments in Laparoscopic Surgery</b></span></div>
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<span style="font-size: 11pt;"><span style="font-family: 'Helvetica Neue', Arial, Helvetica, sans-serif;">Hand instruments in laparoscopic surgery serve the same basic functions as open surgical instruments - There are graspers, scissors, needle holders and retractors, but all the instruments are long and narrow, and have small jaws that allow the introduction and use of the instruments through trocars. A unique instrument in Laparoscopic surgery is a "clip applicator"</span></span><br />
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</v:imagedata></v:shape></div>chiranthiBhttp://www.blogger.com/profile/00946760717407092753noreply@blogger.comtag:blogger.com,1999:blog-5598065032585087917.post-88161377861661996132012-03-04T07:03:00.000-08:002012-03-04T07:18:13.516-08:00Laparoscopy in Gynaecology.<span style="font-family: 'Helvetica Neue', Arial, Helvetica, sans-serif;"><span style="font-size: 19px; line-height: 21px;"><br /></span></span><br />
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<span style="font-family: 'Helvetica Neue', Arial, Helvetica, sans-serif;"><span style="line-height: 21px;"><b><span style="font-size: 19px;">L</span>aparoscopy and dye test.</b></span></span><br />
<span style="font-family: 'Helvetica Neue', Arial, Helvetica, sans-serif;"><span style="line-height: 21px;">This is performed as a diagnostic or a therapeutic procedure in a patient with subfertility. </span></span><br />
<span style="font-family: 'Helvetica Neue', Arial, Helvetica, sans-serif;"><span style="line-height: 21px;">In a diagnostic surgery after gaining access to the abdominopelvic cavity via three ports, a colored dye (methylene blue) is injected through the cervix. If the tubes are not blocked the dye should pass along them and spill into the abdomen. In addition to that Laparoscopy allows the internal organs of the abdomen and pelvis to be inspected visually and excludes other problems such as endometriosis, fibroids, ovarian cysts and adhesions.</span></span><br />
<span style="font-family: 'Helvetica Neue', Arial, Helvetica, sans-serif;"><span style="line-height: 21px;">The procedure becomes therapeutic if adhesiolysis, removal of fibroid or endometrioma were done at the same time.</span></span><br />
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<span style="font-family: 'Helvetica Neue', Arial, Helvetica, sans-serif;"><span style="line-height: 21px;"><b>Other Laparoscopic surgeries in Gynaecology</b></span></span><br />
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<span style="font-family: 'Helvetica Neue', Arial, Helvetica, sans-serif;"><span style="line-height: 21px;"><b>Diagnostic Laparoscopy</b></span></span><br />
<span style="font-family: 'Helvetica Neue', Arial, Helvetica, sans-serif;"><span style="line-height: 21px;"> Frequently, the surgeon needs to assess the pelvis for acute or chronic pain, ectopic pregnancy, endometriosis, adnexal torsion, or other pelvic pathology. Usually, a primary port for the laparoscope is placed infraumbilically and second ports are placed in the lower abdomen to observe pelvic organs. If needed, a biopsy specimen can be obtained to aid in the diagnosis of endometriosis or malignancy.</span></span><br />
<span style="font-family: 'Helvetica Neue', Arial, Helvetica, sans-serif;"><span style="line-height: 21px;">Diagnostic laparoscopy is usually performed under general anesthesia, with endotracheal intubation to minimize the risk of aspiration.</span></span><br />
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<span style="font-family: 'Helvetica Neue', Arial, Helvetica, sans-serif;"><span style="line-height: 21px;"><b>Tubal sterilization.</b></span></span><br />
<span style="font-family: 'Helvetica Neue', Arial, Helvetica, sans-serif;"><span style="line-height: 21px;"> Trocar placement is similar to diagnostic laparoscopy. The tubes are occluded at the mid-isthmic portion, approximately 2 cm are occluded. </span></span><br />
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<span style="font-family: 'Helvetica Neue', Arial, Helvetica, sans-serif;"><span style="line-height: 21px;"><b>Ovarian Cystectomy</b></span></span><br />
<span style="font-family: 'Helvetica Neue', Arial, Helvetica, sans-serif;"><span style="line-height: 21px;"><span class="Apple-tab-span" style="white-space: pre;"> </span>After gaining access to the abdomen ovarian cyst is identified. Then biopsies can be taken, the cyst can be removed or oophoretomy can be done.</span></span><br />
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<span style="font-family: 'Helvetica Neue', Arial, Helvetica, sans-serif;"><span style="line-height: 21px;"><b>Myomectomy</b></span></span><br />
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<span style="font-family: 'Helvetica Neue', Arial, Helvetica, sans-serif;"><span style="line-height: 21px;"><b>Adhesiolysis</b></span></span><br />
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<span style="font-family: 'Helvetica Neue', Arial, Helvetica, sans-serif;"><span style="line-height: 21px;"><b>Treatment of Ectopic Pregnancy</b></span></span><br />
<span style="font-family: 'Helvetica Neue', Arial, Helvetica, sans-serif;"><span style="line-height: 21px;"><span class="Apple-tab-span" style="white-space: pre;"> </span>Laparoscopic salpingostomy or salpingectomy may be performed to remove the embryo and gestational sac.</span></span><br />
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<span style="font-family: 'Helvetica Neue', Arial, Helvetica, sans-serif;"><span style="line-height: 21px;"><b>Laparoscopic Hysterectomy</b></span></span><br />
<span style="font-family: 'Helvetica Neue', Arial, Helvetica, sans-serif;"><span style="line-height: 21px;"> In the total laparoscopic hysterectomy, the laparoscope is used to remove the uterus and oophorectomy may and may not be done at the same time. Access is gained via umbilicus and two lower abdominal incisions. During this uterus is separated from its ligaments and blood vessels, and then detached it with an incision at the top of the vagina. </span></span><br />
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<span style="font-family: 'Helvetica Neue', Arial, Helvetica, sans-serif;"><span style="line-height: 21px;"><b>Laparoscopic Supracervical Hysterectomy</b></span></span><br />
<span style="font-family: 'Helvetica Neue', Arial, Helvetica, sans-serif;"><span style="line-height: 21px;"><span class="Apple-tab-span" style="white-space: pre;"> </span>This is similar to total abdominal hysterectomy. First the supra cervical part is detached from the ligaments and blood vessels then it is detached from the cervix and uterus is removed from the lower abdominal incision.</span></span><br />
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<span style="font-family: 'Helvetica Neue', Arial, Helvetica, sans-serif;"><span style="line-height: 21px;"><b>Laparoscopic Burch Procedure</b></span></span><br />
<span style="font-family: 'Helvetica Neue', Arial, Helvetica, sans-serif;"><span style="line-height: 21px;"><span class="Apple-tab-span" style="white-space: pre;"> </span>This is used for women with stress incontinence. After gaining access via Umbilicus and two lower abdominal incisions the neck of the bladder is attached to the Cooper’s ligament via a permenant stitch.<span class="Apple-tab-span" style="white-space: pre;"> </span></span></span><br />
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<span style="font-family: 'Helvetica Neue', Arial, Helvetica, sans-serif;"><span style="line-height: 21px;"><b>Laparoscopic vault suspension</b></span></span><br />
<span style="font-family: 'Helvetica Neue', Arial, Helvetica, sans-serif;"><span style="line-height: 21px;"><span class="Apple-tab-span" style="white-space: pre;"> </span>In this abdominal access is similar to above procedures.The vault of the prolapsing vagina is attached to the uterosacral ligament.</span></span><br />
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