prospects & constraints in vety Laparoscopy in surgery

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prospects & constraints in vety Laparoscopy in surgery

  1. 1. Welcome To Major Credit Seminar Shahnawaz ahmad bhat M.V.Sc student Div. of surgery & radiology
  2. 2. Prospects and Constraints of Veterinary Laparoscopic Surgery
  3. 3. overview • Introduction. • Instrumentation. • Uses of laparoscopy. • Why to use laparoscopy? • Current status. • Prospects. • Constraints. • Conclusion.
  4. 4. laparoscopy An endoscopic procedure designed for the visual examination, surgical procedures and biopsy of the peritoneal cavity & its organs using specialized instrument called laparoscope. Also called Minimally invasive surgery, Key hole surgery 0r Band-Aid surgery.
  5. 5. • Done under general anesthesia or sedation & local infiltration. • Anesthetic induction need same procedures as in conventional surgery viz. fasting(24-48hrs), water holding(8-12hrs) , preanesthesia & fluid administration. • Ketamine-diazepam or xylazine are recommended for G.A. • Isoflurane for avian laparoscopy.
  6. 6. • 1-1.5cm incisions used. • Veress needle used for pneumoperitoneum. • Needle placement checked by; Hiss test Aspiration test Flow test External evaluation.
  7. 7. • Pressure maintained automatically by insufflators. • Should be less than 15mm Hg. Goats/sheep – 8-10mm Hg Dogs – 10-12mm Hg Horses – 12-15mm Hg. Gas flow rate 2 L/minute.
  8. 8. • Gas selection – transparent, colorless, non-explosive, inert, readily available, less absorbed & readily eliminated by lungs. • Gases - carbon dioxide, nitrous oxide, filtered room air, helium , nitrogen , xenon & argon.
  9. 9. Instrumentation • Laparoscope(small animals 2.7-5mm & large animals 10mm). • Light source(xenon & halogen). • Fibreoptic cable. • Digital video camera. • Video capturing systems with floppy & CD. • Medical grade colour monitor.
  10. 10. • Veress needle for creating pneumoperitoneum • Automatic Carbon dioxide insufflators. • Gas inflation tubing. • Trocar & canulas( 10-12mm & 5-8mm). • Laparoscopic scissors & grasping forceps. • Electrocoagulators. • Irrigation & aspiration systems. • Endoclip forceps, endoclips & staples.
  11. 11. Image documentation system
  12. 12. Medical grade monitor
  13. 13. Insufflator, veress needle & insufflation tube
  14. 14. Laparoscopic forceps
  15. 15. Laparoscopic forceps
  16. 16. Biopsy forceps
  17. 17. Disposable laproscopic forceps
  18. 18. Laparoscopic scissors
  19. 19. Uses of laparoscopy Diagnosis of diseases; by biopsy i.e. histopathology. by direct visualization of body cavities and organs. Surgical treatment of diseases.
  20. 20. Why to use laparoscopy? • Less post-operative morbidity/pain. • Shorter hospital stay & recovery period. • GIT functions rapidly returned to normal. • Few intra-abdominal adhesions • Less contamination of surgical field • Less invasive • Stress indicators increase less & return to base value rapidly indicating less stress to animal.
  21. 21. Current status surgical procedures; • Exploratory laparoscopy. • Ovariohysterectomy. • Ovariectomy. • Vasectomy. • Cholecystectomy. • Inguinal, femoral, umbilical hernia repair.
  22. 22. • Gastrostomy, Gastropexy & partial gastrectomy. • Complex procedures like pyloromyotomy & fundoplication. • Feeding tube jejunostomy, enterotomy. • Small intestinal anastomosis. • Colopexy, rectopexy & cystopexy. • Laparoscopic splenectomy. • Laparoscopic adrenalectomy.
  23. 23. • Intestinal intussusception diagnosis & treatment in a dogs. S.K.maiti et al 2004 • Intra-abdominal vasectomy in dogs. • Lap. Assisted tube cystectomy in goats. N. Kumar et al 2006
  24. 24. Diagnostics; • Infertility; uterine deformities, tubal defect, endometritis, ovarian cysts • Chronic abdominal pain due to adhesions, endometriosis • Ectopic pregnancy- diagnosis & treatment • Urinary tract diseases. • Neoplasia of liver, spleen • Abdominal cryptorchidism • Normal & abnormal anatomy of organs.
  25. 25. • Diagnosis of intra-abdominal pathologies in canines. • Laparoscopic liver biopsies through cauterization in small animals. S.K.Maiti et al 2004
  26. 26. Future prospects in laparoscopic surgery
  27. 27. Sterilization of small animals Common clinical practice in western countries. Both single port & 2 port techniques used. Post surgical activity measured by accelerometer; 25% decrease in LapOVE. 62% decrease in OOVE. William T.N.Culp et al 2009
  28. 28. Equine surgery in standing condition
  29. 29. • Cryptorchid castration. • Inguinal hernia repair. • Standing flank ovariectomy. • Standing flank tubal ligation. • Standing flank oviductal insemination. • Laparoscopically guided per-rectal examination for teaching students.
  30. 30. Laparoscopic mesh incisional hernioplasty in horses 8-16% horses affected after median celiotomy. Open hernioplasty-seroma,wound or mesh infection, fistula & recurrence. Laparoscopic mesh incisional hernioplasty Less soft tissue trauma Lower recurence rates Good cosmetic result J.P.Caron 2009
  31. 31. Laparoscopic embryo transfer For genetically superior animals Mares in athletic performance or unable to maintain pregnancy. Done with a specially designed embryo transfer catheter. Non-surgical method-50-60% success rate Laparoscopic method-80-90% success rate. Squires EL et al 1999
  32. 32. Laparoscope with a specialized embryo transfer catheter.
  33. 33. Laparoscopic ovum pick-up(LOPU)  For obtaining invitro fertilized zygotes in the production of transgenic goats or reproductive rescue of aged goats of high genetic value.  As a source of cytoplasm in nuclear transfer (NT) procedures. Baldassarre H 2007
  34. 34. Prepubertal propagation of superior animals & transgenic cloned goats. The pregnancy and transgenesis rates similar to the rates obtained when using in vivo-produced zygotes Baldassarre H et al 2003
  35. 35. Gasless Laparoscopy in bovines Diagnosis of traumatic reticuloperitonitis. Diaphragmatic hernia. Abomasopexy. PIERRE-YVESMULON 2006
  36. 36. Laparoscopic artificial insemination 70-80 % success rate
  37. 37. Laparoscopic ultrasound(LUS)
  38. 38. • Primary advantage of LUS - ability to image beyond tissue boundaries. • Additionally, the ability to place the transducer directly against an organ allows the use of higher frequency devices which provide better resolution. • Used for staging of neoplasm
  39. 39. LUS of normal liver LUS of gall bladder
  40. 40. Laparoscopy in radiology • Contrast radiographic studies of biliary tract (cholecystocholangiography) & urinary tract have become common technique. • Contrast agent (Iohexol , Meglumine iodipamide) directly injected into gall bladder or urinary bladder under laparoscopic guidance.
  41. 41. Laparoscopic fetal surgery(fetoscopy) • Corrective procedures on fetus at a much earlier age when the wounds heal without scars. • Fetuses treated for congenital conditions like cleft lips, obstructive uropathy, severe congenital diaphragmatic hernia etc. • Successful operations performed in bitches, sows & ewes. Roman M Sydorak 2001
  42. 42. MR-compatible laparoscope • In traditional procedures the surgeon exposes the whole operative site in order to interpret its broader anatomical context. • video-guided MIS - lack of a wide field of view(FoV). • Many Surgeons doubt that patient safety can be warranted using only a key hole perspective.
  43. 43. MR-compatible laparoscopy
  44. 44. • Provides a wide FoV image of moderate resolution. • In addition, the method provides high soft tissue contrast. P.Gross et al 2001
  45. 45. Laparoscopic Surgical Robot (laprobot) Lanfranco AR-2004
  46. 46. • Robotic surgery has been touted as a solution to underdeveloped nations, whereby a single central hospital can operate several remote machines at distant locations. • The potential for robotic surgery has strong military interest, providing mobile medical care while keeping trained doctors safe from battle.
  47. 47. Augmented reality technology
  48. 48. • Allows a physician to see directly inside a patient, using augmented reality (AR). • AR combines computer graphics with images of the real world. This uses laparoscopic range imaging, a video see-through head- mounted display (HMD), and a high- performance graphics computer to create live images that combine computer-generated imagery with the live video image of a patient.
  49. 49. CAPSULE ENDOSCOPY
  50. 50. Constraints In Laparoscopic surgery
  51. 51. Technical constraints • Anesthesia –hypercapnia & acidosis. • Veres needle & Trocar injury. • Insufflation- subcut., periperitoneal, & subfacial emphysema. Pnuemothorax, pnuemomediastinum & pnuemopericardium.
  52. 52. • Gas embolism. • Incisional hernias. • Tumor implantation at trocar sites. • Lack of tactile feedback. • Loss of depth perception due to 2 dimensional view on monitor. • Restricted range of motion & FoV. • Electrosurgical burns. • Time consuming.
  53. 53. Non-technical constraints. • Cost of equipment. • Long procedural learning curve. • High skill level needed. • Lack of skilled assistance. • Cumbersome maintenance of equipments. • Lack of will from surgeons to use the technique.
  54. 54. Conclusion
  55. 55. With the development of skills, research and advancement in technology time is not far when laparoscopic surgery will replace many of the traditional surgical procedures in veterinary sciences as well like human field
  56. 56. "Someday in the future, people will look back at a regular surgical incision as something archaic and barbaric’’ Dr. Paul A. Wetter, Chairman of the Society of Laparoendoscopic Surgeons USA

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