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BASICS PRINCIPLES OF LAPROSCOPY
This document discusses the basic principles of laparoscopy. It describes the key differences between laparoscopic and open surgery for both patients and surgeons. For patients, laparoscopic surgery results in less pain, faster recovery times, and quicker return to normal activities due to smaller incisions. For surgeons, laparoscopy provides a magnified view but with altered tactile response and two-dimensional images. The document outlines the typical laparoscopic setup including the endoscope, light source, camera, monitor, insufflator, trocars and various instruments. It also lists some common laparoscopic procedures that can be used for diagnostic and operative purposes.
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BASICS PRINCIPLES OF LAPROSCOPY
- 1. BASIC PRINCIPLES OF LAPROSCOPY DrDhara Pandya G.M.C, NAGPUR
- 3. Principle Differences between Laparoscopicand Open Surgery FOR THE PATIENT Post operative pain related to size of incision- smaller incisions =less pain. Less Handling of intestines results in little or no disturbance of normal function. Avoidance of the trauma of abdominal wall injury by the incision allows rapid return to normal activity No incision allows early return to more strenuous activities: driving, lifting, sport etc.
- 4. Principle Differences between laparoscopicand open surgery For the Surgeon Magnified view often better than obtained via an incision allows precise dissection. Altered (but not absent) tactile response Two dimensional (flat screen) view. Usually (but not always) longer operating time Need to develop entirely different operating technique Adaptation of principles of open surgery to laparoscopic surgery.
- 5. Laparoscopic Trolly Lahore LaparoscopicSurgery Training Center 5 • The Optical Chain – Endoscope – Light Cable – Light Source – Camera System – Monitor • Gas Insufflation Apparatus – Insufflator – Carbon Dioxide Cylinder
- 6. CAMERA & LIGHTSOURCE
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- 12. Visual Axis andMotor Axis
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- 14. Surgeon’s Stance Ideal relaxedstature Tiring
- 15. Ideal Relaxed Position -straighthead, in the axis of the trunk, without rotation or extension of the cervical spine; - shoulders in a relaxed and neutral position; - arms alongside the body - elbows bent to 70 to 90 degrees - forearms in an horizontal or slightly descending axis- -hands pronated (physiological resting position); - hands and fingers lightly grip the handles/handpiece •Waist line table •Gaze down view of monitor •Straight line principle •Triangulation
- 16. Working against the cameraand ‘blind spots’ “Dueling swords” phenomenon (scissoring effect) Avoid competing for the same space:
- 17. What operations canwe do Laparoscopically DIAGNOSIS Gallstone Appendicitis Hernia Adhesions Perforated ulcer Hiatus Hernia OPERATION Cholecystectomy Appendicectomy Hernia repair Division of adhesions Closure of perforation Hiatus hernia repair.
- 18. What operations canwe do Laparoscopically DIAGNOSIS Colorectal carcinoma Caecal carcinoma Colonic carcinoma Gastric carcinoma Oesophageal carcinoma OPERATION Anterior resection/ APR Right Hemicolectomy Left/Sigmoid Colectomy Gastrectomy Oesophagogastrectomy
- 19. What operations canwe do laparoscopically? Diagnosis Crohn’s Disease Diverticulitis Rectal Prolapse Benign renal disease Gastric Obstruction Some Splenic disorders The list is endless!!! Operation Bowel resection Bowel resection Repair of Prolapse Nephrectomy Bypass Spleenectomy
- 20. PORT PLACEMENTS LAP APPENDICETOMYLAP CHOLECYSTECTOMY
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- 22. Laparoscopic Instruments • Operativeinstruments • Energy sources
- 23. • Hand griptypes
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- 25. Operative instruments • Dissectors •Scissors • Retractors • Forceps
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- 27. 1) MARYLAND 2)CURVED DISSECTORWITH LONG BLADES 3) BLUNT DISSECTOR
- 28. • Bullet nosegrasper • Dorsey intestinal grasper GRASPERS
- 29. • Hunter bowelgrasper • Crocodile graspers
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- 31. 1) CURVED METZENBAUM 2)STRAIGHT 3) NON INSULATED SCISSORS
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- 33. 1) ALLIS 2) BABCOCK(reusable) 3) BABCOCK(disposable)
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- 35. 1) SPATULA 2) BOWELHOLDING SPATULA( SHORT) 3) BOWEL HOLDING SPATULA (LONG) 4) CLAW FORCEPS
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- 37. 1)STONE HOLDING FORCEPS 2)BIOPSYFORCEPS 3)CHOLANGIOGRAM FORCEPS
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- 39. 1)10mm DISPOSABLE 2)5mm STAINLESSSTEEL Hook
- 40. SUCTION NOZZLE HYDATID TROCAR NEEDLEHOLDER a)Ethicon type 5 mm b)Ethicon type 3mm c) conventional needle holder , coaxial ring handle
- 41. 1) VERESS NEEDLE 2)CLIPAPPLICATOR a)10 mm reusable b)5mm reusable 3) LOOP APPLICATOR
- 42. Energy sources • Electrosurgery • Ligasure • Argon beam coagulation • Ultrasonic dissection • Cavitational ultrasonic surgical aspirator (CUSA)
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- 45. COMPLICATIONS OF LAPAROSCOPIC SURGERIES 1.Anaesthetics Complications 2. Complications due to pneumoperitonium 3. Surgical complications 4. Diathermy related injuries 5. Patients factors related complications 6. Post operative complications
- 46. CONTRAINDICATIONS Absolute : • Generalizedperitonitis • Intestinal obstruction • Clotting abnormalities • Liver cirrhosis • Failure to tolerate general anesthesia • Uncontrolled shock Relative : • Multiple abdominal adhesions • Organomegaly • Abdominal aortic aneurysm
- 47. Emerging Technologies • Robotics •SILS • NOTES • Trocarless laparoscopy • ENDOBARRIER
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- 49. SILS (Single Incision Laproscopysurgery)
- 50. N.O.T.E.S. Natural Orifice TransluminalEndoscopic Surgery
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