Laparoscopic surgical innovation in bangladesh

1. ESSENTIALS OF LAPAROSCOPY
BASIS OF MODERN
SURGERY
• Dr. Md. Zakirul Alam(FCPS,FMAS), surgery
Associate professor of surgery,(Unit -3),TMC &RCH
• Presented by Dr. Md Rafiuzzaman Rakib(Intern)
Dr .Md Ashif Nawas(Intern)

2. SYNONYMS
• Minimal Access surgery (MAS).
• Minimally Invasive surgery (MIS).
• Key Hole surgery.

3. INTRODUCTION
• Minimal Access Surgery:--
• Surgical innovation
• Modern technology
• To reduce wound access trauma.
• Ensure minimal somatic and
psychological trauma.

4. HISTORY OF MIS/MAS
• Hippocrates 1st described rectal examination by
speculum( idea about endoscopy).
• 1585--- Aranzi used light source (sunlight).
• 1806--- Philip Bozzini built an endoscope using
wax candle as light source called “LICHTLEITER”
endoscope.
• 1853---Antoine Jean Desormeaux (French
Surgeon)also called Father of endoscope.

5. HISTORY CONT…
• 1901---George kelling( Berlin, Germany) experimental laparoscopy using
cystoscope.
• After 70 years various steps of laparoscopy by Heins kalk, Jhon .C. Ruddock,
Hopkins, Kurt semm
• 1901---George kelling( Berlin, Germany) experimental laparoscopy using
cystoscope upon A dog
• After 70 years various steps of laparoscopy by Heins kalk, Jhon .C. Ruddock,
Hopkins, Kurt semm

6. HISTORY CONT..
• 1978---Hasson 1st introduced use of blunt trocar into peritoneal cavity.
• 1980---Patrick Steptoe started Laparoscopic procedure 1st time in
UK.
• 1983--- prof kurt Semm, Germany gynecologist performed 1st Lap.
Appendicectomy.
• 1985--- Enrich Muhe (Germany) performed 1st time lap.
Cholecystectomy.
• 1987--- Phillipe Mouret(France) did video lap.chole..1st.
• 1989--- Harry Reich performed lap. hysterectomy 1st.
• 2000--- Robotic surgery approved in USA by the use of Da Vinci
surgical system.
• 2004--- Robotic surgery MAS/MIS gained name popularity world
wide.

7. HISTORY OF LAPAROSCOPY IN
BANGLADESH
In 1991 Dr. Sardar Naim General surgeon pioneer in
laparoscopy In1978 Dr. T A Chowdhury famous
gynecologist doing diagnostic laparoscopy in
Bangladesh started their journey at Japan Bangladesh
Friendship[ Hospital and later at BIRDEM Hospital,
Dhaka].
Now this method of surgery in
Bangladesh gained much popularity among
surgeons, physicians. Peoples after a lot of
obstacles even by the professionals. Practice
of laparoscopic method of surgery in our
country spreads rapidly at district, Thana level
outside the capitals.

8. PRINCIPLES OF MAS
There is a pneumonic (I-VITROS)
I = Insufflation
V= Visualization.
I = Identification.
T = Triangulate.
R = Retraction.
O = Operation.
S = Seal/ Suture/ Hemostasis.

9. LAPAROSCOPY
Telescopic visualization of organs, cavity, lumen and
systems into the abdomen
OR
Endoscopic(rigid) examination of peritoneal cavity by
telescope.

10. USES OF LAPAROSCOPY
• Diagnostic Uses:
• All Abdominal malignancies for biopsy and staging.
• pelvic inflammatory disease ,Sterility biopsy, Endometriosis,
biopsy etc.
• therapeutic Uses:
• Nearly all surgeries are attempted e.g GSD(Gold standard
method)
• Hernia
• Appendicitis
• Repair of perforation
• Fundoplication.
• Colectomies.

11. OTHERS MAS/MIS
• Laryngoscopy
• Thoracoscopy
• Hysteroscopy
• Bronchoscopy
• Endoluminal endoscopy
• Cystoscopy, Ureteroscopy, TURP(Trans urethral resection
prostate)
• Hysteroscopy
• Arthroscopy & Intra-articular joints.
• Endoscopic sinus surgery(FESS)(ENT)
• Phaco emulsification(EYE)

12. STANDARD

13. LAPAROSCOPIC SURGERY
• challenging, Innovative a dynamic, Advancing Surgical
techniques
• Rapidly spreading method of surgery creating enthusiasm
among the peoples, physicians, surgeons globally as well as in
Bangladesh.
• National, International seminar, workshops society fellowships,
Associations are active for updating this technology (SLSB)

14. AIMS (EVOLUTION OF MAS)
• To minimize traumatic insult to the patient.
• No compromise about safety and efficacy of
treatment compared to traditional open surgery.

15. PORT POSITION IN ABDOMEN

16. LAPAROSCOPIC INSTRUMENTS
• Telescope (HD, 3D, 4K system)
• Monitor (HD, LED, CRT, UHD system
• Light source
• Gas insuppletor.
• laparoscopic forceps.

17. LAPAROSCOPIC INSTRUMENTS
CONT..
• Various forceps available for laparoscopic surgery now a days for
example…
• Tooth forceps.(Grasper)
• Plain forceps
• veress needle.
• Harmonic scalpel/thunder bit
• Focus diathermy forceps.
• Monopolar forceps,(L-hook).
• Maryland forceps.
• Trocher(5mm,10mm)
• scissor

19. TELESCOPE ACCORDING TO
ORGAN SYSTEM.

20. ADVANTAGES OF MAS/MIS
• Decrease in wound size ,wound trauma.
• Less injury, less pain.
• Reduction in wound infection dehiscence,
bleeding hernia and nerve entrapment.
• Improved visualization
• Early return to normal life.
• Short hospital stay.
• More cosmetic, less scar formation.

21. DISADVANTAGES
• Costly
• Expertise related.
• Long learning curve.
• Not so available (even now).
• Difficult sterilization, disinfection, dismantling (Instruments,
optical device).
• Multidisciplinary team approaches.

22. LIMITATIONS
• Longer forceps/ instruments.
• Remote operative fields.
• Hand–eye-co-ordination.
• Experienced open surgeons
Better laparoscopic surgeons.
• Lap. Procedure in difficulties
Conversing
Open method (When needed)

23. COMPLICATIONS
• Related to
• Pneumoperitoneum:---
• Gas Embolism
• Cardiac arrythmia
• Hypothermia
• Compartment Syndrome.
• Port;---
• Bleeding
• Infection
• Hernia
• Diathermy;---
• Burn Injury
• Related to
• Pneumoperitoneum:---
• Gas Embolism
• Cardiac arrythmia
• Hypothermia
• Compartment Syndrome.
• Port;---
• Bleeding
• Infection
• Hernia
• Diathermy;---
• Burn Injury

24. CONTRAINDICATIONS
• Severe Heart Disease (IHD,MI)
• Severe Lung Disease.
• Cirrhosis of Liver with ascites.
• Intestinal obstruction
• Multiple previous laparotomies.
• Morbid obesity

25. ENERGY SOURCES USED IN
LAPAROSCOPY
• Monopolar Diathermy.
• Bipolar Diathermy.
• Gen11(Harmonic
Scalpel)
• RF(Radio frequency)
• Thunder bit.
• Liga sure.

26. INTRODUCING HD CAMERA
SYSTEM

27. HD CAMERA SYSTEM

28. “4K” TECHNOLOGY

29. 3D CAMERA SYSTEM

30. ROBOTIC LAPAROSCOPIC SURGERY

31. DA VINCI ROBOT-ASSISTED
SURGERY

32. QUESTION ANSWER SESSION

33. THANKS FOR PATIENTS
HEARING
Edited By ----Dr .Ashif Nawas
(Intern Doctor, TMC & RCH, Bogra)