1. Laparoscopy, also known as minimally invasive surgery, has evolved significantly over time from early uses of speculums and tubes to modern laparoscopic techniques and robotic surgery.
2. Pneumoperitoneum, usually with carbon dioxide gas, is used to elevate the abdominal wall during laparoscopy and provides better visualization but can cause respiratory acidosis and other physiological effects both locally and systemically.
3. While laparoscopy has advantages over open surgery like reduced pain, blood loss, and recovery time, it also has disadvantages such as the need for specialized equipment and skills and loss of tactile feedback. Extensive training is needed to minimize difficulties.
This document discusses the challenges facing endourologists performing percutaneous nephrolithotomy (PCNL). It outlines several challenges including difficult patient populations, complex kidney stones, congenital kidney anomalies, and technical difficulties. It also describes advances in imaging technologies like multimodal imaging and stone morphometry analyses that help surgical planning. Advances in patient positioning like prone, supine, and flank positions and new instruments for lithotripsy, retrieval, and hemostasis are discussed. The document emphasizes the importance of training and experience to successfully perform the complicated PCNL procedure.
The document discusses emergency ultrasound in trauma patients. It describes how focused abdominal sonography for trauma (FAST) uses 4 views to detect free fluid in trauma patients in 3 minutes or less. Studies show FAST has a sensitivity of 81-98% and specificity of 88-100% for detecting intra-abdominal bleeding. While not showing specific injuries, FAST effectively detects patients needing surgery. The document also discusses using ultrasound to detect hemothorax, pericardial fluid, and penetrating cardiac wounds.
The document discusses surgical meshes and methods of fixation for hernia repair. It covers biologic and synthetic meshes and factors that influence hernia occurrence. Direct closure of hernias has a high recurrence rate of around 50%, which is reduced to around 5-18% when meshes are used. Long stitch lengths during closure are associated with higher rates of surgical site infection and hernia recurrence compared to short stitch lengths. Polypropylene meshes allow for tissue ingrowth but can cause complications like chronic infection, fistulas and erosion over time. Other synthetic mesh options discussed include ePTFE meshes.
The document discusses different options for managing an open abdomen with a laparostomy, including techniques for closing such as primary suture, component separation with mesh, and considerations for when closure may be possible or necessary. Component separation is described as a useful technique that allows primary fascial closure but is also time consuming and can only be done once. Factors like infection risk, fascial retraction, and granulation are important to consider when determining if and how to close a laparostomy.
1. Video-assisted thoracoscopic surgery (VATS) is a minimally invasive procedure used to diagnose and treat illnesses of the lungs and chest cavity.
2. VATS involves making small incisions and inserting surgical instruments and a camera to allow the surgeon to see inside the chest. This avoids the need for large incisions.
3. VATS is used for procedures like lung biopsies, removal of parts of the lung, treatment of collapsed lungs, and draining fluid from the chest cavity. It offers benefits like less pain, shorter recovery time, and smaller scars compared to traditional open chest surgery.
This document discusses urethral stricture disease, including its definition, risk factors, presentation, diagnosis, and various treatment options. It provides details on endoscopic treatments like dilation and urethrotomy, as well as surgical options like urethroplasty repairs using grafts, flaps, and anastomoses. Five case examples are presented and management options discussed. Key points covered include techniques for anastomotic repairs, the use of buccal mucosa grafts, and monitoring after treatment. Current controversies regarding urethroplasty utilization and outcomes are also noted.
This document provides guidance on ureteroscopic lithotripsy (URSL) for treating ureteral stones. It discusses pre-treatment assessment factors like stone location, size and composition as well as patient factors. It outlines proper patient and equipment positioning. It describes guidewires, catheters, dilation devices, ureteral access sheaths, ureteroscopes, lithotriptors, stone retrieval devices and stents used in the procedure. It provides details on accessing and treating stones in the lower and upper ureters and discusses complications like perforation, stricture and stone extrusion that may occur.
This document discusses the challenges facing endourologists performing percutaneous nephrolithotomy (PCNL). It outlines several challenges including difficult patient populations, complex kidney stones, congenital kidney anomalies, and technical difficulties. It also describes advances in imaging technologies like multimodal imaging and stone morphometry analyses that help surgical planning. Advances in patient positioning like prone, supine, and flank positions and new instruments for lithotripsy, retrieval, and hemostasis are discussed. The document emphasizes the importance of training and experience to successfully perform the complicated PCNL procedure.
The document discusses emergency ultrasound in trauma patients. It describes how focused abdominal sonography for trauma (FAST) uses 4 views to detect free fluid in trauma patients in 3 minutes or less. Studies show FAST has a sensitivity of 81-98% and specificity of 88-100% for detecting intra-abdominal bleeding. While not showing specific injuries, FAST effectively detects patients needing surgery. The document also discusses using ultrasound to detect hemothorax, pericardial fluid, and penetrating cardiac wounds.
The document discusses surgical meshes and methods of fixation for hernia repair. It covers biologic and synthetic meshes and factors that influence hernia occurrence. Direct closure of hernias has a high recurrence rate of around 50%, which is reduced to around 5-18% when meshes are used. Long stitch lengths during closure are associated with higher rates of surgical site infection and hernia recurrence compared to short stitch lengths. Polypropylene meshes allow for tissue ingrowth but can cause complications like chronic infection, fistulas and erosion over time. Other synthetic mesh options discussed include ePTFE meshes.
The document discusses different options for managing an open abdomen with a laparostomy, including techniques for closing such as primary suture, component separation with mesh, and considerations for when closure may be possible or necessary. Component separation is described as a useful technique that allows primary fascial closure but is also time consuming and can only be done once. Factors like infection risk, fascial retraction, and granulation are important to consider when determining if and how to close a laparostomy.
1. Video-assisted thoracoscopic surgery (VATS) is a minimally invasive procedure used to diagnose and treat illnesses of the lungs and chest cavity.
2. VATS involves making small incisions and inserting surgical instruments and a camera to allow the surgeon to see inside the chest. This avoids the need for large incisions.
3. VATS is used for procedures like lung biopsies, removal of parts of the lung, treatment of collapsed lungs, and draining fluid from the chest cavity. It offers benefits like less pain, shorter recovery time, and smaller scars compared to traditional open chest surgery.
This document discusses urethral stricture disease, including its definition, risk factors, presentation, diagnosis, and various treatment options. It provides details on endoscopic treatments like dilation and urethrotomy, as well as surgical options like urethroplasty repairs using grafts, flaps, and anastomoses. Five case examples are presented and management options discussed. Key points covered include techniques for anastomotic repairs, the use of buccal mucosa grafts, and monitoring after treatment. Current controversies regarding urethroplasty utilization and outcomes are also noted.
This document provides guidance on ureteroscopic lithotripsy (URSL) for treating ureteral stones. It discusses pre-treatment assessment factors like stone location, size and composition as well as patient factors. It outlines proper patient and equipment positioning. It describes guidewires, catheters, dilation devices, ureteral access sheaths, ureteroscopes, lithotriptors, stone retrieval devices and stents used in the procedure. It provides details on accessing and treating stones in the lower and upper ureters and discusses complications like perforation, stricture and stone extrusion that may occur.
This document describes a surgical technique called combined inlay and onlay buccal mucosa urethroplasty for treating long and narrow bulbar urethral strictures. The technique involves making a vertical incision in the urethral plate to widen it and placing an additional inlay graft to reduce the size discrepancy between the plate and graft. Results in 22 patients showed significantly improved urine flow rates after surgery, with only 2 minor complications. The conclusion is that this technique avoids completely transecting the urethra, widens the plate anatomically, and reduces disparities, improving success rates for long narrow strictures.
DJ Stenting or Percutaneous nephrostomy(PCN) in acute pyelonephritisGAURAV NAHAR
1. A 35-year-old female presented with left loin pain, fever, vomiting, and dysuria for 7 days and was diagnosed with acute pyelonephritis of the left kidney based on investigations.
2. Initially, a left double J stent was placed but her symptoms persisted, so a left percutaneous nephrostomy was performed which led to significant improvement.
3. For acute pyelonephritis, a double J stent or percutaneous nephrostomy may be used for drainage but percutaneous nephrostomy is preferred if symptoms do not resolve with stenting due to more effective drainage of an obstructed system.
Open right hemicolectomy is performed to treat malignant tumors, polyps, and other conditions in the ileocecal region, ascending colon, and hepatic flexure. The procedure involves mobilizing the right colon, ligating blood vessels, resecting the involved bowel segments, and creating an ileocolic or ileotransverse anastomosis. Key steps include careful dissection to avoid injury to nearby structures like the duodenum and ureter, and ensuring a well-vascularized, tension-free anastomosis to minimize risks of leakage. Post-operative care focuses on early ambulation and advancing diet based on progress.
A general introduction to employment of utilities of meshes as surgical implant. Relevant biomaterial engineering basis are highlighted in context of current limitations of mesh-tissue integration and areas of ongoing translational scientific research.
Single incision laparoscopic Surgery-SILSrkmishra14
World Laparoscopy Hospital is Pioneer in SILS. Single incision laparoscopic surgery (SILS) under direction of Prof. R.K. Mishra is a new technique that has now been utilized in many centers for minimal access surgery. http://www.laparoscopyhospital.com/single_incision_laparoscopic_surgery.html
This document discusses ureteral stents used in urology. It provides a brief history of stent development and outlines ideal stent properties. Common stent materials like silicone, polyethylene and polyurethane are described. The document also discusses various stent designs, coatings, and indications for stent placement including for conditions like ureteral obstruction, urinary stone treatment, and transplantation. Complications are minimized by using the shortest possible indwelling time.
Endoscopy allows examination of body cavities using an endoscope. This document discusses various types of endoscopy including upper GI endoscopy (gastroscopy, ERCP), lower GI endoscopy (colonoscopy, sigmoidoscopy), and therapeutic endoscopy procedures. It describes the anatomy of the digestive tract, techniques, indications, and potential complications of different endoscopic procedures. New imaging technologies such as chromoendoscopy, narrow band imaging, and magnification endoscopy are also mentioned to improve tissue characterization during endoscopy.
This document discusses the principles and techniques of laparoscopic surgery. It begins with an introduction to minimal access surgery and its aims of reducing somatic and psychological trauma while allowing for shorter hospital stays and faster recovery. The document then covers the categories of minimally invasive procedures and diagnostic and therapeutic applications of laparoscopic surgery. It provides details on preoperative evaluation and preparation, creating pneumoperitoneum, intraoperative equipment and techniques, postoperative care, and examples of common laparoscopic procedures like cholecystectomy, hernia repair, and fundoplication. Throughout it includes diagrams to illustrate surgical anatomy and procedure steps.
laparoscopy is recent advancing area in the field of general surgery. the identification and underlying mechanism of action of each laparoscopic instrument is necessary for their handling ans use.
This document provides information about a KUB (kidney, ureter, bladder) x-ray performed at the Department of Urology, Government Royapettah Hospital and Kilpauk Medical College in Chennai. It lists the professors and assistant professors in the department and provides details on the history, physics, techniques, anatomical landmarks, disorders, and interpretations of renal calculi, ureter, bladder, and other findings that can be seen on a KUB x-ray.
1. Urodynamics describes physiological tests used to investigate lower urinary tract function, with cystometry being the most important test. Cystometry measures pressure-volume relationships during bladder filling and voiding.
2. Urodynamics tests the storage and evacuation of urine to reproduce a patient's symptoms and determine their underlying cause. Tests include cystometry, uroflowmetry, and pressure-flow studies.
3. Urodynamics is indicated for incontinence, suspected outflow obstruction, neurogenic bladder dysfunction, and children with voiding issues. It helps characterize detrusor and bladder outlet function and diagnose neuropathies.
What is MIS?
A minimally invasive medical procedure is defined as one that is carried out by entering the body through the skin or through a body cavity or anatomical opening, but with the smallest damage possible to these struct uresIncludes laparoscopic, endoscopic, and other approaches.
Why MIS?
Decreased patient pain
Decreased patient recovery period
Possible decrease in inflammatory response in the patient which may prove to have a better outcome in oncologic operations.
Distant future
In the distant future, there will be a para- digm shift with the development of non-inva- sive surgical techniques in combination with nanotechnologies and a new era in the devel- opment of surgery, and subsequently in surgi- cal techniques, will be opened.
Nanotechnology is an umbrella term for materials and devices that operate at the nanoskill (1 billionth of a meter). In terms of scale, a nanometer is approximately one 1/8000 of a human hair or 10 times the diam- eter of a hydrogen atom. The size of the device can vary but starts from a ten thou- sand-logic element system that will occupy a cube of no more than one hundred nanome- ters. This is a volume slightly larger than 0.001 cubic microns. This would be sufficient to hold a small computer. For example, if red blood cells are approximately eight microns in diameter, the 100 nanomicroprocessor will be 80 times smaller than a red blood cell. Devices this size could easily fit into the circulatory system and could even conceivably enter indi- vidual cells.
Percutaneous nephrolithotomy (PCNL) or nephrolithotripsy is a minimally invasive procedure to remove kidney stones. A guidewire and angioplasty needle are used under fluoroscopy to access the renal pelvis through the flank. Dilators are inserted over the guidewire to enlarge the tract for a nephroscope. The patient is positioned prone to elevate the surgical side. Stones may be removed with forceps or baskets, or fragmented using lithotripsy for larger stones. A nephroscope allows direct visualization to locate and remove any residual fragments, and ultrasounds can identify retained pieces.
Journal club-Determination of surgical priorities in appendicitisYouttam Laudari
This study aimed to identify risk factors for actual appendiceal perforation in patients diagnosed with non-perforated appendicitis by CT scan. The researchers conducted a retrospective case-control study of 1362 patients at a hospital in South Korea between 2006-2013. They found age over 35, temperature over 37.7°C, neutrophil count over 65%, and appendiceal diameter over 8mm were associated with actual perforation. The study identified body temperature, symptom duration, age, and appendiceal diameter as independent risk factors to help determine surgical priority and reduce complications from undiagnosed perforation.
This document discusses principles of bowel anastomosis, including types of anastomoses, indications for anastomoses, pre-operative preparation, intra-operative techniques, post-operative care, complications, and controversies. It covers topics such as hand-sewn versus stapled anastomoses, single versus double layer closure, inversion versus eversion of tissue, and use of abdominal drains and NG tubes. The goal of bowel anastomosis is to successfully rejoin bowel segments through meticulous surgical technique and postoperative management in order to restore intestinal continuity.
A presentation about Imaging the urinary tract using contrast.
contains 45 slides, and covers the following methods :
1 - Antegrade urography
2 - Retrograde urography
3 - Retrograde cystography
4 - Voiding cystography
5 - Retrograde Urethrography
Intravenous urography is covered in a separate presentation, that you can read and download from here :
http://www.slideshare.net/abdallamutwakil/intravenous-urography-ivu-35107052
This presentation was prepared and presented by me in the tutorials of the Radiology Department of Sebha Medical Center.
This document discusses special situations that may occur during laparoscopic appendectomy surgery. It notes that port positions may need to be modified for pregnancy and the appendix may need to be dissected along Toldt's white line if it is retrocaecal and extraperitoneal. For appendicular abscess, drainage and toiletting are needed to identify and remove the ruptured appendix, converting to open surgery if necessary. For an appendicular mass, conservative treatment is followed by interval appendectomy after one and a half months.
This document discusses laparoscopy in children. It begins with a brief history of laparoscopy from the 5th century BC to modern developments. The basic principles of laparoscopy are then explained, including how instruments are inserted and the use of carbon dioxide gas. Common laparoscopic instruments and techniques for pediatric surgery are outlined. Applications in pediatric urology and recent modernizations like single-incision laparoscopy and robotic surgery are also summarized. The conclusion emphasizes that laparoscopy is becoming increasingly popular due to patient benefits but requires experienced surgeons, and residents should learn its basic principles.
Laparoscopy involves using small incisions and a camera to visualize the inside of the abdomen. It has several advantages over open surgery such as less pain, shorter hospital stays, and quicker recovery times. Some of the key equipment used in laparoscopy include rod lens systems and fiber optic cables for optics, trocars for abdominal access, and insufflators to inflate the abdomen with gas. Potential risks include injuries from trocars or pneumoperitoneum as well as effects of the pneumoperitoneum on respiratory and renal systems. Common procedures now performed laparoscopically include cholecystectomy, appendisectomy, hernia repair, and some cancer staging.
SURGICAL EXPLORATION OF THE COMMON BILE DUCT.pptxmasoom parwez
Surgical exploration of the common bile duct involves removing gallstones discovered during cholecystectomy. Key steps include:
1. Performing intraoperative cholangiography to identify stones
2. Making an incision in the bile duct and extracting stones using forceps, balloons, or baskets
3. Placing a T-tube for drainage and performing a follow up cholangiogram to ensure clearance
Post-operatively, patients are monitored for complications like bleeding or leakage and the T-tube is typically removed after 2 weeks if follow up imaging is normal. Surgical exploration effectively treats gallstones and provides pain relief for most patients.
This document discusses complications that can occur during and after laparoscopic cholecystectomy (gallbladder removal surgery). It first describes common complications of gallstones, both within and outside the gallbladder, such as pancreatitis, jaundice, and cholangitis. It then discusses benefits and steps of the laparoscopic procedure. Potential complications of laparoscopic cholecystectomy are outlined, including CO2 embolism, bile duct injury, bleeding, gallbladder perforation, and port site issues. Bile duct injuries are described in further detail using classification systems to characterize the extent of injury. Factors involved in bile duct injuries during the procedure are also mentioned.
Medical thoracoscopy is an invasive procedure used to visualize the pleural space and lungs through small incisions in the chest wall. It allows physicians to biopsy pleural surfaces and diagnose conditions causing pleural effusions. The procedure was originally developed in 1910 and was widely used until the 1950s to divide pleural adhesions in tuberculosis patients. Modern thoracoscopy uses video imaging and improved instruments to perform biopsies and pleurodesis under local anesthesia. It provides fast diagnoses but carries risks of pain, infection and failed procedures if not performed carefully in suitable patients.
This document describes a surgical technique called combined inlay and onlay buccal mucosa urethroplasty for treating long and narrow bulbar urethral strictures. The technique involves making a vertical incision in the urethral plate to widen it and placing an additional inlay graft to reduce the size discrepancy between the plate and graft. Results in 22 patients showed significantly improved urine flow rates after surgery, with only 2 minor complications. The conclusion is that this technique avoids completely transecting the urethra, widens the plate anatomically, and reduces disparities, improving success rates for long narrow strictures.
DJ Stenting or Percutaneous nephrostomy(PCN) in acute pyelonephritisGAURAV NAHAR
1. A 35-year-old female presented with left loin pain, fever, vomiting, and dysuria for 7 days and was diagnosed with acute pyelonephritis of the left kidney based on investigations.
2. Initially, a left double J stent was placed but her symptoms persisted, so a left percutaneous nephrostomy was performed which led to significant improvement.
3. For acute pyelonephritis, a double J stent or percutaneous nephrostomy may be used for drainage but percutaneous nephrostomy is preferred if symptoms do not resolve with stenting due to more effective drainage of an obstructed system.
Open right hemicolectomy is performed to treat malignant tumors, polyps, and other conditions in the ileocecal region, ascending colon, and hepatic flexure. The procedure involves mobilizing the right colon, ligating blood vessels, resecting the involved bowel segments, and creating an ileocolic or ileotransverse anastomosis. Key steps include careful dissection to avoid injury to nearby structures like the duodenum and ureter, and ensuring a well-vascularized, tension-free anastomosis to minimize risks of leakage. Post-operative care focuses on early ambulation and advancing diet based on progress.
A general introduction to employment of utilities of meshes as surgical implant. Relevant biomaterial engineering basis are highlighted in context of current limitations of mesh-tissue integration and areas of ongoing translational scientific research.
Single incision laparoscopic Surgery-SILSrkmishra14
World Laparoscopy Hospital is Pioneer in SILS. Single incision laparoscopic surgery (SILS) under direction of Prof. R.K. Mishra is a new technique that has now been utilized in many centers for minimal access surgery. http://www.laparoscopyhospital.com/single_incision_laparoscopic_surgery.html
This document discusses ureteral stents used in urology. It provides a brief history of stent development and outlines ideal stent properties. Common stent materials like silicone, polyethylene and polyurethane are described. The document also discusses various stent designs, coatings, and indications for stent placement including for conditions like ureteral obstruction, urinary stone treatment, and transplantation. Complications are minimized by using the shortest possible indwelling time.
Endoscopy allows examination of body cavities using an endoscope. This document discusses various types of endoscopy including upper GI endoscopy (gastroscopy, ERCP), lower GI endoscopy (colonoscopy, sigmoidoscopy), and therapeutic endoscopy procedures. It describes the anatomy of the digestive tract, techniques, indications, and potential complications of different endoscopic procedures. New imaging technologies such as chromoendoscopy, narrow band imaging, and magnification endoscopy are also mentioned to improve tissue characterization during endoscopy.
This document discusses the principles and techniques of laparoscopic surgery. It begins with an introduction to minimal access surgery and its aims of reducing somatic and psychological trauma while allowing for shorter hospital stays and faster recovery. The document then covers the categories of minimally invasive procedures and diagnostic and therapeutic applications of laparoscopic surgery. It provides details on preoperative evaluation and preparation, creating pneumoperitoneum, intraoperative equipment and techniques, postoperative care, and examples of common laparoscopic procedures like cholecystectomy, hernia repair, and fundoplication. Throughout it includes diagrams to illustrate surgical anatomy and procedure steps.
laparoscopy is recent advancing area in the field of general surgery. the identification and underlying mechanism of action of each laparoscopic instrument is necessary for their handling ans use.
This document provides information about a KUB (kidney, ureter, bladder) x-ray performed at the Department of Urology, Government Royapettah Hospital and Kilpauk Medical College in Chennai. It lists the professors and assistant professors in the department and provides details on the history, physics, techniques, anatomical landmarks, disorders, and interpretations of renal calculi, ureter, bladder, and other findings that can be seen on a KUB x-ray.
1. Urodynamics describes physiological tests used to investigate lower urinary tract function, with cystometry being the most important test. Cystometry measures pressure-volume relationships during bladder filling and voiding.
2. Urodynamics tests the storage and evacuation of urine to reproduce a patient's symptoms and determine their underlying cause. Tests include cystometry, uroflowmetry, and pressure-flow studies.
3. Urodynamics is indicated for incontinence, suspected outflow obstruction, neurogenic bladder dysfunction, and children with voiding issues. It helps characterize detrusor and bladder outlet function and diagnose neuropathies.
What is MIS?
A minimally invasive medical procedure is defined as one that is carried out by entering the body through the skin or through a body cavity or anatomical opening, but with the smallest damage possible to these struct uresIncludes laparoscopic, endoscopic, and other approaches.
Why MIS?
Decreased patient pain
Decreased patient recovery period
Possible decrease in inflammatory response in the patient which may prove to have a better outcome in oncologic operations.
Distant future
In the distant future, there will be a para- digm shift with the development of non-inva- sive surgical techniques in combination with nanotechnologies and a new era in the devel- opment of surgery, and subsequently in surgi- cal techniques, will be opened.
Nanotechnology is an umbrella term for materials and devices that operate at the nanoskill (1 billionth of a meter). In terms of scale, a nanometer is approximately one 1/8000 of a human hair or 10 times the diam- eter of a hydrogen atom. The size of the device can vary but starts from a ten thou- sand-logic element system that will occupy a cube of no more than one hundred nanome- ters. This is a volume slightly larger than 0.001 cubic microns. This would be sufficient to hold a small computer. For example, if red blood cells are approximately eight microns in diameter, the 100 nanomicroprocessor will be 80 times smaller than a red blood cell. Devices this size could easily fit into the circulatory system and could even conceivably enter indi- vidual cells.
Percutaneous nephrolithotomy (PCNL) or nephrolithotripsy is a minimally invasive procedure to remove kidney stones. A guidewire and angioplasty needle are used under fluoroscopy to access the renal pelvis through the flank. Dilators are inserted over the guidewire to enlarge the tract for a nephroscope. The patient is positioned prone to elevate the surgical side. Stones may be removed with forceps or baskets, or fragmented using lithotripsy for larger stones. A nephroscope allows direct visualization to locate and remove any residual fragments, and ultrasounds can identify retained pieces.
Journal club-Determination of surgical priorities in appendicitisYouttam Laudari
This study aimed to identify risk factors for actual appendiceal perforation in patients diagnosed with non-perforated appendicitis by CT scan. The researchers conducted a retrospective case-control study of 1362 patients at a hospital in South Korea between 2006-2013. They found age over 35, temperature over 37.7°C, neutrophil count over 65%, and appendiceal diameter over 8mm were associated with actual perforation. The study identified body temperature, symptom duration, age, and appendiceal diameter as independent risk factors to help determine surgical priority and reduce complications from undiagnosed perforation.
This document discusses principles of bowel anastomosis, including types of anastomoses, indications for anastomoses, pre-operative preparation, intra-operative techniques, post-operative care, complications, and controversies. It covers topics such as hand-sewn versus stapled anastomoses, single versus double layer closure, inversion versus eversion of tissue, and use of abdominal drains and NG tubes. The goal of bowel anastomosis is to successfully rejoin bowel segments through meticulous surgical technique and postoperative management in order to restore intestinal continuity.
A presentation about Imaging the urinary tract using contrast.
contains 45 slides, and covers the following methods :
1 - Antegrade urography
2 - Retrograde urography
3 - Retrograde cystography
4 - Voiding cystography
5 - Retrograde Urethrography
Intravenous urography is covered in a separate presentation, that you can read and download from here :
http://www.slideshare.net/abdallamutwakil/intravenous-urography-ivu-35107052
This presentation was prepared and presented by me in the tutorials of the Radiology Department of Sebha Medical Center.
This document discusses special situations that may occur during laparoscopic appendectomy surgery. It notes that port positions may need to be modified for pregnancy and the appendix may need to be dissected along Toldt's white line if it is retrocaecal and extraperitoneal. For appendicular abscess, drainage and toiletting are needed to identify and remove the ruptured appendix, converting to open surgery if necessary. For an appendicular mass, conservative treatment is followed by interval appendectomy after one and a half months.
This document discusses laparoscopy in children. It begins with a brief history of laparoscopy from the 5th century BC to modern developments. The basic principles of laparoscopy are then explained, including how instruments are inserted and the use of carbon dioxide gas. Common laparoscopic instruments and techniques for pediatric surgery are outlined. Applications in pediatric urology and recent modernizations like single-incision laparoscopy and robotic surgery are also summarized. The conclusion emphasizes that laparoscopy is becoming increasingly popular due to patient benefits but requires experienced surgeons, and residents should learn its basic principles.
Laparoscopy involves using small incisions and a camera to visualize the inside of the abdomen. It has several advantages over open surgery such as less pain, shorter hospital stays, and quicker recovery times. Some of the key equipment used in laparoscopy include rod lens systems and fiber optic cables for optics, trocars for abdominal access, and insufflators to inflate the abdomen with gas. Potential risks include injuries from trocars or pneumoperitoneum as well as effects of the pneumoperitoneum on respiratory and renal systems. Common procedures now performed laparoscopically include cholecystectomy, appendisectomy, hernia repair, and some cancer staging.
SURGICAL EXPLORATION OF THE COMMON BILE DUCT.pptxmasoom parwez
Surgical exploration of the common bile duct involves removing gallstones discovered during cholecystectomy. Key steps include:
1. Performing intraoperative cholangiography to identify stones
2. Making an incision in the bile duct and extracting stones using forceps, balloons, or baskets
3. Placing a T-tube for drainage and performing a follow up cholangiogram to ensure clearance
Post-operatively, patients are monitored for complications like bleeding or leakage and the T-tube is typically removed after 2 weeks if follow up imaging is normal. Surgical exploration effectively treats gallstones and provides pain relief for most patients.
This document discusses complications that can occur during and after laparoscopic cholecystectomy (gallbladder removal surgery). It first describes common complications of gallstones, both within and outside the gallbladder, such as pancreatitis, jaundice, and cholangitis. It then discusses benefits and steps of the laparoscopic procedure. Potential complications of laparoscopic cholecystectomy are outlined, including CO2 embolism, bile duct injury, bleeding, gallbladder perforation, and port site issues. Bile duct injuries are described in further detail using classification systems to characterize the extent of injury. Factors involved in bile duct injuries during the procedure are also mentioned.
Medical thoracoscopy is an invasive procedure used to visualize the pleural space and lungs through small incisions in the chest wall. It allows physicians to biopsy pleural surfaces and diagnose conditions causing pleural effusions. The procedure was originally developed in 1910 and was widely used until the 1950s to divide pleural adhesions in tuberculosis patients. Modern thoracoscopy uses video imaging and improved instruments to perform biopsies and pleurodesis under local anesthesia. It provides fast diagnoses but carries risks of pain, infection and failed procedures if not performed carefully in suitable patients.
Basics of laproscopic surgery..
by dr navdeep s kamboj presented at sgrdumsar amritsar.
topics covered--
1 basics of laparoscopy
2 lap cholecystectomy
3 lap appendixcectomy
pneumoperitonem
merits and demerits of laproscopy
ligasure
endoscopy,
laparoscopic instruments
Laparoscopic repair of inguinal hernias Gergis Rabea
Since the introduction of laparoscopic cholecystectomy, surgeons have developed laparoscopic approaches to other commonly performed open abdominal and thoracic procedures
Laparoscopy is an innovative diagnostic and surgical tool in veterinary field. Laparoscopic surgeries revolutionizes the minimally invasive surgical approaches with less surgical trauma and faster recovery.
This document provides an overview of minimal access surgery (MAS). It defines MAS as applying modern technology to minimize surgical trauma without compromising exposure or safety. The history of MAS is traced from early laparoscopic procedures in the 1900s to developments like natural orifice transluminal endoscopic surgery (NOTES) and single incision laparoscopic surgery (SILS) more recently. The advantages of MAS include reduced pain, wounds, and recovery time compared to open surgery. Potential complications include injuries and those related to pneumoperitoneum such as arrhythmias. A variety of endoscopic, laparoscopic, and catheter-based minimal access procedures across several specialties are described in the document.
This document discusses surgical management of rhinosinusitis, including different approaches to endoscopic sinus surgery and their indications. It describes techniques for uncinectomy, ethmoidectomy, maxillary antrostomy, and opening the frontal sinus and sphenoid. Local or general anesthesia can be used. Post-operative management involves cleaning the surgical cavity, antibiotics, steroids, and follow-up visits. Antral lavage is discussed as a treatment for acute rhinosinusitis and as an adjunct to external drainage of orbital complications.
This document provides an overview of laparoscopic surgery, including:
- Definitions and indications for laparoscopic surgery, which is a minimally invasive procedure used to examine and operate on internal organs through small incisions.
- Advantages like quicker recovery, less pain, and reduced risk of complications compared to open surgery. Disadvantages include technically challenging aspects.
- Details on operating room setup, equipment, anesthesia options, port placement following triangulation principles, and roles of the operating room technician in assisting the surgeon. Complications are also outlined.
Anaesthetic considerations for Robotic Surgery, What to expect, how to go ahead. An update and incite on the intricacies of Robotic Surgery and Anaesthetic implications.
The document discusses tracheostomy, including its history, types, techniques, and indications. Some key points:
- Tracheostomy involves making an opening in the trachea and bringing it out through the skin, bypassing the larynx. It dates back to ancient Egypt but was further developed in the 15th-20th centuries.
- It can be temporary or permanent, and is classified by location (high, mid, low). Common techniques are open surgical and percutaneous tracheostomy.
- Indications include upper airway obstruction, removing secretions, prolonged ventilation, and as part of other procedures like laryngectomy. Percutaneous tracheostomy is now common in intensive care.
The document discusses strategies for reducing the cardiac hazard associated with suctioning. It covers the anatomy of related structures like the vagus nerve and how suctioning can stimulate reflexes. It also outlines objectives for staff training on identifying hazards, assessing patients, and reducing risks through techniques like using the minimum safe suction pressure. Several hazards of suctioning are identified, including hypoxia, infection, trauma, and changes to intracranial pressure.
The document discusses complications that can occur during and after laparoscopic surgeries. Some common complications discussed include:
1. Anaesthetic complications such as inadequate muscle relaxation during the procedure, hyperventilation prior to surgery, and possible air embolism from carbon dioxide used for pneumoperitoneum.
2. Complications due to pneumoperitoneum such as respiratory acidosis, increased pressure on veins, and possible effects on renal function from increased abdominal pressure.
3. Surgical complications such as injuries to organs like the stomach, bowel, bladder from trocars or instruments. Thermal injuries from diathermy are also discussed.
4. Other complications mentioned include bleeding, infections, inc
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1. LAPAROSCOPY
isit really minimally invasive??
BY
Hosam Mohamad Hamza, MD
Lecturer of General Surgery and GI Endoscopy
Minia Faculty of Medicine
EGYPT
2. Minimally Invasive Surgery
(MIS)
Definition:
A philosophical approach to surgery in which the trauma of surgical
access is minimized without compromising the quality of the surgical
procedure.
Historical background:
•Although the term is relatively recent, the history of MIS is not new.
•The use of tube and speculum in medicine dates from the earliest days of
civilization in ancient Greece.
•Laparoscopy (LAP) that is considered the newest and most popular variety is,
in fact, the oldest (primitive laparoscopy, placing a cystoscope within an inflated
abdomen, was first performed by Kelling in 1901).
3. Historical background, contd:
•The explosion of video-assisted surgery in the past 30 years changed
our understanding of surgical anatomy and reshaped surgical practice.
•Lap-guided gall stone clearance was 1st performed in animal model
by Frimberger and associates in Germany in 1971.
•In 1987, Mouret (Lyon, France) was the 1st
surgeon to perform
cholecystectomy in human using standard laparoscopic equipment,
then, great advances follow in lap. techniques in various specilalities.
•The motivation to develop surgical robots was to overcome the
limitations related to the technical and mechanical nature of lap.
equipment as:
- Loss of tactile feedback.
- Loss natural hand-eye coordination.
- Fulcrum effect.
- Amplification of physiologic tremors of the surgeon.
4. Historical background, contd:
•RoboDoc (a robotic system designed to drill the femur shaft in hip
replacement) was the 1st
computer-assisted surgical robot approved
by the FDA in the late 1980's.
•Advances then continue till introduction of the Automated Endoscopic
System for Optimal Positioning (AESOP), a robotic arm controlled by
the surgeon's voice commands and Da Vinci and
Zeus surgical systems.
•IN THE FUTUREIN THE FUTURE, equipped nanorobots introduced through BVs and
guided by a human surgeon may be capable of performing precise
intracellular surgeries beyond the capabilities of the human / robotic
hand.
7. LAPAROSCOPY
Definitions:
1.LAP is inspection of the peritoneal cavity with a telescope introduced
through the abd wall after creation of pneumoperitoneum.
2.Lap. surgery is the execution of an established surgical procedure by
remote manipulations within the closed abd cavity using LAP.
Advantages (rationale for minimally invasive surgery):
☞ Minimal invasion
1.Minimization of body invasion & parietal trauma (avoiding large access
wounds).
2.Significant ↓ of postoperative pain.
3.Significant ↓ of perioperative morbidity:
• ↓ cardiopulmonary complications.
• ↓ postoperative ileus.
• ↓ postoperative adhesions.
• ↓ wound complications (e.g. infection, dehiscence, …. ).
• ↓ cosmetic insult.
8. 4. ↑ Speed of recovery.
5. Minimization of the stress response to surgery (decreased levels of
catecholamines, cortisol, glucose and other acute phase reactants
compared with laparotomy).
6. Minimization of surgery-induced immunosuppression (preserved
cell mediated immunity compared with laparotomy) that may have
important implications esp in cancer surgery.
☞ Visual enhancement: by the magnifying effect of the telescope.
☞ ↓ incidence of infection:
The greatly ↓ contact with patient's blood and body fluids ↓
transmission
of viral diseases for both patient and surgeon.
9. DIFFICULTIES (disadvantages):
minimized by appropriate training and
experience
☞ Equipment-related:
Necessity to purchase & maintain expensive high technology
equipment.
☞ Procedure-related:
•Necessity for insufflation (effects of pneumoperitoneum).
•Necessity to access space via needle & trocars (risk of visceral injury).
•Diathermy injuries.
•Haemostasis can be difficult to achieve.
•Intact organ retrieval, particularly if tumourous, may be seriously limited.
☞ Surgeon-related:
•Requires more technical expertise and long time, at least initially.
•Loss of touch sensation & tactile feedback.
•Loss of 3-D visualization (images of current camera systems are 2-D).
•Loss of eye/hand co-ordination.
•Limited degrees of motion.
•Fulcrum effect.
•Amplification of the surgeon's physiologic tremors through the length of
11. Inadvertent Pneumo-preperitoneumInadvertent Pneumo-preperitoneum
•2% of cases.
•Diagnosis:
1. Drop or aspiration test.
2. palpation of crepitus under the skin.
3. typical spider-web appearance after inserting the 1st
cannula
(further stripping of peritoneum by the telescope tip is to be avoided)
•Management:
1.if detected early (before cannula insertion):
* allow gas to escape.
* then re-introduce needle through the same or another site.•g
•If detected after cannula insertion:
* withdraw cannula & telescope.
* allow gas to escape.
* re-introduce needle or use “open technique”.
12. PHYSIOLOGICAL CHANGES WITHPHYSIOLOGICAL CHANGES WITH
PNEUMOPERITONEUMPNEUMOPERITONEUM
•The singular feature of laparoscopy is the need to lift the abdominal wall
from the abdominal organs.
•2 methods:
IDEAL GAS FOR INSUFFLATIONIDEAL GAS FOR INSUFFLATION
1.Colourless.
2.Non expensive.
3.Non explosive (doesn’t support combustion).
4.Non toxic.
5.Limited systemic absorption across peritoneum.
6.Limited systemic effects if absorbed.
7.Rapid excretion if absorbed.
8.High solubility in blood.
Gasless laparoscopy.Pneumoperitoneum or
13. • Throughout the early 20th
century, pneumoperitoneum was achieved by
inflating the abd cavity with air using sphygmomanometer bulb.
• CO2 and N2O were then used.
N2O CO2
Advantages 1. Highly soluble.
2. Better analgesia.
3. ↓ intraoperative end-tidal CO2.
4. Insignificant acid/base imbalance.
1. More soluble.
2. Less expensive.
3. Doesn’t support combustion.
4. Readily available.
Disadvant. 1. Possibility of combustion.
2. Lap. cancer surgery (CAUTIONCAUTION).
3. Safety in pregnancy has yet to be
elucidated.
1.Acidosis:
Cardio-depression
Pulmonary HTN
Systemic VD
1.v
2. Hypercarbia: Sympathetic ++ :
Tachycardia , Arrhythmias , HTN
1.H
2.h
3.Stored CO2 may take hours to
be eliminated.
15. A. LOCAL (abdominal) EFFECTS OF PNEUMOPERITONEUM:
1.Peritoneal distention: and postoperative pain.
2.Elevated diaphragm.
3.Vagal Stimulation:
•A rapid stretch of peritoneum often causes a vagovagal response with
bradycardia (commonest cardiac dysrhythmias with laparoscopy) and,
occasionally, hypotension.
•Appropriate management is:
_ desufflation of the abdomen
_ vagolytic agents (e.g., atropine)
_ adequate volume replacement.
4.4. Adhesions:Adhesions:
1.Peritoneum is a 37 °C potential space covered by a wet film of fluid.
2.The currently used CO2 is instilled at 21°Cat 21°C and extremely dryextremely dry.
3.Absence of water in a gas going into a wetted cavity causes tissue
desiccation and damage that precede adhesion formation.
16. B. SYSTEMIC EFFECTS OF PNEUMOPERITONEUM:
1. Hypothermia:
Absence of water in a gas going into a wetted cavity causes
evaporative hypothermia
2. Respiratory effects:
a. Respiratory acidosis and hypercarbia:
•Insufflation → CO2 is rapidly absorbed → hydration to carbonic acid in RBCs
(buffering capacity of Hb).
•Respiratory acidosis is prevented by body buffers (largest reserve lies in bone
that absorb up to 120 L of CO2).
•Once the body buffers are saturated, acidosis rapidly develops.
•Mild respiratory acidosis is probably an insignificant problem.
•More severe respiratory acidosis= cardiac arrhythmias has been reported.
•Hypercarbia= tachycardia & ↑systemic vascular resistance=↑BP& ↑myocardial O2
demand.
•In patients with normal respiratory function; anesthesiologist shouldIn patients with normal respiratory function; anesthesiologist should ↑↑ thethe
ventilatory rate on the ventilator (within limits).ventilatory rate on the ventilator (within limits).
•In some situations, it is advisable to reduce the IAP (or even evacuate theIn some situations, it is advisable to reduce the IAP (or even evacuate the
pneumoperitoneum) to allow time for the anesthesiologist to adjust forpneumoperitoneum) to allow time for the anesthesiologist to adjust for
hypercarbia.hypercarbia.
17. b. increased intrathoracic pressure:
The direct effect of pneumoperitoneum leads to:
•↑ intrathoracic pressure.
•↑ pressure across the chest wall.
•↑ likelihood of pulmonary barotrauma.
c. pneumothorax: (esp in lap. surgery at the GO junction)
Mechanisms:Mechanisms:
1. gas tracking:
_along the tissue planes & potential channels
_along surgically traumatized pleura
_along undetected diaphragmatic hernia
2. Barotrauma (rupture of an emphysematous bleb).
DetectionDetection:
Unexplained Occurrence Of One Or More of the following should
alert us to the possibility of pneumothorax:
1* sudden ↓ oxygen satura-tion 2*↓ motion of hemidiaphragm
3* ↓ air entry on auscultation 4* ↑ airway pressure
18. c. pneumothorax, contd :
Management:Management:
1. DON’T RUSH for an ICT.
2. PEEP (if NO pulmonary barotrauma).
3. Stop gas.
4. Exsufflate.
5. Tube drainage (if spontaneous resolution does not occur for 1
hour of exsufflation).
d. Endobronchial intubation:
•Due to upward tracheal displacement during high P peritoneal insufflation.
•If occurs→ bronchospasm, hypoxia and atelectasis.
•Position of the ETT should always be checked intra-operatively.Position of the ETT should always be checked intra-operatively.
19. e. Aspiration of gastric contents: due to:
1* increased intra-abdominal pressure
2* change in posture
3* manipulation of the stomach
•Risk is reduced by appropriate NG and ET tube placementNG and ET tube placement.
f. Gas embolism:
•Rare but SERIOUSSERIOUS (potentially lethal).
•Causes my include:
1* inadvertent intravascular gas in-j. through a misplaced Veress
needle
2* forcing of gas into a vein splinted open
3* extensive argon beam use in LH (argon gas embolism)
20. • Clinical effects:
Pulmonary gas embolism Cerebral gas embolism
-Slow infusionSlow infusion of CO2 is readily absorbed
across the capillary - alveolar membrane.
-High ratesHigh rates→ bronchospasm &
pulmonary
oedema.
-Large infusion rates ≥ 3 ml/kgrates ≥ 3 ml/kg → airlock
at rt ventricle→ cardiovascular collapse.
-May occur as a result of gas entering
the systemic circulation via a patentpatent
cardiac foramencardiac foramen or through the
pulmonary capillary system.
-Can result in neurological dysfunctionneurological dysfunction
)delayed recovery, coma, fits,
paresis(
1.Physiological effects depend on rate & volume of gasrate & volume of gas.
2.Effect tends to be less dramatic with COless dramatic with CO22.
3.May occur as a delayed phenomenonMay occur as a delayed phenomenon (late post-operative) if gas is
trapped in the portal circulation.
21. DIAGNOSIS of gas embolism during laparoscopy:
1.Suspect if hypotension develops during insufflation.
2.Oesophageal stethoscope= characteristic "Mill wheel" murmur.
3.Transoesophageal Echosonography: can detect even subclinical embol-i
Treatment:
G A S
1.Get rid of emboli:
_ place the patient in left lat. decubitus with the head down.
_ rapidly placed central venous catheter→ foamy blood.
_ external cardiac massage.
1.Ask for
_ 100% O2
_ hyperventilation
_ I.V. fluids
3. Stop gas:
_ turn-off gas flow.
_ desufflate the abdomen.
22. 3. Cardiovascular effects: "more marked during the initial 30 min of insufflation"
a. ↓ cardiac ouput (COP):
due to ↓venous return secondary to:
•excessive pressure on IVCpressure on IVC.
•reverse Trendelenburg'sreverse Trendelenburg's (lap. upper
abdominal operations)
•loss of LL muscle toneLL muscle tone.
this decrease is not seen if:
• patient is normovolaemic.
• IAP is kept under 20 mmHg.
b. ↑ central venous pressure:
↑intra-abdominal pressure is
transmitted directly across the
paralyzed diaphragm to thoracic
cavity→↑ CVP
c. ↑ mean arterial BP:
•due to ↑ systemic vascular
resistance by:
1.mechanical compression of aorta &
splanchnic vessels.
2.neurohumoral factors (e.g.
vasopressin, catecholamines)
•Reverse Trendelenburg position canReverse Trendelenburg position can
compensatecompensate for ↑ ABP
(gravitational effect).
23. d.↑ risk of thromboembolic events:
•venous engorgement & ↓ venous returnvenous engorgement & ↓ venous return.
•Many advanced lap. proceduresadvanced lap. procedures in which DVT prophylaxis was not given
demonstrate the frequency of pulmonary embolus. This usually is an
avoidable complication with the use of:
* sequential compression stockings.
* low molecular weight heparin (LMWH).
•In short-duration lap. proceduresshort-duration lap. procedures (e.g. appendectomy, hernial repair or
cholecystectomy), the risk of DVT may not be sufficient to warrant extensive
DVT prophylaxis.
24.
25. 4. Oliguria:
•Intraoperative oliguria is common with laparoscopyIntraoperative oliguria is common with laparoscopy due to:
•↑ intra-abd. P → direct pressure on kidney & its BVs → ↓renal blood flow
(RBF)→ ↓GFR.
•↑ circulating ADH levels that also are found during pneumoperiton.
•↓ RBFRBF →↑ plasma reninplasma renin→↑ Na retention.Na retention.
NBNB
•Effects of pneumoperitoneum on RBF are immediately reversible.
•Hormonal changes can ↓ urine output (UOP) for up to 1 hr after procedure
has ended.
•During LAP, UOP is not a reflection of intravascular volume status.
SO…….. regarding IV fluid administration in uncomplicated procedures:
1. IV fluid administration should not be linked to UOP.
2. Compared to open surgery, more judicious I.V. fluid use is a
MUSTMUST because insensible fluid losses through the open
abdomen are eliminated.
26. Haemodynamic consequences of pneumoperitoneum are well
tolerated by healthy individuals for a prolonged period and by most
individuals for at least a short period.
Difficulties occur when a patient with compromised cardiovascular
function is subjected to a long lap. procedure (alternative approaches
should be considered).
Alternative gases suggested for laparoscopy include the inert gases
helium, neon and argon.
They cause no metabolic effects, but are poorly soluble in blood
(unlike CO2 & N2O)→ prone to create gas emboli if they have direct
access to the venous system.
27. PHYSIOLOGICAL CHANGES WITH PATIENTPHYSIOLOGICAL CHANGES WITH PATIENT
POSITIONINGPOSITIONING
1. Cardiovascular changes:
•Head-up position: ↓VR, COP, mean ABP, ↑systemic and pulmonary
vascular resistance
•Head-down position: vice versa
•Lateral decubitus position: direct pressure over the IVC may result in
↓↓↓VR→ ↓BP
2. Respiratory changes:
•Head down position:
* ↑ the risk of: * gas embolism
* hypoxia & atelectasis (by changes in intrathoracic blood
volume & small airway collapse)
* endobronchial intubation.
* :↓ * functional residual capacity (FRC)
* total lung volume
28. Gasless LaparoscopyGasless Laparoscopy
•An abdominal lifting deviceabdominal lifting device is placed through a 10-12 mm trocar at the
umbilicus to avoid the disadvantages of CO2 insufflation.
•Advantages of using abdominal lifting devices:
1* They create little physiologic derangement.
2* They significantly minimize the risk of gas embolization.
3* They may allow performing of MIS with standard nonlaparoscopic
surgical instruments.
4* They eliminate the need and maintenance of a gas-tight operating
environment.
29. • Disadvantages:
Despite these inventions, technique of gasless LAP has not yet
achieved wide popularity may be due to:
1. The bulky naturebulky nature of most of these devices.
2.2. Greater postoperative painGreater postoperative pain than pneumoperitoneum.
3.3. ExposureExposure and working room are inferior.
• Because the physiological effects of pneumoperitoneum appear to
be most marked after initial abdominal insufflation and during high
pressure insufflation (> 14mmHg), the use of a hybrid system of low
pressure pneumoperitoneum (<5mmHg) combined with an
abdominal wall retracting technique may provide the best of both
worlds.
31. 1. From the surgical point of view, LAP is considered minimally invasive.
2. From the physiological point of view and body response, a number of
physiological changes occur as a result of:
* pneumoperitoneum
* postural changes involved in patient positioning.
Physiologically, LAP is not considered minimally invasive, particularly
in:
1. Patients with very old age.
2. Patients with very young.
3. Patients with significant pre-existing diseases.
(cardiovascular, pulmonary and neurological disorders).
32. 3. The major problems during laparoscopic surgery are related to CO2-induced
pneumoperitoneum, these problems can be averted if certain precautions have
been kept in mind:
1.All cardiopulmonary-compromised patients should be assessed preoperatively
by a physician or a cardiologist.
2.Lower pressure pneumoperitoneum (10–12 mmHg) with proper patient
hydration can prevent cardiac problems.
3.Minimize operative time by the help of experienced person.
4.Use helium or nitrous oxide gas for pneumoperitoneum, if available in
cardiopulmonary-compromised patients.
33. References:
1.A Guide to Laparoscopic Surgery book Wiley-Blackwell; 1st
edition
(December 15, 1998) ISBN-10: 086542649X ISBN-13: 978-
0865426498
2.A Guide to Laparoscopic Surgery. Ann R Coll Surg Engl. 2000
September; 82(5): 370.
3.Secrets of safe laparoscopic surgery: Anaesthetic and surgical
considerations. J Minim Access Surg. 2010 Oct-Dec; 6(4): 91–94.
4.Shakespeare's view of the laparoscopic pneumoperitoneum. JSLS.
2011 Jul-Sep;15(3):282-4