This document discusses complications that can occur during endoscopic and hysteroscopic surgeries. It notes that reported complication rates for endoscopic surgery are around 3-5 cases per 1000, and have decreased by around 50% since the 1970s. Common complications include injuries from trocars or the Veress needle, organ perforation, and hemorrhage. The document provides tips for minimizing complications, such as using cauterization and identifying tissue planes before dissection. It also discusses specific complications for hysteroscopic procedures like trauma, hemorrhage, and thermal damage. Overall, the document outlines various complications and best practices for reducing risks during minimally invasive gynecological surgeries.
Laparoscopic sterilization was the first popular minimal access surgical procedure ever performed. Laparoscopic sterilization is very straightforward procedure. Worldwide laparoscopic sterilization is now the most commonly applied method for family planning
Laparoscopic cholecystectomy is the gold standard for the treatment of gallstone disease. The operation is routinely performed using four or three ports of entry into the abdomen. At laparoscopy hospital, we frequently perform cholecystectomy by two-port method using modified extracorporeal knot.
Laparoscopic colon resections are being performed with increasing frequency all over the world. However, the use of minimal access surgery in colorectal surgery has lagged behind its application in other surgical fields.
Laparoscopic sterilization was the first popular minimal access surgical procedure ever performed. Laparoscopic sterilization is very straightforward procedure. Worldwide laparoscopic sterilization is now the most commonly applied method for family planning
Laparoscopic cholecystectomy is the gold standard for the treatment of gallstone disease. The operation is routinely performed using four or three ports of entry into the abdomen. At laparoscopy hospital, we frequently perform cholecystectomy by two-port method using modified extracorporeal knot.
Laparoscopic colon resections are being performed with increasing frequency all over the world. However, the use of minimal access surgery in colorectal surgery has lagged behind its application in other surgical fields.
This presentation will help u know with the history,present and coming up trends in laparoscopy .Also it is an acquaintance presentation regarding laparoscopy.
Laparoscopy in gynaecology presented by drs igbodike emeka philip and dr rotimiigbodikeobgyn
This slide will be helpful if the presentation revolves around laparoscopy in gynaecological practice. Kindly like , clip and share the slide. it is free!
Minimal access surgery (MAS) a new surgical and interventional approach, was called by different name and one of the popular is minimally invasive surgery. However,unique complications are associated.
One of the limitations of minimal access surgery is difficulty in retrieval of tissue. Previously, surgeons were reluctant to perform many of the advanced surgical procedure due to this difficult procedure.
Dr Pradeep Jain Reviews, Fortis Hospital - Laparoscopy Surgery New HorizonesDr Pradeep Jain Reviews
Dr Pradeep Jain Reviews, Fortis Hospital - Laparoscopy Surgery New Horizones. High volume experience of Dr Pradeep Jain means better outcome for patients.
Peritoneal adhesions are a common cause of bowel obstruction, pelvic pain, and infertility. More often than not, these adhesions need to be released surgically for the management of these complications.
It has not changed the nature of disease
The basic principles of good surgery still apply,including appropriate case selection, excellent exposure,adequate retraction and a high level technical expertise
If a procedure makes no sense with conventional access, it will make no sense with a minimal access approach
The cleaner and gentler the act of operation, the less the patient suffers, the smoother and quicker his convalescence,the more exquisite his healed wound.
We actually do not know what is there stored for us, but we believe that laparoscopy is trending towards advancement and nano and robotic technology is going to replace in future.
3D cameras have come into existence and various newer technologies are being invented.
When widespread use of laparoscopy and thoracoscopy in adult patients occurred in the first part of the 1990s, it did not transfer into widespread application in the pediatric population for a number of reasons.
Slideshow of Laparoscopic Surgery by Prof. R.K. Mishra Prof. R.K. Mishra has the distinction of being first Asian who is honoured as Professor of Minimal Access Surgery by legislated University of Govt. of India. He is is currently the most experienced professor of minimal surgery in the world who has alone as a single faculty trained more than 3000 surgeon and gynaecologists from 108 countries. http://www.laparoscopyhospital.com/drrkmishra.htm
Hysteroscopy is a procedure used to view the inside of the uterus through a telescope-like device called a hysteroscope. Hysteroscopy offers a valuable extension to the gynecologist’s armamentarium.
Appendicitis was first recognized as a disease entity in the 16th century and was called perityphlitis. McBurney first described its clinical findings in 1889.
Laparoscopic surgery. Intro. History of Armata manus laparoscopic simulatorsDmitriy Shamrai
Introduction to lap.surgery - different laparoscopic techniques, equipment, instruments, benefits of laparoscopy for surgeons, hospitals and patients, laparoscopic education, Armata manus laparoscopic training and basic exercises.
Advanced exercises and IInd generation boxes with moveble camera are not shown here.
This presentation was reported during the I Laparoscopic school (by Armata manus).
P.S.: originally my or edited slides are marked by Armata manus symbol. Other slides were found in the Internet.
P.S.S.: contact author (shamraydv@gmail.com, facebook.com/dmitriy.shamrai).
Our page: armata-manus.com.
This presentation will help u know with the history,present and coming up trends in laparoscopy .Also it is an acquaintance presentation regarding laparoscopy.
Laparoscopy in gynaecology presented by drs igbodike emeka philip and dr rotimiigbodikeobgyn
This slide will be helpful if the presentation revolves around laparoscopy in gynaecological practice. Kindly like , clip and share the slide. it is free!
Minimal access surgery (MAS) a new surgical and interventional approach, was called by different name and one of the popular is minimally invasive surgery. However,unique complications are associated.
One of the limitations of minimal access surgery is difficulty in retrieval of tissue. Previously, surgeons were reluctant to perform many of the advanced surgical procedure due to this difficult procedure.
Dr Pradeep Jain Reviews, Fortis Hospital - Laparoscopy Surgery New HorizonesDr Pradeep Jain Reviews
Dr Pradeep Jain Reviews, Fortis Hospital - Laparoscopy Surgery New Horizones. High volume experience of Dr Pradeep Jain means better outcome for patients.
Peritoneal adhesions are a common cause of bowel obstruction, pelvic pain, and infertility. More often than not, these adhesions need to be released surgically for the management of these complications.
It has not changed the nature of disease
The basic principles of good surgery still apply,including appropriate case selection, excellent exposure,adequate retraction and a high level technical expertise
If a procedure makes no sense with conventional access, it will make no sense with a minimal access approach
The cleaner and gentler the act of operation, the less the patient suffers, the smoother and quicker his convalescence,the more exquisite his healed wound.
We actually do not know what is there stored for us, but we believe that laparoscopy is trending towards advancement and nano and robotic technology is going to replace in future.
3D cameras have come into existence and various newer technologies are being invented.
When widespread use of laparoscopy and thoracoscopy in adult patients occurred in the first part of the 1990s, it did not transfer into widespread application in the pediatric population for a number of reasons.
Slideshow of Laparoscopic Surgery by Prof. R.K. Mishra Prof. R.K. Mishra has the distinction of being first Asian who is honoured as Professor of Minimal Access Surgery by legislated University of Govt. of India. He is is currently the most experienced professor of minimal surgery in the world who has alone as a single faculty trained more than 3000 surgeon and gynaecologists from 108 countries. http://www.laparoscopyhospital.com/drrkmishra.htm
Hysteroscopy is a procedure used to view the inside of the uterus through a telescope-like device called a hysteroscope. Hysteroscopy offers a valuable extension to the gynecologist’s armamentarium.
Appendicitis was first recognized as a disease entity in the 16th century and was called perityphlitis. McBurney first described its clinical findings in 1889.
Laparoscopic surgery. Intro. History of Armata manus laparoscopic simulatorsDmitriy Shamrai
Introduction to lap.surgery - different laparoscopic techniques, equipment, instruments, benefits of laparoscopy for surgeons, hospitals and patients, laparoscopic education, Armata manus laparoscopic training and basic exercises.
Advanced exercises and IInd generation boxes with moveble camera are not shown here.
This presentation was reported during the I Laparoscopic school (by Armata manus).
P.S.: originally my or edited slides are marked by Armata manus symbol. Other slides were found in the Internet.
P.S.S.: contact author (shamraydv@gmail.com, facebook.com/dmitriy.shamrai).
Our page: armata-manus.com.
FUNDAMENTALS OF LAPAROSCOPIC AND ROBOTIC UROLOGIC SURGERY.pptxvaidyamk89
In past 30 years- minimally invasive urology has become predominant. Laparoscopic and robotic procedures have shown equivalent efficacy and acceptable efficiency as well as the distinct advantages of
decreased postoperative pain,
improved cosmesis,
expedited recovery, a shorter hospital stay,
European hernia society guidelines: Adult Inguinal Hernia (Post operative car...Jibran Mohsin
This presentation gives general overview of European Hernia Society (EHS) guidelines regarding post operative care and complications in adult inguinal hernia.
Ureteric injury in Gyenec Surgery, Serious complication of gynecologic surgery
Significant morbidity and long-term sequelae
Uncommon in benign gynecologic surgery
Vaginal hysterectomy has the lowest rate of ureteral injury
Laparoscopic hysterectomy has the highestThe ureters are the muscular ,thick walled narrow tubes(Right and Left)
Each measures 25-30 cm in length and extends from renal pelvis to its entry in the bladder.The ureter are located retroperitonealy and run from the renal pelvic to urinary bladder.
First part –Enter the pelvis by crossing the common iliac vessel from lateral to medial aspect at their bifurcation just medial to ovarian vessel and run downwards along with greater sciatic notch & reaches ischial spine.
tracheostomy is important surgery in emergency and icu patient so this presentation is very good opportunity to gain informative ideas about this surgery
Ashu skin care - best hair transplant clinic in bhubaneswar odisha www.hai...Rabi Satpathy
Ashu Skin Care - Best Hair Transplant Clinic in bhubaneswar Odisha for Hair restoration and is one of the Top trichology & Skin Care clinic provides newest hair loss treatments along with cosmetic skin treatments for acne, pimples, skin brightening, acne scars.
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Best skin Specialist doctor in bhubaneswar dr anita rathRabi Satpathy
Dr Anita Rath - The Best Dermatologist & Trichologist , Laser Specialist Doctor in Bhubaneswar, only available at Ashu Skin Care, the best dermatology Clinic in Bhubaneswar.
Ashu Skin Care offers you Skin care, Hair Care, Laser Skin Care , Slimming & Weight Loss treatment Services with highly Successful results in shortest possible time with the help of Clinical Expertise, Use of International very high Quality Products & latest innovations in medical Science.
ASHU SKIN CARE is the most trusted Skin Clinic in Bhubaneswar & Reveiwed as the Best Skin Clinic , Hair Clinic, Cosmetology Clinic , Laser Treatment Clinic & Hair transplant clinic in Bhubaneswar, Odisha, India.
Best dermatologist & skin specialist in bhubaneswar dr anita rathRabi Satpathy
Dr Anita Rath - The Best Dermatologist & Trichologist , Laser Specialist Doctor in Bhubaneswar, only available at Ashu Skin Care, the best dermatology Clinic in Bhubaneswar.
Ashu Skin Care offers you Skin care, Hair Care, Laser Skin Care , Slimming & Weight Loss treatment Services with highly Successful results in shortest possible time with the help of Clinical Expertise, Use of International very high Quality Products & latest innovations in medical Science.
ASHU SKIN CARE is the most trusted Skin Clinic in Bhubaneswar & Reviewed as the Best Skin Clinic , Hair Clinic, Cosmetology Clinic , Laser Treatment Clinic & Hair transplant clinic in Bhubaneswar, Odisha, India.
prostaglandin, labour, pregnancy, obstetrics, delivery, normal labour, normal delivery, first stage of labour, induction of labour, pph, post partum haemorrhage, bleeding in pregnancy, abortion
Interventional ultrasound in obstetrics dr rabiRabi Satpathy
usg in pregnancy, interventional ultrasound, pregnancy ultrasound, obstetric ultrasound, congenital disease, intra uterine treatment of the fetus, fetal therapy,
Ozempic: Preoperative Management of Patients on GLP-1 Receptor Agonists Saeid Safari
Preoperative Management of Patients on GLP-1 Receptor Agonists like Ozempic and Semiglutide
ASA GUIDELINE
NYSORA Guideline
2 Case Reports of Gastric Ultrasound
Tom Selleck Health: A Comprehensive Look at the Iconic Actor’s Wellness Journeygreendigital
Tom Selleck, an enduring figure in Hollywood. has captivated audiences for decades with his rugged charm, iconic moustache. and memorable roles in television and film. From his breakout role as Thomas Magnum in Magnum P.I. to his current portrayal of Frank Reagan in Blue Bloods. Selleck's career has spanned over 50 years. But beyond his professional achievements. fans have often been curious about Tom Selleck Health. especially as he has aged in the public eye.
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Introduction
Many have been interested in Tom Selleck health. not only because of his enduring presence on screen but also because of the challenges. and lifestyle choices he has faced and made over the years. This article delves into the various aspects of Tom Selleck health. exploring his fitness regimen, diet, mental health. and the challenges he has encountered as he ages. We'll look at how he maintains his well-being. the health issues he has faced, and his approach to ageing .
Early Life and Career
Childhood and Athletic Beginnings
Tom Selleck was born on January 29, 1945, in Detroit, Michigan, and grew up in Sherman Oaks, California. From an early age, he was involved in sports, particularly basketball. which played a significant role in his physical development. His athletic pursuits continued into college. where he attended the University of Southern California (USC) on a basketball scholarship. This early involvement in sports laid a strong foundation for his physical health and disciplined lifestyle.
Transition to Acting
Selleck's transition from an athlete to an actor came with its physical demands. His first significant role in "Magnum P.I." required him to perform various stunts and maintain a fit appearance. This role, which he played from 1980 to 1988. necessitated a rigorous fitness routine to meet the show's demands. setting the stage for his long-term commitment to health and wellness.
Fitness Regimen
Workout Routine
Tom Selleck health and fitness regimen has evolved. adapting to his changing roles and age. During his "Magnum, P.I." days. Selleck's workouts were intense and focused on building and maintaining muscle mass. His routine included weightlifting, cardiovascular exercises. and specific training for the stunts he performed on the show.
Selleck adjusted his fitness routine as he aged to suit his body's needs. Today, his workouts focus on maintaining flexibility, strength, and cardiovascular health. He incorporates low-impact exercises such as swimming, walking, and light weightlifting. This balanced approach helps him stay fit without putting undue strain on his joints and muscles.
Importance of Flexibility and Mobility
In recent years, Selleck has emphasized the importance of flexibility and mobility in his fitness regimen. Understanding the natural decline in muscle mass and joint flexibility with age. he includes stretching and yoga in his routine. These practices help prevent injuries, improve posture, and maintain mobilit
New Drug Discovery and Development .....NEHA GUPTA
The "New Drug Discovery and Development" process involves the identification, design, testing, and manufacturing of novel pharmaceutical compounds with the aim of introducing new and improved treatments for various medical conditions. This comprehensive endeavor encompasses various stages, including target identification, preclinical studies, clinical trials, regulatory approval, and post-market surveillance. It involves multidisciplinary collaboration among scientists, researchers, clinicians, regulatory experts, and pharmaceutical companies to bring innovative therapies to market and address unmet medical needs.
The Gram stain is a fundamental technique in microbiology used to classify bacteria based on their cell wall structure. It provides a quick and simple method to distinguish between Gram-positive and Gram-negative bacteria, which have different susceptibilities to antibiotics
Basavarajeeyam is an important text for ayurvedic physician belonging to andhra pradehs. It is a popular compendium in various parts of our country as well as in andhra pradesh. The content of the text was presented in sanskrit and telugu language (Bilingual). One of the most famous book in ayurvedic pharmaceutics and therapeutics. This book contains 25 chapters called as prakaranas. Many rasaoushadis were explained, pioneer of dhatu druti, nadi pareeksha, mutra pareeksha etc. Belongs to the period of 15-16 century. New diseases like upadamsha, phiranga rogas are explained.
Flu Vaccine Alert in Bangalore Karnatakaaddon Scans
As flu season approaches, health officials in Bangalore, Karnataka, are urging residents to get their flu vaccinations. The seasonal flu, while common, can lead to severe health complications, particularly for vulnerable populations such as young children, the elderly, and those with underlying health conditions.
Dr. Vidisha Kumari, a leading epidemiologist in Bangalore, emphasizes the importance of getting vaccinated. "The flu vaccine is our best defense against the influenza virus. It not only protects individuals but also helps prevent the spread of the virus in our communities," he says.
This year, the flu season is expected to coincide with a potential increase in other respiratory illnesses. The Karnataka Health Department has launched an awareness campaign highlighting the significance of flu vaccinations. They have set up multiple vaccination centers across Bangalore, making it convenient for residents to receive their shots.
To encourage widespread vaccination, the government is also collaborating with local schools, workplaces, and community centers to facilitate vaccination drives. Special attention is being given to ensuring that the vaccine is accessible to all, including marginalized communities who may have limited access to healthcare.
Residents are reminded that the flu vaccine is safe and effective. Common side effects are mild and may include soreness at the injection site, mild fever, or muscle aches. These side effects are generally short-lived and far less severe than the flu itself.
Healthcare providers are also stressing the importance of continuing COVID-19 precautions. Wearing masks, practicing good hand hygiene, and maintaining social distancing are still crucial, especially in crowded places.
Protect yourself and your loved ones by getting vaccinated. Together, we can help keep Bangalore healthy and safe this flu season. For more information on vaccination centers and schedules, residents can visit the Karnataka Health Department’s official website or follow their social media pages.
Stay informed, stay safe, and get your flu shot today!
- Video recording of this lecture in English language: https://youtu.be/lK81BzxMqdo
- Video recording of this lecture in Arabic language: https://youtu.be/Ve4P0COk9OI
- Link to download the book free: https://nephrotube.blogspot.com/p/nephrotube-nephrology-books.html
- Link to NephroTube website: www.NephroTube.com
- Link to NephroTube social media accounts: https://nephrotube.blogspot.com/p/join-nephrotube-on-social-media.html
Adv. biopharm. APPLICATION OF PHARMACOKINETICS : TARGETED DRUG DELIVERY SYSTEMSAkankshaAshtankar
MIP 201T & MPH 202T
ADVANCED BIOPHARMACEUTICS & PHARMACOKINETICS : UNIT 5
APPLICATION OF PHARMACOKINETICS : TARGETED DRUG DELIVERY SYSTEMS By - AKANKSHA ASHTANKAR
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Title: Sense of Smell
Presenter: Dr. Faiza, Assistant Professor of Physiology
Qualifications:
MBBS (Best Graduate, AIMC Lahore)
FCPS Physiology
ICMT, CHPE, DHPE (STMU)
MPH (GC University, Faisalabad)
MBA (Virtual University of Pakistan)
Learning Objectives:
Describe the primary categories of smells and the concept of odor blindness.
Explain the structure and location of the olfactory membrane and mucosa, including the types and roles of cells involved in olfaction.
Describe the pathway and mechanisms of olfactory signal transmission from the olfactory receptors to the brain.
Illustrate the biochemical cascade triggered by odorant binding to olfactory receptors, including the role of G-proteins and second messengers in generating an action potential.
Identify different types of olfactory disorders such as anosmia, hyposmia, hyperosmia, and dysosmia, including their potential causes.
Key Topics:
Olfactory Genes:
3% of the human genome accounts for olfactory genes.
400 genes for odorant receptors.
Olfactory Membrane:
Located in the superior part of the nasal cavity.
Medially: Folds downward along the superior septum.
Laterally: Folds over the superior turbinate and upper surface of the middle turbinate.
Total surface area: 5-10 square centimeters.
Olfactory Mucosa:
Olfactory Cells: Bipolar nerve cells derived from the CNS (100 million), with 4-25 olfactory cilia per cell.
Sustentacular Cells: Produce mucus and maintain ionic and molecular environment.
Basal Cells: Replace worn-out olfactory cells with an average lifespan of 1-2 months.
Bowman’s Gland: Secretes mucus.
Stimulation of Olfactory Cells:
Odorant dissolves in mucus and attaches to receptors on olfactory cilia.
Involves a cascade effect through G-proteins and second messengers, leading to depolarization and action potential generation in the olfactory nerve.
Quality of a Good Odorant:
Small (3-20 Carbon atoms), volatile, water-soluble, and lipid-soluble.
Facilitated by odorant-binding proteins in mucus.
Membrane Potential and Action Potential:
Resting membrane potential: -55mV.
Action potential frequency in the olfactory nerve increases with odorant strength.
Adaptation Towards the Sense of Smell:
Rapid adaptation within the first second, with further slow adaptation.
Psychological adaptation greater than receptor adaptation, involving feedback inhibition from the central nervous system.
Primary Sensations of Smell:
Camphoraceous, Musky, Floral, Pepperminty, Ethereal, Pungent, Putrid.
Odor Detection Threshold:
Examples: Hydrogen sulfide (0.0005 ppm), Methyl-mercaptan (0.002 ppm).
Some toxic substances are odorless at lethal concentrations.
Characteristics of Smell:
Odor blindness for single substances due to lack of appropriate receptor protein.
Behavioral and emotional influences of smell.
Transmission of Olfactory Signals:
From olfactory cells to glomeruli in the olfactory bulb, involving lateral inhibition.
Primitive, less old, and new olfactory systems with different path
1. MISADVENTURES INMISADVENTURES IN
ENDOSCOPIC SURGERYENDOSCOPIC SURGERY
Dr. Rabinarayan SatapathyDr. Rabinarayan Satapathy
Asst. ProfessorAsst. Professor
Dept. of Obst.& GynaeDept. of Obst.& Gynae
S.C.B. Medical College,CuttackS.C.B. Medical College,Cuttack
2. Complications :Complications :
** Related to endoscopy itselfRelated to endoscopy itself
** Related to anaesthesiaRelated to anaesthesia
3. • Reported complication rate of 3.2/1000( FrenchReported complication rate of 3.2/1000( French
multicentric, collaborative study of 15,521cases)multicentric, collaborative study of 15,521cases)
• Nezhat et al reported complication rate of 3.08% ofNezhat et al reported complication rate of 3.08% of
6949 advanced endoscopic surgeries6949 advanced endoscopic surgeries
• Complication rate ↑ to 5 .2/1000 for advancedComplication rate ↑ to 5 .2/1000 for advanced
interventionsinterventions
• Complication rateComplication rate↓↓ by almost 50 % since 1972 (6.8 vsby almost 50 % since 1972 (6.8 vs
3.2/1000)3.2/1000)
4. ANAESTHETIC COMPLICATIONSANAESTHETIC COMPLICATIONS
RareRare
HypoventilationHypoventilation
Inadvertent endobronchial intubation (as hilumInadvertent endobronchial intubation (as hilum
of lung displaced upwards in deep Trendelenburgof lung displaced upwards in deep Trendelenburg
position)position)
↑↑ risk of regurgitation of gastric contentsrisk of regurgitation of gastric contents
Adverse cardiorespiratory effectsAdverse cardiorespiratory effects
6. Complications of PneumoperitoneumComplications of Pneumoperitoneum
Associated with Veress needleAssociated with Veress needle ::
** Preperitoneal & omental emphysemaPreperitoneal & omental emphysema
** Injury to blood vesselInjury to blood vessel
**Injury to intestinal tractInjury to intestinal tract
**Injury to bladderInjury to bladder
**Gas embolismGas embolism
7. Minimizing complications ofMinimizing complications of
PneumoperitoneumPneumoperitoneum
• Percuss left upper quadrant to detect gastricPercuss left upper quadrant to detect gastric
distensiondistension
• Test spring mechanism before insertionTest spring mechanism before insertion
• Leave valve openLeave valve open
• Direct towards hollow of sacrumDirect towards hollow of sacrum
• Advance only 2-3mm after piercing parietalAdvance only 2-3mm after piercing parietal
peritoneumperitoneum
8. ……contdcontd
• Perform safety testsPerform safety tests ::
**hissing phenomenonhissing phenomenon
**aspiration testaspiration test
**hanging drop methodhanging drop method
**monitoring intra-abd pressuremonitoring intra-abd pressure
• Do not insufflate at more than 1L/min initiallyDo not insufflate at more than 1L/min initially
• If no obliteration of liver dullness, suspectIf no obliteration of liver dullness, suspect
extravasationextravasation
• Avoid over-insufflation of peritoneal cavityAvoid over-insufflation of peritoneal cavity
9. Extraperitoneal InsufflationExtraperitoneal Insufflation
• Usually pre-peritoneal
• Recognized by abnormal high insufflation
pressure & palpation of abdomen
• Remove needle, allow gas to escape, then re-
introduce
• Complications include mediastinal
emphysema & compromised cardiac function
• Pneumo-omentum harmless & rare (2%)
10. Complications due to TrocarsComplications due to Trocars
♦♦ Major injuries due to adherent bowel or lowMajor injuries due to adherent bowel or low
intraperitoneal pressure at time of introductionintraperitoneal pressure at time of introduction
( wait for intraperitoneal pressure of 15 mm Hg)( wait for intraperitoneal pressure of 15 mm Hg)
♦♦ Injury to hollow viscera or blood vesselsInjury to hollow viscera or blood vessels → due to→ due to
uncontrolled entry or improper directionuncontrolled entry or improper direction
↓↓
Laparotomy and vascular repair
11. Injury to epigastric vessels:Injury to epigastric vessels:
Transillumination of abdominal wall isTransillumination of abdominal wall is
preventivepreventive
Transparietal suturesTransparietal sutures
BBipolar laparoscopic coagulationipolar laparoscopic coagulation
Compression by Foley’s catheter at involvedCompression by Foley’s catheter at involved
site by introduction through 5 mm trocarsite by introduction through 5 mm trocar
sleevesleeve
12. Minimizing complications with TrocarMinimizing complications with Trocar
** Place finger guard to within 3cm of trocar tipPlace finger guard to within 3cm of trocar tip
** Use controlled twisting motionUse controlled twisting motion
** Direct trocar tip towards sacral hollowDirect trocar tip towards sacral hollow
** Advance no more than 2cm beyond parietalAdvance no more than 2cm beyond parietal
peritoneumperitoneum
** Replace laparoscope into trocar sheath firstReplace laparoscope into trocar sheath first
during withdrawalduring withdrawal
13. Minimizing complicationsMinimizing complications
** Transilluminate for epigastric vesselsTransilluminate for epigastric vessels
** Place trocars as high above symphysis pubisPlace trocars as high above symphysis pubis
as cosmetically possible ( never less than 3cm)as cosmetically possible ( never less than 3cm)
** Insert ancillary trocar under direct lap visionInsert ancillary trocar under direct lap vision
** Direct downward, not laterallyDirect downward, not laterally
14. Injuries during Operative ProcedureInjuries during Operative Procedure
Injury to bladder
Due to:
* dissection
* electrocoagulation
* laser use
Predisposing factors include previous CS,
endometriosis
Detection by noting presence of blood & gas
in urobag. Confirmation by infusion of methylene
blue dye into bladder
Small injury – heals spontaneously with indwelling
catheter
Large injury – suture by laparotomy or laparoscopy
15. Injuries during OperativeInjuries during Operative
Procedure…Procedure… contd.contd.
Injury to ureterInjury to ureter
**Due to:Due to:
-- sharp dissectionsharp dissection
-- electrosurgeryelectrosurgery
-- laserlaser
-- during isolation of uterosacral ligamentduring isolation of uterosacral ligament
-- improper evaluation of anatomyimproper evaluation of anatomy
-- adhesions, myomas, endometriosisadhesions, myomas, endometriosis
** Diagnosis madeDiagnosis made 48-72 hrs after surgery48-72 hrs after surgery
** Confirm by IVPConfirm by IVP
** Treatment is reanastomosisTreatment is reanastomosis
16. Injuries during OperativeInjuries during Operative
Procedure…Procedure… contd.contd.
Injury to small bowelInjury to small bowel
* Occurs during surgery for adhesions
* Electro or laser surgery causes occult thermal
lesions- apparent after 48-72 hrs.
* Frank bowel perforation warrants laparotomy
for transverse suture or resection-anastomosis
17. Injuries during OperativeInjuries during Operative
Procedure…Procedure… contd.contd.
Vascular injuryVascular injury
* Occurs mainly during lap hysterectomy
* Careful isolation and coagulation of uterine
arteries by bipolar electrosurgery is the key
* Beware of improper haemostasis
* Other sites are tubal, ovarian or vaginal vessels
* Should be managed laparoscopically
* Ensure haemostasis before withdrawing scope
19. Minimizing complications ofMinimizing complications of
Endoscopic SurgeryEndoscopic Surgery
** Minimize use of unipolar electrocauteryMinimize use of unipolar electrocautery
** Disconnect all electrosurgical units when not in useDisconnect all electrosurgical units when not in use
** Identify ureters before ant surgery of pelvic side wallIdentify ureters before ant surgery of pelvic side wall
** Use traction/countertraction to identify tissue planesUse traction/countertraction to identify tissue planes
** Minimize forceful blunt dissectionMinimize forceful blunt dissection
** Spread jaw of scissors to develop tissue planesSpread jaw of scissors to develop tissue planes
** Cauterize vessels before transectionCauterize vessels before transection
** Avoid scissor action between instruments to avoidAvoid scissor action between instruments to avoid
pinching of bowel or omentumpinching of bowel or omentum
** Do not cut any tissue before identifying its anatomyDo not cut any tissue before identifying its anatomy
20. Complications of HysteroscopyComplications of Hysteroscopy
** TraumaTrauma
** HaemorrhageHaemorrhage
** Complications related to distension mediaComplications related to distension media
** InfectionInfection
** Thermal damageThermal damage
** CO2 & air embolismCO2 & air embolism
21. TraumaTrauma
* Cervical & Uterine perforationCervical & Uterine perforation
** Occurs during insertion of manipulators,Occurs during insertion of manipulators,
dilators, hysteroscope or during surgerydilators, hysteroscope or during surgery
** Hysteroscopic surgery suspended due to gasHysteroscopic surgery suspended due to gas
or fluid leakageor fluid leakage
** Small, mechanical perforations – observationSmall, mechanical perforations – observation
onlyonly
22. Trauma…Trauma…contdcontd..
** Lateral wall injury or broad ligamentLateral wall injury or broad ligament
haematoma- concurrent use of laparoscopehaematoma- concurrent use of laparoscope
usefuluseful
** Perforation due to electrosurgical electrode –Perforation due to electrosurgical electrode –
laparotomy warrantedlaparotomy warranted
** Uterine perforations avoided by gentleUterine perforations avoided by gentle
insertion of hysteroscope under direct visioninsertion of hysteroscope under direct vision
** In difficult cases, do concomitant laparoscopyIn difficult cases, do concomitant laparoscopy
23. HaemorrhageHaemorrhage
** Occurs during surgery for submucusOccurs during surgery for submucus
myoma/TCREmyoma/TCRE
** Usually possible to control withUsually possible to control with
electrocauteryelectrocautery
** Post opereative tamponade with Foley’sPost opereative tamponade with Foley’s
catheter usefulcatheter useful
** If field of vision obscured, stop operationIf field of vision obscured, stop operation
24. Complications related to distension mediaComplications related to distension media
** Distension media used:Distension media used:
CO2CO2
Dextran-70Dextran-70
5% dextrose5% dextrose
Glycine, Sorbitol, MannitolGlycine, Sorbitol, Mannitol
** Should be non-conductive in hysteroscopic surgeryShould be non-conductive in hysteroscopic surgery
** Dangers:Dangers:
Dextran - anaphylaxis, DIC, ARDS, non-cardiogenicDextran - anaphylaxis, DIC, ARDS, non-cardiogenic
pulmonary oedemapulmonary oedema
5% dext - hyperglycaemia, hyponatraemia5% dext - hyperglycaemia, hyponatraemia
CO2 – Fatal gas embolismCO2 – Fatal gas embolism
25. FLUID OVERLOADFLUID OVERLOAD
~ Monitor fluid intake & output carefully. Look
out for +ve fluid balance
~ Length of hysteroscopic procedure and the
amount of raw uterine surface created are
important factors.
~ Dilutional hyponatraemia causes cerebral
oedema , convulsions and even death
26. + ve fluid balance+ ve fluid balance RemarksRemarks
1000ml1000ml AlertAlert
1500m1500m Finish surgeryFinish surgery
quicklyquickly
2000ml2000ml STOP SURGERY!!STOP SURGERY!!
Give diureticsGive diuretics
27. CONCLUSIONCONCLUSION
** Complications of endoscopic surgery areComplications of endoscopic surgery are
directly related to the skill of the surgeondirectly related to the skill of the surgeon
** Availability of appropriate instruments is anAvailability of appropriate instruments is an
important factorimportant factor
** Prevention of complications should be thePrevention of complications should be the
aimaim
** Early detection of complications is essentialEarly detection of complications is essential
28. FOREWARNED IS FOREARMEDFOREWARNED IS FOREARMED
MISADVENTUREMISADVENTURE
↓↓
ADVENTUREADVENTURE
ENDOSCOPIC SURGERY IS SAFE!!ENDOSCOPIC SURGERY IS SAFE!!