腹腔镜外科学英文版课件

单击此处编辑母版标题样式,单击此处编辑母版文本样式,第二级,第三级,第四级,第五级,*,*,LAPAROSCOPICSURGERY,JanePBradleyHendricks,RGN,BSE(hons),MCS,IndependentNursePresc,riber,SurgicalCarePractitioner,LaparoscopicSurgery.,ColchesterGeneralHospital,SHORT HISTORY,?,1982 Semm performed first Laparoscopic,Appendicectomy.,?,1987 Mouret performed first,Laparoscopic Cholecystectomy.,?,1992 First UK Laparoscopic Training,centre established.,LAPAROSCOPIC SURGERY,“KEYHOLE SURGERY”,MINIMALLY INVASIVE SURGERY,MINIMAL ACCESS SURGERY,What operations can we do,laparoscopically?,Diagnosis,Crohns Disease,Diverticulitis,Rectal Prolapse,Benign renal disease,Gastric Obstruction,Some Splenic disorders,Operation,Bowel resection,Bowel resection,Repair of Prolapse,Nephrectomy,Bypass,Spleenectomy,What operations can we do,Laparoscopically,Diagnosis,Gallstone,Appendicitis,Hernia,Adhesions,Perforated ulcer,Hiatus Hernia,Operation,Cholecystectomy,Appendicectomy,Hernia repair,Division of adhesions,Closure of perforation,Hiatus hernia repair.,What operations can we do,Laparoscopically,Diagnosis,Colorectal carcinoma,Caecal carcinoma,Colonic carcinoma,Gastric carcinoma,Oesophageal carcinoma,The list is endless!,Operation,Anterior resection/APR,Right Hemicolectomy,Left/Sigmoid Colectomy,Gastrectomy,Oesophagogastrectomy,Principle Differences between,Laparoscopic and Open Surgery,FOR THE PATIENT,?,Post operative pain related to size of incision-,smaller incisions=less pain.,?,Less Handling of intestines results in little or no,disturbance of normal function.,?,Avoidance of the trauma of abdominal wall injury,by the incision allows rapid return to normal,activity,?,No incision allows early return to more strenuous,activities:driving,lifting,sport etc.,Principle Differences between,laparoscopic and open surgery,FOR THE HOSPITAL,?,Initial capital costs to establish laparoscopic,surgery in the order of,30,000-,40,000,?,Reduced overall costs by shortening of,hospital stay e.g.cholecystectomy reduced,from 5 to 1 day,hiatus hernia repair reduced,from 7 to 3 days.,Principle Differences between,laparoscopic and open surgery,For the Surgeon,?,Magnified view often better than obtained via an,incision allows precise dissection.,?,Altered(but not absent)tactile response,?,Two dimensional(flat screen)view.,?,Usually(but not always)longer operating time,?,Need to develop entirely different operating,technique,?,Adaptation of principles of open surgery to,laparoscopic surgery.,Instruments,?,Redesign of instruments for laparoscopic,use.,?,Instruments for open surgery in general 6,10”in length built around a box joint.,?,Laparoscopic instruments in general 15,18”,in length with an articulated connecting rod,between handles and scissor blades,jaws,etc.,Equipment Necessary for MAS,Camera,Light Source,Insufflator,TV Monitor,Telescopes,Light Guide Cable,Apart from the,insufflator the system,will work better if all,the components are,from the same,company as one piece,talks to another,CAMERA,?,These can be single chip or 3 chip.,?,CHIP:thois is also called a charged coupled,device in short,CCD.,?,These are flat silicone wafers with a matrix,a grid,of minute image sensors called pixels.,?,White balance and sometimes black balance,?,Sleeve it dont soak it!,?,Light Source,?,Halogen or Xenon,cold light but beware can still,burn holes in drapes esp.disposable and burn,patients skin if left on the abdomen.,?,Brightest to darkest measured in units of decibels.,?,Automatic illumination,does it talk to the camera,and are the necessary leads plugged in.,?,Lamp life meter,look at it.Is it nearly out?EBME,keep the spares and they change it.,?,White balance by making sure white is correct,then all the colours through the spectrum are,correct.,Insufflator,?,CO2 because this has the same refractive index as,air,so doesnt distort the image and is non,combustible.,?,Intraabdominal pressure run between 10 and 13,mmhg.,?,Use disposable filter and tubing for each patient.,?,High flow insufflators(35 litres)output,determined by size of outlet.,?,Ensure you know how to change a cylinder and,were they are stored.,TV Monitors,?,Usually a 20”screen.,?,If your monitor has MD in the spec.they are,compliant with th lines.e hospital electrical safety,systems for example Son 1343-MD.,?,You can use a standard TV but it must be run,through an isolated transformer.,?,Horizontal resolution is the number of vertical,lines.,?,Vertical resolution is the number of horizontal,lines,?,More lines of resolution,better detail of picture.,Telescopes,?,Come in varying sizes,laparoscopes usually 5mm,or 10mm.,?,Diagnostic 3mm scope available but not in general,use in this hospital.,?,Made up of a rod and lens system.,?,Bundles of fibres,incoherent carry light and,coherent carry image.,?,Wide range of angles available 0 and 30 degree,are fairly standard.,?,All laparoscopes are autoclavable and can go thru,steris,no ultrasonic bath.,Light guide Cables,?,Different diameters,?,Fibre light cable,?,Buy auroclavable,?,Dont bend to acutely as will break fibre