Can Endolaparoscopic Techniques Solve all surgical

Teknik minimal invasif dalam penanganan seluruh kasus bedah

1. Can Endo Laparoscopic Techniques Solve All Surgical Problems? dr. Tommy Ruchimat , Sp.B , Subsp.BD(K) 1 st Beyond the Scalpel ( B.t.S .) Controversies in Trauma & Minimally Invasive Surgery

2. Endoscopy is a minimally invasive diagnostic medical procedure that is used to assess the interior surfaces of an organ by inserting a tube into the body May have a rigid or flexible tube and not only provide an image for visual inspection and photography, but also enable taking biopsies and retrieval of foreign objects Definition of Endoscopy 1 st Beyond the Scalpel ( B.t.S .) Controversies in Trauma & Minimally Invasive Surgery

3. History of Endoscopy 1 st Beyond the Scalpel ( B.t.S .) Controversies in Trauma & Minimally Invasive Surgery Gulati S, Patel M, Emmanuel A, Haji A, Hayee BH, Neumann H. The future of endoscopy: Advances in endoscopic image innovations. Digestive Endoscopy. 2020 May;32(4):512-22.

4. History of Laparoscopy 1 st Beyond the Scalpel ( B.t.S .) Controversies in Trauma & Minimally Invasive Surgery Alkatout I, Mechler U, Mettler L, Pape J, Maass N, Biebl M, Gitas G, Laganà AS, Freytag D. The development of laparoscopy—a historical overview. Frontiers in surgery. 2021 Dec 15;8:799442. Alkatout I, Mechler U, Mettler L, Pape J, Maass N, Biebl M, Gitas G, Laganà AS, Freytag D. The development of laparoscopy—a historical overview. Frontiers in surgery. 2021 Dec 15;8:799442.

5. History of Laparoscopy 1 st Beyond the Scalpel ( B.t.S .) Controversies in Trauma & Minimally Invasive Surgery Alkatout I, Mechler U, Mettler L, Pape J, Maass N, Biebl M, Gitas G, Laganà AS, Freytag D. The development of laparoscopy—a historical overview. Frontiers in surgery. 2021 Dec 15;8:799442.

6. History of Laparoscopy 1 st Beyond the Scalpel ( B.t.S .) Controversies in Trauma & Minimally Invasive Surgery Alkatout I, Mechler U, Mettler L, Pape J, Maass N, Biebl M, Gitas G, Laganà AS, Freytag D. The development of laparoscopy—a historical overview. Frontiers in surgery. 2021 Dec 15;8:799442.

7. History of Laparoscopy 1 st Beyond the Scalpel ( B.t.S .) Controversies in Trauma & Minimally Invasive Surgery Alkatout I, Mechler U, Mettler L, Pape J, Maass N, Biebl M, Gitas G, Laganà AS, Freytag D. The development of laparoscopy—a historical overview. Frontiers in surgery. 2021 Dec 15;8:799442.

8. Use of Artificial Intelligence and Deep Learning: Deep Learning involving artificial neural networks (ANNs) aims to replicate the learning process of the brain and is able to process large volumes of high dimensional data, relevant to endoscopic image recognition. Hypoxia imaging Tissue oxygenation can provide vital information on hypoxia dependent cellular pathways and mitochondrial function reflecting tissue metabolic state and cell health. Benefits of Endoscopy 1 st Beyond the Scalpel ( B.t.S .) Controversies in Trauma & Minimally Invasive Surgery

9. Minimally Invasive: Endoscopic surgery requires only small incisions or natural orifices, leading to less tissue damage, reduced pain, and faster recovery times. Reduced Risk of Complications: The smaller incisions lower the risk of infections and other surgical complications. Shorter Hospital Stays: Patients often have shorter hospital stays and quicker returns to normal activities. Improved Visualization: High-definition cameras provide magnified views of the surgical field, which can improve precision Benefits of Laparoscopy 1 st Beyond the Scalpel ( B.t.S .) Controversies in Trauma & Minimally Invasive Surgery

10. Complex or Large Tumors: Some cancers or large growths may not be accessible or treatable via endoscopy, requiring open surgery for complete removal. Severe Inflammation or Scar Tissue: Conditions like severe diverticulitis or dense adhesions from previous surgeries can make endoscopic approaches challenging. Emergency Situations: While some emergencies can be managed endoscopically (e.g., bleeding ulcers), others may need immediate open surgery due to the need for direct access and quick action. Dangers of Endoscopy 1 st Beyond the Scalpel ( B.t.S .) Controversies in Trauma & Minimally Invasive Surgery

11. Structural Limitations: Certain anatomical structures or disease processes may not be easily reached or treated through endoscopy. For example, some spinal surgeries or complex cardiac procedures still require open techniques. Learning Curve: Not all surgeons are trained or experienced in endoscopic methods, and there can be a steep learning curve to master these techniques. Dangers of Endoscopy 1 st Beyond the Scalpel ( B.t.S .) Controversies in Trauma & Minimally Invasive Surgery

12. Appendectomy Cholecystectomy Esophageal Surgery Reflux Surgery Gastric Surgery Colorectal Surgery Colon cancer Rectal Surgery Laparoscopic Surgeries 1 st Beyond the Scalpel ( B.t.S .) Controversies in Trauma & Minimally Invasive Surgery Rectal Cancer Liver Surgery Surgery of the adrenal glands Pancreatic Surgery Surgery of the Spleen Laparoscopic Hernia Surgery Buia A, Stockhausen F, Hanisch E. Laparoscopic surgery: a qualified systematic review. World journal of methodology. 2015 Dec 12;5(4):238.

13. Contraindication of Laparoscopy: Anatomic and Physiologic Contraindications 1 st Beyond the Scalpel ( B.t.S .) Controversies in Trauma & Minimally Invasive Surgery Buote NJ, McClaran JK. Laparoscopic contraindications, complications, and conversion. Small animal laparoscopy and thoracoscopy. 2015 Sep 15:93-102.

14. Non-specific abdominal pain Acute cholecystitis Acute appendicitis Acute sigmoid diverticulitis Acute gallstone pancreatitis Acute intestinal obstruction due to pain Gastro-duodenal ulcer disease Emergency Laparoscopic: Role and Implementation 1 st Beyond the Scalpel ( B.t.S .) Controversies in Trauma & Minimally Invasive Surgery Lupinacci RM, Menegaux F, Trésallet C. Emergency laparoscopy: role and implementation. Journal of Visceral Surgery. 2015 Dec 1;152(6):S65-71.

15. Cost and Accessibility Requires expensive specialized equipment. Limits access in resource-limited areas Learning Curve The technique has a steep learning curve. Lack of experience can increase the risk of complications. Requires additional time and cost for adequate training. Controversies in Laparoscopic Surgeries 1 st Beyond the Scalpel ( B.t.S .) Controversies in Trauma & Minimally Invasive Surgery Buia A, Stockhausen F, Hanisch E. Laparoscopic surgery: a qualified systematic review. World journal of methodology. 2015 Dec 12;5(4):238.

16. Hidden Risk Complications like internal bleeding or perforation may be hard to detect. Gas insufflation can affect cardiopulmonary function Patient Selection Not all patients are suitable for laparoscopy. Patients with extensive adhesions, morbid obesity, or prior abdominal surgeries may not benefit optimally. Controversies in Laparoscopic Surgeries 1 st Beyond the Scalpel ( B.t.S .) Controversies in Trauma & Minimally Invasive Surgery Buia A, Stockhausen F, Hanisch E. Laparoscopic surgery: a qualified systematic review. World journal of methodology. 2015 Dec 12;5(4):238.

17. Adhesion inability to obtain adequate exposure for the critical region of interest Very large mass may fill the entire abdomen and limit vision and access to organs When to convert to laparotomy? 1 st Beyond the Scalpel ( B.t.S .) Controversies in Trauma & Minimally Invasive Surgery Mehasseb M. Laparoscopic surgery: when to convert to laparotomy?. Gynecologic and obstetric surgery: challenges and management options. 2016 Feb 24:267-8.

18. Obesity Conversion risks are higher with a BMI greater than 30, and dramatically increase with a BMI greater than 50 Hemorrhage Comorbid Pre‐existing chronic obstructive and restrictive lung diseases When to convert to laparotomy? 1 st Beyond the Scalpel ( B.t.S .) Controversies in Trauma & Minimally Invasive Surgery Mehasseb M. Laparoscopic surgery: when to convert to laparotomy?. Gynecologic and obstetric surgery: challenges and management options. 2016 Feb 24:267-8.

19. Patient Preparation: Identify conditions like bleeding disorders, cardiovascular issues, or allergies that may increase risks. Adhere to fasting guidelines to minimize the risk of aspiration. Use the least amount of sedation necessary for patient comfort, and monitor vital signs throughout. Operator’s Expertise: Ensure the endoscopist is adequately trained in both diagnostic and therapeutic procedures. Familiarity with managing adverse events like perforation, bleeding, or cardiopulmonary instability is critical. Tips to reduce risk of complication or convertion : 1 st Beyond the Scalpel ( B.t.S .) Controversies in Trauma & Minimally Invasive Surgery Buia A, Stockhausen F, Hanisch E. Laparoscopic surgery: a qualified systematic review. World journal of methodology. 2015 Dec 12;5(4):238.

20. Equipment-Related Precautions Employ state-of-the-art endoscopes with enhanced imaging capabilities to improve precision. Perform routine checks and maintenance to avoid equipment-related failures during procedures. Procedural Techniques Avoid excessive force or manipulation of tissues to minimize trauma. Continuously monitor vital signs and endoscopic views to promptly identify and address complications. Tips to reduce risk of complication or convertion : 1 st Beyond the Scalpel ( B.t.S .) Controversies in Trauma & Minimally Invasive Surgery Buia A, Stockhausen F, Hanisch E. Laparoscopic surgery: a qualified systematic review. World journal of methodology. 2015 Dec 12;5(4):238.

21. Post-Procedural Care Monitor patients post-procedure for signs of complications like bleeding, perforation, or infection. Provide comprehensive discharge instructions, including signs and symptoms of potential complications and when to seek medical attention. Tips to reduce risk of complication or convertion : 1 st Beyond the Scalpel ( B.t.S .) Controversies in Trauma & Minimally Invasive Surgery Buia A, Stockhausen F, Hanisch E. Laparoscopic surgery: a qualified systematic review. World journal of methodology. 2015 Dec 12;5(4):238.

22. Conclusion While endoscopic techniques have significantly expanded the possibilities for minimally invasive surgery, they are not a universal solution. The choice between endoscopy, laparoscopy, open surgery, or other methods depends on the specific condition, the patient's overall health, and the expertise of the surgical team. 1 st Beyond the Scalpel ( B.t.S .) Controversies in Trauma & Minimally Invasive Surgery

23. Thank you! 1 st Beyond the Scalpel ( B.t.S .) Controversies in Trauma & Minimally Invasive Surgery