Presentation on Principles of laparoscopic surgery .pptx

This topic is very helpful in surgical field of laparoscopy. Every surgeon should have the knowledges about principle of laparoscopy. The information i provided is tremendously helpful to do safe , meticulous and hazardless surgery.

1. Basic principles of Laparoscopic Surgery Presented by- Dr. P. C. Biswas Registrar,CuMCH

2. Dr. Kurt Semm 1982-1 st Lap. Appendicectomy Short H istory Dr. Philippe Mouret 1987-1 st Lap. cholecystectomy

3. Prof. Dr. Sarder A. Nayeem Pioneer of laparoscopic surgery in Bangladesh

4. Synonyms Minimal access surgery (MAS) Key hole surgery Minimal invasive surgery

5. Minimal Access Surgery Surgical innovation Modern technology To reduce wound access trauma Ensure less somatic and psychological trauma

6. Core Principle of MAS I – VITROS I – Insufflate V-Visualize I- Identify T- Triangulate R- Retract O- Operate S – Seal/ Hemostasis

7. Laparoscopy Thoracoscopy Retro- peritoneoscopy Endoluminal endoscopy Arthroscopy Combined Extent of MAS-

8. Laparo means abdominal cavity Scopy means to see It’s a type of key hole surgery use to explore and operate on the organs inside the abdominal and pelvic area Both diagnostic and therapeutic Laparoscopy

9. W hat operations can we do laparoscopically? All abdominal surgery except LUCS

10. C hecklist for Laparoscopic S urgery Overall fitness of patient Previous surgery – scars, adhesions Body habitus : obesity, skeletal deformity Coagulation profile Informed consent

11. Advantages Minimal invasive surgery less somatic and psychological trauma Less post-operative morbidity Less hospital stay Minimal scar Early ambulation and return to normal life

12. Disadvantages Costly Expertise related Long learning curve More operation time Potential for major complication in inexperienced hand

13. General requirements Optical system Light source and cable Insufflator Instruments Energy sources

14. Laparoscopic Trolley TV monitor Light Source Camera unit Insufflator

15. Laparoscopic camera

16. Light source- Halogen , Xenon & LED cold lights Light Source Fiber-optic cable

17. CO2 gas is preferred due to- non-combustible Doesn’t distort the image Same refractive index as air Diffusion capacity 20 times higher then oxygen Insufflator

18. Commonly used laparoscopic instruments

19. 10 mm 5mm Trocar and cannula Laparoscopic hook

20. Maryland forceps Clip applicator

21. ‘0’ degree 30 degree 30 30 Telescope

22. Short reducer Long reducer Laparoscopic reducer Suture passer

23. Atraumatic forceps

24. Traumatic forceps Dolphin forceps

25. Needle holder Laparoscopic scissors

26. Veress needle

27. How to hold trocar and cannula?

28. Physical method Chemical method Physical method includes: - Disassemble- Assemble - Manual/ mechanical cleaning - Rinse and dry - Lubrication Sterilization

29. Chemical method: Commonly used solution- CIDEX 2% Glutaraldehyde, acidic, Biocidal Duration needed: 15-20 minutes 15 cases or 15days ,which one is easier Stabimed 2 % also used

30. “Ergon” means work “Nomos” means natural law So, It is the science to make the settings & surroundings favorable for laparoscopic surgeon Ergonomics

31. I mportance of Ergonomics Reduces mechanical discomfort Reduces suturing time/ operation time Avoid unintentional visceral injury

32. Ergonomics Straight line principle Triangulation Manipulation angle Elevation angle Low lying table Gaze down view

33. S traight L ine P rinciple Monitor Surgeon Pathology

34. V isual Axis Co axial alignment It maintains straight line principle

35. Determination of Port Position Basic principles- Half of the instrument should be inside and half outside, so that the elevation angle is 60 º Contralateral port position with equal azimuth angle Manipulation angle should be 60 degree

36. Determined by 2 principles- 2 arc concept Baseball-Diamond concept

37. Two Arc Concept Step 1 : Find out the target of dissection Step 2 : Find the length of instrument. Adult- 36 cm, Neonate-20 cm,Pediatric-28 cm Step 3 : Target organ at the center , draw 2 arc line 1 st - at ½ of instrument length 2 nd - at 2/3 of instrument length All ports including camera port should be in between arc line

38. Target 24 cm 18 cm

39. 2/3 rd of instrument ½ of instrument Instrument 36cm

40. Working port Optical port Target organ Baseball-Diamond concept Working port Applicable for getting the secondary port position Not for optical port

41. 2 nd principle Telescope should be in the middle of the working instrument Azimuth angle -angle between telescope and working port and must be equal Normal range 15 º to 45 º & indicates contralateral port position

42. A nother P rinciple Tip of index finger over target pathology Tip of thumb over side of telescope Anatomical snuff box gives rough estimation of secondary port position Target of dissection Optical port Anatomical snuffbox

43. T riangulation Facilitate smooth instrument manipulation along with adequate visualization Usually trocars are placed in triangular fashion

44. Manipulation Angle -Angle between 2 contralateral working instruments Azimuth angle- Angle between telescope and working instruments Elevation angle- Angle between horizontal plane & instrument or laparoscope facing towards the target.

45. Sectorization Concept When optical port placed as one of the lateral port called sectorization Sometimes required due to limited space for port placement in baseball diamond concept( appendicectomy)

46. H ow to get 1 st port ? Two ways Open technique \ Hasson’s technique Close technique - Verres needle assisted - Under optical guidance ( Visiport )

47. Ot table Height .49 of surgeon’s height(best) The angle between arm and forearm should be within 90 º - 120 º

48. M onitor H eight and Distance The best view within 15 to 40 degrees below the horizontal plane of eye Five times away from the diagonal length of monitor

49. I deal R elaxed Position Waist line table Gaze down view of monitor Handle and elbow at same level Triangulation Straight line principle

50. Type 1 is more convenient & technically acceptable Type 2 lever Type 3 lever Types of lever in laparoscopy Type 1 lever

51. Hammer grip Pistol grip Pencil grip Types of Grip

52. Better ergonomics reduce operative time Reduce mechanical pain of surgeon Reduce per operative injury rate Never activate diathermy in air and out of vision Take Home Message

53. Thank You