Principles of Minimal Invasive Surgery or Laparoscopic Surgery

This topic - Principles of Minimal Invasive Surgery [MIS] is very important for the MBBS Students, as they have to know the basic principles of Laparoscopy before entering into OT. Only then, they can understand the concept of MIS as well as the procedure being done. Moreover this topic is now being included in the syllabus of MBBS Course as well. 

1. Principles
Of
Laparoscopic Surgery
Prof. U.Murali.

2. OUTLINE
•Definition of Laparoscopic Surgery [LS] / Short History.
•Advantages and disadvantages of LS.
•Perioperative planning & Theatre set-up + Tools.
•General principles of Laparoscopic Surgery.
•Operative problems & Contraindications of L S.

3. Minimal Access Surgery is the marriage of the
modern technology and Surgical Innovation.

4. DEFINITION
Laparoscopic Surgery can be defined as the
application of modern technology to minimize the
trauma of surgical access without compromising the
exposure of the surgical site, (or) the safety of the
patient.

5. Other Names
“ KEYHOLE SURGERY ”
“ MINIMAL INVASIVE SURGERY ”
“ MINIMAL ACCESS SURGERY ”

6. Short History
1901 - Von Ott - First inspection of
abd.cavity – speculum & candlelight.
Kelling – cystoscope – exp.lap in dogs.
1938 - Janos Veress – Developed –
spring-loaded needle.
1978 - Hasson – Alt. method – Trocar
entry.
1983 - First lap.app. – Kurt Semm, a
Germ. gynae.
1985 - First lap.Chole – Erich Muhe, a
Germ. surg.
1987 - First lap.ing.hernia repair – Ger.
1989 - First lap.hyst. – Harry Reich.
1990 - “MIS” – Wickman & Fitzpatrick.
1992 - “MAS” – Cuschieri.

7. Extent of L S
Laparoscopy.
Thoracoscopy.
Endoluminal endoscopy.
Perivisceral endoscopy.
Arthroscopy & Intra-articular Surgery.
Combined Approach [CELS].

8. Advantages of L S
Decrease in wound size & scar /
wound pain.
Good Instrument access &
Improved vision.
Shorter stay & Faster recovery.
Reduction in wound infection,
dehiscence, bleeding, herniation,
nerve entrapment & adhesions.

9. Limitations of L S
Reliance on remote vision and
operating
Loss of tactile feedback
Dependence on hand–eye
coordination
Difficulty with hemostasis
Reliance on new techniques
Extraction of large specimens
Costly procedure

10. Preparation for L S
Overall fitness: cardiac /mediations-
allergies
Previous surgery: scars, adhesions
Body habitus: obesity, skeletal
deformity
Normal coagulation
Thrombo-prophylaxis
Informed consent

11. Theatre set -up

12. Theatre set -up

14. General Intra-operative Principles
Technique CO2 - Common
-Creating Pneumo.p. with
12 - 15 mm Hg
-Laparoscope inserted –
umbilical port – 10 mm
-Abdomen evaluated
-Organs – visualized
-Additional ports placed
-Cheaper
-Readily
available
-Easily absorbed
-Released via
respiration
-Highly diffusion
coefficient

15. Pneumoperitoneum - Changes

16. Triangulation - Principle
P
R
L C
S
Monitor

17. Port Placement

18. Ideal Angles

19. Tools / Instruments
> 0°/30° Laparoscope
> Light source – Halogen lamp
> Camera – 3 Chip
> Video-monitor
> CO 2 insufflator
> Veress needle
> Trocars – 10mm / 5mm
> Suction-irrigation apparatus
> Working instruments

22. Surgery Principles
Meticulous care – creation of a pneumo.
Controlled dissection of adhesions
Adequate exposure of operative field
Avoidance and control of bleeding
Avoidance of organ injury
Avoidance of diathermy damage
Vigilance in the postoperative period

23. Electro-surgery
Principles
Inadvertent touching (or) grasping.
Direct coupling between the tissue &
the instrument.
Break in insulation.
Direct sparking to bowel from the
diathermy probe.
Passage of current to the bowel from
recently coagulated tissue.

24. Operative
Problems
Perforation of hollow viscus
Bladder Injury
Bleeding
From Major Vessel
From Gall bladder bed
From Trocar site

25. Post-operative
Care
Nausea
Shoulder tip pain
Port-site pain
Analgesia
Oral fluids
Oral feeding
Drains

26. Contraindications – Relative
Compromised cardiac status
Peritonitis
Multiple Abdominal Surgeries
Bleeding disorders
Morbid obesity
III rd Trimester pregnancy
Portal hypertension

27. Common - Surgeries
Diagnostic laparoscopy
Cholecystectomy
Appendicectomy
Repair of all types of Hernia
Hysterectomy
Tubectomies

28. Other Lap - Surgeries
Colectomy
G J & Vagotomy
Nissen's Fundoplication
Gastrectomy & O G T
Closure of Perforation
Adhesiolysis & Splenectomy
HAR & LAR
The list is endless!!!

29. Core Principles of L S

30. REFERENCES

31. Good
Laparoscopic
Surgeon

32. Future is Only Minimal Access Surgery
Join Hands for
Surgical Procedure of
New Millennium
Near Future is Robotic Surgery