L6: Minimally Invasive Surgery Flashcards
Def of Minimal Invasive Surgery
History of Minimal Invasive Surgery
Minimal Invasive Surgery approaches
Most of the trauma of an open procedure is inflicted because the surgeon must have a ……. that is large enough to give adequate exposure for safe dissection at a target site
wound
……….. prolongs recovery time and, by reducing mobility, contributes to an increased
incidence of pulmonary atelectasis, chest infection, paralytic ileus and deep venous
thrombosis
Wound pain
The wound is often the cause of morbidity, including infection, dehiscence, bleeding, herniation, and nerve entrapment.
..
Mechanical and human …… cause additional trauma. Body wall retractors can inflict localized damage that may be as painful as the wound itself.
retractors
……. of any body cavity to the atmosphere also causes morbidity through cooling and fluid loss by evaporation.
Exposure
In the manual ……. of intestinal loops, the surgeon and assistant disturb the peristaltic activity of the gut and provoke adynamic ileus
handling
- In contrast, during laparoscopy, the retraction is provided by the low-pressure pneumoperitoneum, giving a diffuse force applied gently and evenly over the whole-body wall, causing minimal trauma.
- The incidence of postsurgical adhesions is reduced using minimally invasive approaches because there is less damage to delicate serosal coverings.
…
Adverse Effects of open Surgery
Advantages of minimal access surgery
Preparation for minimal access surgery
Contraindications to laparoscopy
Increased risk during laparoscopic surgery
- It used to be thought that the conditions listed here were contraindications to laparoscopy.
- However, with increasing expertise and use of laparoscopic techniques, many of these patients can be safely operated on by an experienced laparoscopic surgeon.
..
Equipment for minimal access surgery
The perfect gas for insufflation during laparoscopy must have the next characteristics:
Principles of minimal access surgery
- Establishing a Pneumoperitoneum
- placement of laparoscopic ports
- Closure of laparoscopic port sites
Methods of Establishing a Pneumoperitoneum
There are two accepted methods: open (Hassan) or closed (Verress)
a) The open method is preferred by the Royal College of Surgeons (Eng).
b) The Verress method is safe in experienced hands.
Physiological consequences of a pneumoperitoneum Laparoscopic surgery induces multiple physiological responses in the patient due to:
a) Positioning of the patient to extreme positions (eg head up).
b) Mechanical effects of elevated intra-abdominal pressure due to insufflation of gas (eg decreased venous return).
c) Absorption of CO2 and biochemical changes.
Summary of Hemodynamic Changes due to CO2 insufflation
placement of laparoscopic ports
Closure of laparoscopic port site
Limitations of minimal access surgery
Operative problems
Future of laparoscopy
