Bases of endoscopic surgery презентация

Endoscopic surgery
it is area of the surgery, allowing to execute radical operations or diagnostic procedures without a wide dissection of integument or through dot punctures of tissues (laparoscopic, thoracoscopic, rhinoscopic, arthroscopic operations), or through natural physiological apertures (FGDS, colonoscopy, bronchoscopy, cystoscopy, etc.)

Development of endoscopic surgery
Hippocrat (460-375 up to AD) - has described carrying out of the proctoscopy;
Abdul Quasim (936-1013) - investigated neck of uterus using a glass mirror reflector;
R.P. Arnaud (1651-1723) - has created the first extracorporal source of light for the medical purposes;
Phillip Bozini (1773-1809) - has created endoscope which design has been named "LICHTLEITER";
John Fisher, 1827 – has created one of the first endoscops;
Gustave Trouve in 1873 in has designed "polyscope", intended for gastroscopy and cystoscopy, brightness of a luminescence of a platinum wire in which was adjusted with a help of a rheostat.

George Kelling (1901) – for the first time has made a laparoscopy in experiment on a dog;
D.O.Ott (1901) – has informed about "ventroscopy" inspection of a abdominal cavity by means of a candle, a frontal mirror and a tube;
Heinz Kalk (1928 г) - has developed a technique laparoscopic puncture biopsy of a liver, and in 1939 has published the work based on research of 200 patients;
Janos Veress (1938) - has invented a needle with spring mandrin. For today is most widely used tool for imposing of pneumoperitoneum;
Raul Palmer (1947) - has offered ways of definition of position of a needle widely used now for insufflation (Palmer-test);
Kurt Semm - with the colleagues and pupils have developed methodics of the majority laparoscopic interventions on organs of a small pelvis, have created enormous amount laparoscopic tools and devices
De Kok in 1977 for the first time has executed laparoscopic appendectomy;
E. Muhe (1985 г) - has executed the first laparoscopic cholecystectomy;
U.I. Gallinger (1991 г) for the first time in Russia has executed laparoscopic cholecystectomy in the Science Centre of surgery of Russian Academy of Medical Science.

Light source of Arno

Fisher’s
endoscope

Phillip Bozini

Bozini’s endoscope

Trouve’s “polyscope”

George Kelling

Heinz Kalk

Raul Palmer

Kurt Semm

Мурре

Harold Hopkins

Advantages of endosurgery in comparison with traditional operations
Slight trauma of tissues
Short hospital period
Decrease of disability terms
Cosmetic effect
Decrease of frequency and weight of complications
Economic efficiency

Complications
General lethality come to 0,5 %, and frequency of complications – 10 %;
Wound infection – meets in 1-2 % of cases;
Damage of internal organs;
Pneumomediastinum, subcutaneous emphysema;
Pneumothorax;
Development of a gas embolism
Electrosurgical damages;
Cardiovascular collapse;
Postoperative pain in a right shoulder;
Damage of vessels and nerves of a forward belly wall;
Hernias of an abdominal wall.

Relative contraindications
Heavy accompanying pathology of cardiovascular and respiratory systems
- Obstructive diseases of lungs
- Cardiovascular insufficiency of 2-3 degrees
- Old myocardial infarction
- The transferred operations on heart and large vessels
- The congenital and acquired heart diseases
Diffuse peritonitis
Heavy coagulopathy
Adiposity of 3-4 degrees
Late terms of pregnancy
Portal hypertensia
Insufficient qualification of the operator

The minimal set for carrying out endoscopic operations
a) Needles for imposing pneumoperitoneum;
b) trocars with clamps and adapters;
c) Tools for suture of trocar apertures;
d) Manipulators: dissectors, cissors, clips, retractors;
e) The equipment for irrigation and aspiration;
f) Tools for coagulation;
i) Suture materials and tools for endoscopic suture;
j) Devices for ligation vessels and ducts.

The general requirements to endoscopic tools
а) Handiness: the handle of the tool should not complicate manipulations, at long operation there should not be a weariness of a wirst;
б) Sensitivity: the tool should provide the maximal sensitivity as the surgeon is deprived at endoscopic manipulations of tactile sensitivity;
в) Electroisolation: isolating layer should reach up to branches of the tool and to be strong enough;
г) Presence of the rotary mechanism providing rotation of a working part of the tool on 360 degrees around of a longitudinal axis.

Essentially the complex will consist of the following blocks:
a) A videocamera;
b) A video monitor;
c) The illuminator - the electronic device having a powerful lamp (xenon or halogen);
d) Laparoscope with an optical path;
e) Insufflator - it is intended for submission of carbonic gas in a abdominal cavity at imposing and maintenance of pneumoperitoneum;
f) Aquapurator - it is intended for washing and evacuation of liquid contents of a abdominal cavity;
i) Electrocoagulator;
j) The rack - handcart.

Endosurgical
complex

illuminator

Aquapurator

videocamera

Telescope

Usual telescope and telescope of Hopkins‘s system

Insufflator

Veress needles

Trendelenburg’s position

Fauler’s position

Points of a puncture for imposing a pneumoperitoneum

Puncture through the back fornix of vagina

Needle position

Trocars
VERSAPORT

Trocar
VISIPORT

Introduction of trocar
by Hasson

Elevation of an abdominal wall

Types of a working part of electrotools

retractor

Forceps

иглодержатели

endoGIA-30

EndoStitch

Introduction of an atraumatic needles

The scheme of Reder’s knot