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1、單擊此處編輯母版標題樣式,單擊此處編輯母版文本樣式,第二級,第三級,第四級,第五級,*,*,單擊此處編輯母版標題樣式,單擊此處編輯母版文本樣式,第二級,第三級,第四級,第五級,*,*,LAPAROSCOPICSURGERY,JanePBradleyHendricks,RGN,BSE(hons),MCS,IndependentNursePresc,riber,SurgicalCarePractitioner,LaparoscopicSurgery.,ColchesterGeneralHospital,LAPAROSCOPICSURGERY JanePB,SHORT HISTORY,?,1982

2、Semm performed first Laparoscopic,Appendicectomy.,?,1987 Mouret performed first,Laparoscopic Cholecystectomy.,?,1992 First UK Laparoscopic Training,centre established.,SHORT HISTORY?1982 Semm p,LAPAROSCOPIC SURGERY,“KEYHOLE SURGERY”,MINIMALLY INVASIVE SURGERY,MINIMAL ACCESS SURGERY,LAPAROSCOPIC SURG

3、ERY “KEYHOLE,What operations can we do,laparoscopically?,Diagnosis,Crohns Disease,Diverticulitis,Rectal Prolapse,Benign renal disease,Gastric Obstruction,Some Splenic disorders,Operation,Bowel resection,Bowel resection,Repair of Prolapse,Nephrectomy,Bypass,Spleenectomy,What operations can we do lapa

4、,What operations can we do,Laparoscopically,Diagnosis,Gallstone,Appendicitis,Hernia,Adhesions,Perforated ulcer,Hiatus Hernia,Operation,Cholecystectomy,Appendicectomy,Hernia repair,Division of adhesions,Closure of perforation,Hiatus hernia repair.,What operations can we do Lapa,What operations can we

5、 do,Laparoscopically,Diagnosis,Colorectal carcinoma,Caecal carcinoma,Colonic carcinoma,Gastric carcinoma,Oesophageal carcinoma,The list is endless!,Operation,Anterior resection/APR,Right Hemicolectomy,Left/Sigmoid Colectomy,Gastrectomy,Oesophagogastrectomy,What operations can we do Lapa,Principle Di

6、fferences between,Laparoscopic and Open Surgery,FOR THE PATIENT,?,Post operative pain related to size of incision-,smaller incisions=less pain.,?,Less Handling of intestines results in little or no,disturbance of normal function.,?,Avoidance of the trauma of abdominal wall injury,by the incision all

7、ows rapid return to normal,activity,?,No incision allows early return to more strenuous,activities:driving,lifting,sport etc.,Principle Differences between,Principle Differences between,laparoscopic and open surgery,FOR THE HOSPITAL,?,Initial capital costs to establish laparoscopic,surgery in the or

8、der of,30,000-,40,000,?,Reduced overall costs by shortening of,hospital stay e.g.cholecystectomy reduced,from 5 to 1 day,hiatus hernia repair reduced,from 7 to 3 days.,Principle Differences between,Principle Differences between,laparoscopic and open surgery,For the Surgeon,?,Magnified view often bet

9、ter than obtained via an,incision allows precise dissection.,?,Altered(but not absent)tactile response,?,Two dimensional(flat screen)view.,?,Usually(but not always)longer operating time,?,Need to develop entirely different operating,technique,?,Adaptation of principles of open surgery to,laparoscopi

10、c surgery.,Principle Differences between,Instruments,?,Redesign of instruments for laparoscopic,use.,?,Instruments for open surgery in general 6,10”in length built around a box joint.,?,Laparoscopic instruments in general 15,18”,in length with an articulated connecting rod,between handles and scisso

11、r blades,jaws,etc.,Instruments?Redesign of instr,Equipment Necessary for MAS,Camera,Light Source,Insufflator,TV Monitor,Telescopes,Light Guide Cable,Apart from the,insufflator the system,will work better if all,the components are,from the same,company as one piece,talks to another,Equipment Necessar

12、y for MAS Ca,CAMERA,?,These can be single chip or 3 chip.,?,CHIP:thois is also called a charged coupled,device in short,CCD.,?,These are flat silicone wafers with a matrix,a grid,of minute image sensors called pixels.,?,White balance and sometimes black balance,?,Sleeve it dont soak it!,?,CAMERA?The

13、se can be single ch,Light Source,?,Halogen or Xenon,cold light but beware can still,burn holes in drapes esp.disposable and burn,patients skin if left on the abdomen.,?,Brightest to darkest measured in units of decibels.,?,Automatic illumination,does it talk to the camera,and are the necessary leads

14、 plugged in.,?,Lamp life meter,look at it.Is it nearly out?EBME,keep the spares and they change it.,?,White balance by making sure white is correct,then all the colours through the spectrum are,correct.,Light Source?Halogen or Xenon,Insufflator,?,CO2 because this has the same refractive index as,air

15、,so doesnt distort the image and is non,combustible.,?,Intraabdominal pressure run between 10 and 13,mmhg.,?,Use disposable filter and tubing for each patient.,?,High flow insufflators(35 litres)output,determined by size of outlet.,?,Ensure you know how to change a cylinder and,were they are stored.

16、,Insufflator?CO2 because this,TV Monitors,?,Usually a 20”screen.,?,If your monitor has MD in the spec.they are,compliant with th lines.e hospital electrical safety,systems for example Son 1343-MD.,?,You can use a standard TV but it must be run,through an isolated transformer.,?,Horizontal resolution is the number of vertical,lines.,?,Vertical resolution is the number of horizontal,lines,?,More lines of resolution,better detail of picture.,TV Monitors?Usually a 20”scr,Telescopes,?,Come in varying