فورسپس دی باکی اندوسکوپی ( endoscpic debakey forceps )
نام وسیله : فورسپس دی باکی اندوسکوپی ( endoscpic debakey forceps )
توضیح : فورسپس دی باکی اندوسکوپی ( endoscpic debakey forceps ) دارای آرواره های سوراخ بانوک بلانت است که دارای دوردیف شیارهای موازی در تمام طول یکی از آرواره های خود می باشد. آرواره دیگر ، دارای یک ردیف شیار در مرکز خود می باشد که در هنگام بستن فورسپس ، در درون آرواره دیگر قرار دارد.
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OF LAPAROSCOPIC SURGERY
The historical development of laparoscopy can be traced
back to 1901 when George Killing of Germany inserted a
cystoscope into the abdomen of a living dog after creating a
pneumoperitoneum using air. A century ahead, we are now more
technical and technological.
technological advances, laparoscopic surgery is ingrained in our
surgical practice and we are able to perform diverse and
complex laparoscopic procedures, also termed minimally invasive
surgery.
Laparoscopic surgery is defined by its three main
components of image production (light source, laparoscope or
rod lens system, and camera), pneumoperitoneum- the
insufflation of carbon dioxide gas to create space for operation,
and laparoscopic instruments.
With this combination, surgeons
could perform diagnostic and some basic gynaecological
procedures since the 1960’s.
However, a major revolutionary shift in surgical practice and
thinking came in 1988 when Mouret of France performed the first
laparoscopic cholecystectomy.
Instead of removing the
gallbladder through a Kocher’s incision, he did it through a few
small wounds each not larger than 1 cm.
This exciting concept
sparked intense developments in instrumentation, innovation in
advanced technical procedures, proliferation of training
programs, and setting-up of laparoscopic centres. We are indeed
in an era of modern surgery.
Laparoscopic surgery and traditional open surgery is likely
to co-exist together.
It is part of the repertoire a young surgeon in
training should develop skills in. This brings us back to the objectives
of this manual- for training development and safety in practice.
INTRODUCTION
Introduction
HY SHOULD WE DO LAPAROSCOPIC SURGERY?
The answer is simple: because patients can and do benefit from it. As long as the evidence suggests- and there is ample data by now- that laparoscopy has its benefits, it can be justified to be performed in various procedures.
Laparoscopic
cholecystectomy has replaced the traditional open approach to non-complicated gallbladder disease as the new gold standard because it results in less postoperative pain, less postoperative pulmonary dysfunction, faster return of bowel function, shorter length of hospital stay, faster return to normal
activities and work, and greater patient satisfaction.
These benefits also generally extend to other laparoscopic procedures.The advantages mentioned above result from the most obvious difference between laparoscopic and open surgery- that of less surgical trauma to the wound in laparoscopy. The access scar is minimized, leading to less pain, less wound infection and dehiscence, and better cosmetic result.
In addition, laparoscopy
also reduces tissue trauma during dissection, and subsequent blood loss, reduces systemic and immune response, and reduces adhesive complications.
From the surgeon’s point of view, the projected image on the monitor is a magnified image, resulting in better definition of structures.
It’s faster to close smaller wounds. And the recorded procedure can be used for review and training purposes. As in all surgical techniques and technologies, minimally invasive surgery also has its limitations and disadvantages. First, there may be problems encountered during access into the
abdominal cavity, such as iatrogenic injuries to the bowel or major vascular structures.
The incidence is about 0.05 to 0.1%. This incidence is reduced by practicing the open technique of introduction, rather than using the “blind” Veress needle technique, and using blunt-tipped trocars. Second, there may be undesirable side-effects of the carbon-dioxide pneumoperitoneum, such as hypercarbia, etc (see chapter on physiology of neumoperitoneum).
And third, from the surgeon’s perspective, the migration from open to laparoscopic skills means Introduction that the 3D vision is reduced to onocular 2D vision on the screen, depth perception and field of view is much reduced, and haptics, or the “feel” and tactile sensation of tissues, is limited to ross probing of tissues.
However, these limitations, once understood
and overcome have not hampered the development of laparoscopy. In a way, the surgeon is required to master a new set of skills to perform aparoscopy safely. With training and experience, surgery can be performed at a new standard that benefits patients.
IS WHICH TYPES OF SURGERY IS LAPAROSCOPY APPLICABLE?
Laparoscopy can now be performed in three main areas
of the body- the abdomen, the thorax, and closed spaces.
Laparoscopy can be used to resect tissues or to reconstruct tissues.
In the abdomen, we group laparoscopic techniques
according to major systems, as shown below.
a)
Gastrointestinal tract
– Laparoscopic-assisted oesophagectomy
– Laparoscopic cardiomyotomy for achalasia
– Laparoscopic fundoplication for gastro-oesophageal
reflux disease
– Laparoscopic bariatric surgery (banding, bypass) for
morbid obesity
– Laparoscopic gastrectomy and small bowel procedures
– Laparoscopic appendicectomy
– Laparoscopic colectomy
– Laparoscopic adhesiolysis and diagnostic laparoscopy
b)
Hepato-biliary-pancreatic system
– Laparoscopic cholecystectomy
– Laparoscopic liver and bile duct procedures
– Laparoscopic management of pseudocysts and
pancreatic procedures
Introduction
– Laparoscopic bypass procedures
– Laparoscopic splenectomy
c)
Endocrine system
– Laparoscopic adrenalectomy
– Laparoscopic enucleation of benign pancreatic islet
tumours
– Endoscopic Neck Surgery
d)
Abdominal Wall
– Laparoscopic inguinal hernia repair
– Laparoscopic repair of incisional hernia
e)
Urologic system
– Laparoscopic nephrectomy
– Laparoscopic procedures for ureteric and bladder
conditions
f)
Gynecology
– Laparoscopic management of tubo-ovarian conditions
– Laparoscopic hysterectomy
In the thorax, some procedures include,
– Thoracoscopic sympathectomy for palmar
hyperhidrosis
– Thoracoscopic pleurodesis
– Thoracoscopic bullectomy and partial lobectomy
With the use of novel devices, adequate operating space can
be created in “closed” spaces so that endoscopic techniques
can be performed, such as,
– Endoscopic extraperitoneal inguinal hernia repair
– Endoscopic ligation of saphenous venous perforators
in the leg
– Endoscopic approach to neck organ such as the thyroid
and parathyroid glands
Introduction
One can see that laparoscopy is
widely applied. It’s important,however, to realize that for certain conditions, laparoscopy is
feasible but does not necessarily replace open techniques. The
practice will depend on the expertise available and also on
literature evidence that laparoscopy is superior to the open
approach.
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