History of Laparoscopy 1902 - Georg Kelling, of Dresden, Saxony, performed the first laparoscopic procedure on dogs. 1910 - Hans Christian Jacobaeus of Sweden, reported the first laparoscopic operation on humans. 1980 - Patrick Steptoe from England, started to perform laparoscopic procedures in the operating room under sterile conditions. 1982 - The first solid state camera was introduced and this was the start of 'video-laparoscopy'. 1987 - Phillipe Mouret performed the first video-laparoscopic cholecystectomy in Lyons, France. 1994 - A robotic arm was designed to hold the laparoscope camera and instruments. 1996 - The first ever live broadcast of laparoscopic surgery via the Internet was performed. http://www.drsanjaykolte.in/
Laparoscopy, also known as keyhole surgery, is done to find out problems like adhesions, fibroid, infections and cysts.
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History of Laparoscopy 1902 - Georg Kelling, of Dresden, Saxony, performed the first laparoscopic procedure on dogs.
1910 - Hans Christian Jacobaeus of Sweden, reported the first laparoscopic operation on humans.
1980 - Patrick Steptoe from England, started to perform laparoscopic procedures in the operating room under sterile conditions.
1982 - The first solid state camera was introduced and this was the start of 'video-laparoscopy'.
1987 - Phillipe Mouret performed the first video-laparoscopic cholecystectomy in Lyons, France.
1994 - A robotic arm was designed to hold the laparoscope camera and instruments.
1996 - The first ever live broadcast of laparoscopic surgery via the Internet was performed.
What is Laparoscopic Surgery?Laparoscopic surgery, also known as minimally invasive surgery (MIS) or ‘keyhole’ surgery is a modern surgical technique for carrying out operations in the abdomen through cannulae (also known as ports) which are channels into the body through small incisions. Using a video camera the surgeon is able to view the operative field without invasive surgery. The abdomen is usually insufflated with carbon dioxide gas.
By inflating the abdomen, the abdominal wall is elevated above the internal organs to create a working and viewing space for the surgeons.
Why Laparoscopy?There are a number of advantages to operating on the patient with laparoscopic surgery versus open surgery. Some of these are: Less post-operative scarring
Reduced pain
Shorter recovery time
Less time spent in hospital to recover
Reduced hemorrhaging
Reduced risk of exposing internal organs to external contaminants
One of the most common types of laparoscopic surgery is bariatric (obesity). Over the last decade there have been more advancements in bariatric surgery than there had been in the previous 50 years, fuelled largely by the growing obesity epidemic which began in the 1970s. The epidemic created the need for effective treatment of severe obesity and its co morbidities leading to the development of procedures such as gastric banding, gastric bypass and duodenal switch over the past decade. More recently, the advent of minimally invasive surgery in the mid-1990s accounted for the second wave of advances.
Before Laparoscopic Surgery
Before laparoscopy was practiced, surgeons operated using open/invasive surgery. This means cutting skin and tissues so that the surgeon has direct access to structures and organs. This involves more direct access than in minimally invasive procedures as the openings are bigger so the internal organs are openly exposed.
Advantages and DisadvantagesAdvantagesMinimal pain & illeusImproved cosmesisShorter hospital stay , faster recovery & rapid return to workNon muscle splinting incision & less blood lossPost op respiratory muscle function returns to normal more quicklyWound complications i.e. infection & dehiscence are lessLap surgery can be done as day care surgery
DisadvantagesLonger duration of surgeryLoss of 3D view, impaired touch sensationpoor dexterity, fulcrum effect, risk of visceral / vsl. Injury (may go unrecognised)Long learning curve for surgeons
Ideal insufflating gas of choiceColorless, non toxic, nonflammable, easily available, inexpensive, inert, readily soluble in blood and easily ventilated out of lungs
Why CO2 is the gas of choice for laparoscopy?
Nonflammable & does not support combustion
Highly soluble in blood because of rapid buffering in blood so risk of embolisation is small
Rapidly diffusible through membranes so easily removed by lungs
CO2 levels in blood & expired air can be easily measured & its elimination is augmented by increasing ventilation
Absorption of carbon dioxide (CO2) from the peritoneal cavity
VA/Q mismatch: Increased physiologic dead space Abdominal Distention Position of the patient (e.g., steep tilt) Controlled mechanical ventilation Reduced cardiac output These mechanisms are accentuated in sick patients
Increased metabolism (e.g., insufficient plane of anesthesia)
Depression of ventilation by anesthetics (e.g., spontaneous breathing)
Accidental events CO2 emphysema (i.e., subcutaneous or body cavities) Capnothorax CO2 embolism (Selective bronchial intubation)
PACDone in usual manner with special attention to cardiac & pulmonary system Investigations Complete hemogram RBS Na, K BUN, Creatinine Coagulation profile CXR, ECG BG, CM Special investigations ECHO PFT
Physiological changes = adultsPaco2 ETco2 increase but ETco2 overestimates Paco2Co2 abs more rapid and intense due to larger peritoneal SA / body wt.More chances of trauma to liver during trocar insertionMore chances of bradycardia , maintain IAP to as low as possible
About Dr. Sanjay KolteDNB, FMAS(AMASI IDIA), F.C.P.S.(Mumbai)
MBBS - OCTOBER 1995-BHARATI VIDYAPEETH'S MEDICAL COLLEGE, PUNE, INDIAFCPS (General Surgery) - SEPTEMBER 2000, MUMBAI, INDIA
(FELLOW OF COLLEGE OF PHYSICIANS AND SURGEONS)
DNB (General Surgery) - MAY 2001-KING EDWARD MEMORIAL HOSPITAL, PUNE, INDIA (DIPLOMATE OF NATIONAL BOARD, NEW DELHI)MNAMS - MEMBER OF NATIONAL ACADEMY OF MEDICAL SCIENCES, NEW DELHI