Sunday, 8 August 2010

Laparoscopy Surgery

Laparoscopic surgery are all actions that do not require surgical incision width in conducting his explorations, but need the tools cameras, monitors and special instruments to do the surgery through the monitor screen without seeing and touching the patient's limbs. Laparoscopic surgery is a new method is more convenient for patients that minimally invasive surgery. Since it was first introduced this surgical technique demonstrated its superiority compared to conventional surgery today.

Laparoscopy Surgery


It is difficult to credit one individual with the pioneering of the laparoscopic approach. In 1902 Georg Kelling, of Dresden, Saxony, performed the first laparoscopic procedure in dogs and in 1910 Hans Christian Jacobaeus of Sweden reported the first laparoscopic operation in humans. In the ensuing several decades, numerous individuals refined and popularized the approach further for laparoscopy. The introduction of computer chip television camera was a seminal event in the field of laparoscopy. This innovation in technology provided the means to project a magnified view of the operative field onto a monitor, and at the same time freed both the operating surgeon's hands, thereby facilitating performance of complex laparoscopic procedures.

Prior to its conception, laparoscopy was a surgical approach with very limited application and used mainly for purposes of diagnosis and performance of simple procedures in gynecologic applications.
The first publication on Diagnostic Laparoscopy by Raoul Palmer, appeared in the early 1950s, followed by the publication of Frangenheim and Semm. Hans Lindermann and Kurt Semm practised CO 2 hysteroscopy during the mid-seventies.

In 1972, Clarke invented, published, patented, presented and recorded on film laparoscopic surgery, with instruments marketed by the Ven Instrument Company of Buffalo, New York, USA. In 1975, Tarasconi, from the Department of Ob-Gyn of the University of Passo Fundo Medical School (Passo Fundo, RS, Brazil), started his experience with organ ressection by Laparoscopy (Salpingectomy), first reported in the Third AAGL Meeting, Hyatt Regency Atlanta, November 1976 and later published in The Journal of Reproductive Medicine in 1981. This Laparoscopic Surgical Procedure was the first Laparoscopic organ resection reported in the Medical Literature.

In 1981, Semm, from the Universitats Frauenklinik, Kiel, Germany, performed the first Laparoscopic Appendectomy. Following his lecture on Laparoscopic Appendectomy, the President of the German Surgical Society wrote to the Board of Directors of the German Gynecological society suggesting suspension of Semm from medical practice. Subsequently, Semm submitted a paper on Laparoscopic Appendectomy to the American Journal of Obstetrics and Gynecology, which was rejected as unacceptable for publication on the ground that the technique reported on was ' unethical.' His paper was finally published in the Journal Endoscopy. The Abstract of his paper on "Endoscopic Appendectomy" can be found at here.

Semm established several standard procedures that were regularly performed, such as ovarian cyst enucleation, myomectomy, treatment of ectopic pregnancy and finally laparoscopic-assisted vaginal hysterectomy (nowadays termed as Cervical intra-fascial Semm hysterectomy). He also developed a medical instrument company Wisap in Munich, Germany, which still produces various endoscopic instruments of high quality.

In 1985, he constructed the pelvi-trainer = laparo-trainer, a practical surgical model whereby colleagues could practice laparoscopic techniques. Semm published over 1000 papers in various journals. He also produced over 30 endoscopic films and more than 20,000 colored slides to teach and inform interested colleague about his technique.

His first Atlas More Details on pelviscopy and hysteroscopy was published in 1976, a slide atlas on pelviscopy, hysteroscopy, and fetoscopy in 1979, and his books on gynecological endoscopic surgery in German, English and many other languages in 1984, 1987, and 2002.

Prior to 1990, the only specialty performing laparoscopy on a widespread basis was gynecology, mostly for relatively short, simple procedures such as a diagnostic laparoscopy or tubal ligation. The introduction in 1990 of a laparoscopic clip applier with twenty automatically advancing clips (rather than a single load clip applier that would have to be taken out, reloaded and reintroduced for each clip application) made general surgeons more comfortable with making the leap to laparoscopic cholecystectomies (gall bladder removal). On the other hand, some surgeons continue to use the single clip appliers as they save as much as $200 per case for the patient, detract nothing from the quality of the clip ligation, and add only seconds to case lengths.

Gains and Losses

Laparoscopic surgery has many advantages, but also has some limitations. Some advantages of this method is
   1. Operating a small wound ranged from 2-10 mm in so much pain after surgery is reduced.
   2. In cosmetic surgery scar is significantly different compared with post-surgical scar of conventional surgery. Laparoscopic surgical wound measuring 2 mm or less up to size 10 mm will be lost or hidden in the navel area, which is difficult with conventional surgery.
   3. Because pain after surgery was minimal and not a lot of manipulation on intestinal organs, the period of recovery after surgery is much faster and the period of hospitalization becomes shorter.
   4. With a small tool, all manufer and exploration became increasingly widespread in the cavity of the operation area.

As mentioned previously, laparoscopic surgical techniques also have limitations, which is still expensive tools, such as disposable trokar. However, the overall cost of operation resembles a conventional surgical treatment for a shorter period.

Number of gains by the patients with laparoscopic surgical technique led to this technique is more attractive and friendly to the patient.

Growth of Laparoscopy

An operative laparoscopic surgical procedure with minimal approach invasivif loaded with high technology. Design engineering and engineering continue in the laparoscopic surgical equipment and devices for ease of doing procedures as well as comfort and safety for patients. Gambran three dimensions to give a more natural image and a robot assistant that can be activated by an operator's voice has become a reality. What is now being developed is an action undertaken by the surgical dissection is not in the patient's side, outside, or far from the operating room known as telepresence surgery.

Minimally invasive surgery is now the gold standard (gold standard) of the various operations, such as gall bladder disease, appendicitis (appendicitis), acute and chronic joint disorders in the fields of MDs, abnormalities in the thoracic cavity, known as VATS (Video Assisted Thoracoscopy Surgery ), disorders and diseases in the field of urology and gynecology (womb).

Laparoscopy Equipment 

Robotics and technology

The process of minimally invasive surgery has been augmented by specialized tools for decades. For example, TransEnterix of Durham, North Carolina received U.S. Food and Drug Administration approval in October 2009 for its SPIDER Surgical System using flexible instruments and one incision in the navel area instead of several, allowing quicker healing for patients. Dr. Richard Stac of Duke University developed the process.
In recent years, electronic tools have been developed to aid surgeons. Some of the features include:
•    Visual magnification — use of a large viewing screen improves visibility
•    Stabilization — Electromechanical damping of vibrations, due to machinery or shaky human hands
•    Simulators — use of specialized virtual reality training tools to improve physicians' proficiency in surgery
•    Reduced number of incisions
Robotic surgery has been touted as a solution to underdeveloped nations, whereby a single central hospital can operate several remote machines at distant locations. The potential for robotic surgery has had strong military interest as well, with the intention of providing mobile medical care while keeping trained doctors safe from battle.

 Robotic Laparoscopy

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