Bases of endoscopic surgery

1. Bases of endoscopic surgery

Theme of lecture:
Bases of endoscopic
surgery

2. 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.)

3. 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.

4.

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.

5. Light source of Arno

6. Fisher’s endoscope

7. Phillip Bozini

8. Bozini’s endoscope

9. Trouve’s “polyscope”

10.

George Kelling

11. Heinz Kalk

12. Raul Palmer

13. Kurt Semm

14. Мурре

15. Harold Hopkins

16. 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

17. 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.

18. 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

19. 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.

20. 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.

21. 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.

22. Endosurgical complex

23.

24. illuminator

25. Aquapurator

26. videocamera

27. Telescope

28. Usual telescope and telescope of Hopkins‘s system

29. Insufflator

30. Veress needles

31. Trendelenburg’s position

32. Fauler’s position

33. Points of a puncture for imposing a pneumoperitoneum

34. Puncture through the back fornix of vagina

35. Needle position

36. Trocars VERSAPORT

37. Trocar VISIPORT

38. Introduction of trocar by Hasson

39. Elevation of an abdominal wall

40. Types of a working part of electrotools

41. retractor

42.

Forceps

43. иглодержатели

44. endoGIA-30

45. EndoStitch

46. Introduction of an atraumatic needles

47. The scheme of Reder’s knot