04-12-2012, 03:23 PM
Laparoscopic surgery
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Introduction:
• Laparoscopic surgery, also called minimally invasive surgery (MIS), bandaid surgery, or keyhole surgery, is a modern surgical technique in which operations in the abdomen are performed through small incisions (usually 0.5–1.5 cm) as opposed to the larger incisions needed in laparotomy.
• Keyhole surgery makes use of images displayed on TV monitors to magnify the surgical elements.
• Laparoscopic surgery includes operations within the abdominal or pelvic cavities, whereas keyhole surgery performed on the thoracic or chest cavity is called thoracoscopic surgery. Laparoscopic and thoracoscopic surgery belong to the broader field of endoscopy.
• The abdomen is usually insufflated, or essentially blown up like a balloon, with carbon dioxide gas. This elevates the abdominal wall above the internal organs like a dome to create a working and viewing space. CO2 is used because it is common to the human body and can be absorbed by tissue and removed by the respiratory system. It is also non-flammable, which is important because electrosurgical devices are commonly used in laparoscopic procedures
Advantages:
Reduced hemorrhaging, which reduces the chance of needing a blood transfusion.
Smaller incision, which reduces pain and shortens recovery time, as well as resulting in less post-operative scarring.
Less pain, leading to less pain medication needed.
Although procedure times are usually slightly longer, hospital stay is less, and often with a same day discharge which leads to a faster return to everyday living.
Reduced exposure of internal organs to possible external contaminants thereby reduced risk of acquiring infections.
Disadvantages:
While laparoscopic surgery is clearly advantageous in terms of patient outcomes, the procedure is more difficult from the surgeon's perspective when compared to traditional, open surgery:
The surgeon has limited range of motion at the surgical site resulting in a loss of dexterity
Poor depth perception
Surgeons must use tools to interact with tissue rather than manipulate it directly with their hands. This results in an inability to accurately judge how much force is being applied to tissue as well as a risk of damaging tissue by applying more force than necessary. This limitation also reduces tactile sensation, making it more difficult for the surgeon to feel tissue (sometimes an important diagnostic tool, such as when palpating for tumors) and making delicate operations such as tying sutures more difficult.
The tool endpoints move in the opposite direction to the surgeon's hands due to the pivot point, making laparoscopic surgery a non-intuitive motor skill that is difficult to learn.
About the da Vinci® Surgical System
The da Vinci® Surgical System consists of an ergonomically designed surgeon's console, a patient-side cart with four interactive robotic arms, a high-performance vision system and proprietary EndoWrist® Instruments. The net result is an intuitive interface with breakthrough surgical capabilities.
The System extends the surgeon's capabilities to provide these significant benefits:
• Enhanced 3-D Visualization – Provides the surgeon with a true 3-dimensional view of the operating field. This direct and natural hand-eye instrument alignment is similar to open surgery with "all-around" vision and the ability to zoom-in and zoom-out.
• Improved Dexterity – Provides the surgeon with instinctive operative controls that make complex minimally invasive surgery procedures feel more like open surgery than laparoscopic surgery.
• Greater Surgical Precision – Permits the surgeon to move instruments with such accuracy that the current definition of surgical precision is exceeded.
• Improved Access – Surgeons perform complex surgical maneuvers through 1-cm ports, eliminating the need for large traumatic incisions.
• Increased Range of Motion – EndoWrist® Instruments restore full range of motion and ability to rotate instruments more than 360 degrees through tiny incisions.
• Reproducibility – Enhances the surgeon's ability to repetitively perform technically precise maneuvers such as endoscopic suturing and dissection.
How Does Robotic Surgery Work?
Robotic-assisted surgery is like other minimally invasive surgery in that instruments and cameras are inserted through small incisions. What is different is that the surgeon sits at a console next to the patient.
The surgeon looks into a viewfinder at the three-dimensional, high-quality image sent back by the cameras and works the surgical “arms” using hand and foot controls.
The quality of the images and precise movement of the surgical arms essentially puts the surgeon right next to the area in which he or she is operating.
Technology in the Hands of Experts
It is important to note that robotic-assisted surgery is performed by a surgeon — not a robot. The equipment is a tool for skilled surgeons, enhancing their ability to provide the best care for their patients. The success of robotic-assisted surgery depends on the skill and experience of the physicians, not the equipment.
Enhanced Control for Better Results
Because of its many benefits, robotic-assisted surgery has gained increased popularity among the medical community in recent years. But technology is only as good as the hands that control it. And just as high performance race cars are meant to be driven by professional drivers, surgery-assisting robotic technology is meant to be operated by skilled and experienced surgeons.
While more and more hospitals are adopting robotic-assisted surgical technology, the robotic surgery program at Penn is already home to eight da Vinci® Robotic Surgical Systems and staffed by surgeons who far exceed the recommended level of experience required for its use.
Just as computers revolutionized the latter half of the 20th century, the field of robotics has the potential to equally alter how we live in the 21st century. We've already seen how robots have changed the manufacturing of cars and other co¬nsumer¬ goods by streamlining and speeding up the assembly line. We even have robotic lawn mowers and robotic pets. And robots have enabled us to see places that humans are not yet able to visit, such as other planets and the depths of the ocean.
In the coming decades, we may see robots that have artificial intelligence. Some, like Honda's ASIMOrobot, will resemble the human form. They may eventually become self-aware and conscious, and be able to do anything that a human can. When we talk about robots doing the tasks of humans, we often talk about the future, but robotic surgery is already a reality. Doctors around the world are using sophisticated robots to perform surgical procedures on patients.
Not all surgical robots are equal. There are three different kinds of robotic surgery systems: supervisory-controlled systems, telesurgical systems and shared-control systems. The main difference between each system is how involved a human surgeon must be when performing a surgical procedure. On one end of the spectrum, robots perform surgical techniques without the direct intervention of a surgeon. On the other end, doctors perform surgery with the assistance of a robot, but the doctor is doing most of the work [source: Brown University].