Showing posts with label Laparoscopy Techniques. Show all posts
Showing posts with label Laparoscopy Techniques. Show all posts

Article Medically Reviewed by: Dr Sandeep Moolchandani MS DrNB MHA

  1. What Is Inguinal Hernia?
  2. What Are The Symptoms Of Inguinal Hernia?
  3. How Do Doctors Treat Inguinal Hernia?
  4. What Is A Laparoscopic Hernia Surgery?
  5. How Does A Mesh Fix Hernia?
  6. What Is The Difference Between TEP and Tapp?
  7. What Are The Complications Of Laparoscopic Hernia Repair?
  8. How To Prepare Yourself For The Laparoscopic Hernia Repair?
  9. What Should I Expect After Laparoscopic Hernia Repair?


What Is Inguinal Hernia?


Inguinal hernia occurs when the abdominal contents protrude through an abnormal exit or a weakened area in the abdominal wall. Hernia can protrude through the lower side of the abdominal wall, on both sides of the groin. In this case, the layer of your peritoneum, that is the lining of your abdomen bulges out of the wall and forms a sac.



What Are The Symptoms Of Inguinal Hernia?


  • A bulge is found in the groin area.

  • Discomfort in the groin,

  • Pain around the groin,

  • Swelling of the scrotum in males.


How Do Doctors Treat Inguinal Hernia?


Inguinal hernia can be only fixed up by surgeries. If your hernia is minor and you are not symptomatic, you may not require a hernia surgery.  Your doctor may clearly proceed to watch for symptoms.


Gradually, hernia tends to get bigger when the abdominal wall gets weaker. Often, doctors recommend surgery to prevent a rare but serious stage which is known as strangulation. 


Strangulation appears when a piece of fatty tissue or a loop of an intestine is trapped inside the hernia and the blood supply is reduced or cut off. 


The signs and symptoms of strangulation are 


  • Nausea or vomiting

  • Hernia bulge occurs to be red, or  dark purple and swollen

  • Inability to move.

  • Intense pain.

  • Fatigue

  • Bloody stools

  • And also fever.


What Is A Laparoscopic Hernia Surgery?


For laparoscopic surgery, you'll acquire general anesthesia. Small incisions are made carefully by surgeons and your abdominal area is pumped up with a safe gas. This offers the operating surgeon a better appearance of your body organs. They'll prepare a few short small incisions near the hernia. They'll put a thin tube along with a very small video camera on laparoscope. The surgeon uses pictures from the laparoscope as an overview to fix the hernia using mesh. 


How Does A Mesh Fix Hernia?


Surgeons use mesh made from Polypropylene or any other kind of material to hold the protrusion of organs or tissues. They act as flexible scaffolds in hernia repair. They use sutures, or surgical glue to keep the mesh in place. 


Gradually, the tissue grows in the small pores of the mesh along with strengthening the muscle wall. 


The procedure allows shorter recovery time and less blood loss when compared to open hernia repair.


What Is The Difference Between TEP and Tapp?

What Is The Difference Between TEP and Tapp?



TEP


Tep ( Trans extraperitoneal surgery) is a laparoscopic or keyhole surgery that repairs the inguinal hernia from the outside of the peritoneum without inserting instruments through it and repairing it from the inside. The peritoneum is the sac that consists of all the abdominal organs.  Instead, the mesh seals your hernia from the outside of the peritoneum.


TAPP


In this case, surgeons enter the peritoneal cavity to repair the inguinal hernia. The mesh is placed inside the peritoneum to repair the hernia.


Both open and laparoscopic surgeries of hernia work well and are safe. But laparoscopic hernia surgeries include benefits like reduced postoperative pain, shorter recovery time, and decreased blood loss.


What Are The Complications Of Laparoscopic Hernia Repair?

Infection of the wound


Antibiotics can deal with minor infections around the suture site on the skin.

Deeper, chronic infections around hernia mesh are more challenging to deal with.

Clients frequently require surgical treatment to remove the mesh.


Blood clots


Those can develop since you are actually under anesthesia and do not move for an extended period.


Hernia mesh adhesions


Chronic, usually severe, discomfort might be a person's only signs and symptom of a mesh adhesion. The issue might even bring about serious digestive tract blockages.


Pain


In most cases, the area will be sore as you heal. Yet some people get chronic, lasting pain after surgical treatment for a groin hernia, for instance. Specialists think the treatment might damage specific nerves. Laparoscopic surgical treatment might trigger less discomfort than an open procedure.


Hernia Mesh Rejection

Materials in hernia surgical mesh may occasionally cause the body's immune response.

This can trigger the body to reject the mesh.


Re-occurrence


The hernia might come back after the surgical procedure. Research reveals that making use of mesh can lower your possibility of this occurring by fifty percent.

Surgeons started utilizing hernia mesh to get over this problem. The concept is that mesh can, even more, reinforce weakened tissue.

However, making use of mesh is very little warranty versus recurrence.


How To Prepare Yourself For The Laparoscopic Hernia Repair?


  • It is recommended to cleanse yourself with mild antibiotic soap the night before surgery or during the morning. 

  • You shouldn't eat or drink even fluids 4-6 hours before surgery. Your doctor may advise you to take your regular medications if needed with a sip of water. 

  • If you're under medications like aspirin, blood thinners, NSAIDs, vitamin E, they should be compulsory stopped one week before the surgery. Taking this medication may lead to increased blood loss during the surgery.

  • Brush your teeth along with rinse your mouth out with mouthwash.

  • Do not shave the surgical site; your operative team will certainly clip the hair closest to the incision site.


What Should I Expect After Laparoscopic Hernia Repair?


After the surgery is successfully done, you will be relocated to a monitoring room nearby and your vitals will be monitored by the team until you are awake. You will be awakened in usually one to two hours. 


You will be sent home in a day when you start drinking fluids, able to walk, and urinate. 


After laparoscopic surgery, your recovery time will be less, and will be back to work soon after. 


You could remain overnight if you got an open surgery of the hernia repair, a laparoscopic repair with a much longer anesthetic time, post-anesthesia problems as a sick stomach and vomiting or you are incapable to pass urine.



Reference Links:












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Diploma in Minimal Access Surgery (DipMAS) is offered as a flagship program of College of AMASI. DipMAS is a one year, blended learning and a mentor led programme. This program covers general laparoscopy in semester 1 and speciality in semester 2, with online and in person learning.



You may choose your speciality from the following:

1. HPB Surgery
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Syllabus

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Laparoscopic Operation Simulator Training


This is a laparoscopic operation simulator with USB camera. It can be connected to a PC. It is ideal for surgery students, medical schools and for CME courses offering laparoscopic training.

Feature list


  • Small-type training box with 5 silicone holes.
  • Endoscope can be connected to a PC by USB
  • 300,000 dynamic pixel , manual focusing.
  • Operating Systems; Winxp,Win7,Win8 Operating System, not compatible with a Mac system.
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Below are few more images.

Laparoscopic Operation Simulator Training



Laparoscopic Operation Simulator Training 

Keywords: Surgery Simulation, Laparoscopy, Laparoscopy Techniques, Learn Surgery


Monopolar Electrosurgical Probes
Monopolar Electrosurgical Probes
 What are types of injuries while using Laparoscopic Monopolar Electrosurgery? 
Two types: Direct Thermal Injury and Indirect Thermal Injury 
What is direct thermal injury? 
Direct thermal injury occurs when the surgeon misidentifies anatomic structures or accidentally applies the tip of the active electrode to non-targeted tissue (i.e., surgical “pilot error”) 
What is Indirect thermal injury? 
Indirect thermal injury can result when electrical current is conducted along unintended pathways and burns or vaporizes a non-targeted tissue. Such indirect injuries occur during laparoscopic monopolar electrosurgery as a result of insulation failure, direct coupling, and/or capacitive coupling. 
What is Insulation failure? 
Insulation failure occurs when the layer of insulation covering the shaft of the active electrode breaks down. 




What is Direct coupling? 
Direct coupling can occur if the tip of the active electrode comes in direct contact with another metal instrument or conductor within the surgical field 
What is capacitive coupling? 
Capacitive coupling is the induction of stray current to a surrounding conductor through the intact insulation of an active electrode (e.g., active electrode—insulation—metal trocar sheath). The magnitude of the coupled charge is proportional to the amount of voltage and trocar diameter.     
Check out this video tutorial on Injuries associated with Laparoscopic Monopolar Electrosurgery: 
http://youtu.be/EVIEnNP4qdA
 
References
Brill AI, Feste JR, Hamilton TL, et al. Patient Safety During Laparoscopic Monopolar Electrosurgery - Principles and Guidelines. JSLS : Journal of the Society of Laparoendoscopic Surgeons. 1998;2(3):221-225.




While creating pneumoperitoneum, the abdomen is inflated with a pressure-limited insufflator. During the process of insufflation, it is essential that the surgeon observe the pressure and flow readings on the monitor to confirm an intraperitoneal location of the Veress needle tip. CO2 gas usually is used, with maximal pressures in the range of:

A) 6-8 mmHg
B) 8 to 10 mmHg
C) 14 to 15 mmHg
D) 18-20 mmHg

Answer in the comment section below. Detailed explanation will be posted.
 
Laparoscopy, Pneumoperitoneum
Laparoscopy, Pneumoperitoneum
What are various options for creating pneumoperitoneum?
CO2, N2O, Air, Helium, Neon and Argon
What is the problem with using Air for insufflation?

  • The problem with using air insufflation is that nitrogen of air is poorly soluble in blood and is slowly absorbed across the peritoneal surfaces. 
  • Air pneumoperitoneum was believed to be more painful than nitrous oxide (N2O) pneumoperitoneum. 
  • However air is less painful than carbon dioxide (CO2) pneumoperitoneum.    

What are the advantages of using N2O as an insufflating agent?
  • N2O has the advantage of being physiologically inert and rapidly absorbed. It also provided better analgesia for laparoscopy performed under local anesthesia when compared with CO2 or air.
  • Despite initial concerns that would not suppress combustion, controlled clinical trials have established its safety within the peritoneal cavity.
  • N2O has been shown to reduce the intraoperative end-tidal CO2 and minute ventilation required to maintain homeostasis when compared to CO2 pneumoperitoneum.
What are issues with using inert gases for insuffluation?

  • Alternative gases that have been suggested for laparoscopy include the inert gases helium, neon, and argon. 
  • These gases are appealing because they cause no metabolic effects, but are poorly soluble in blood (unlike CO2 and N2O) and are prone to create gas emboli if the gas has direct access to the venous system
What are various local and systemic effects of Carbon dioxide gas insufflated into the peritoneal cavity ?
Local and systemic effects of CO2 pneumoperitoneum
Local and systemic effects of CO2 pneumoperitoneum
 
What is most common arrhythmia caused due to pneumoperitoneum?

  • The most common arrhythmia created by laparoscopy is bradycardia. 
  • A rapid stretch of the peritoneal membrane often causes a vagovagal response with bradycardia and, occasionally, hypotension. 
  • The appropriate management of this event is desufflation of the abdomen, administration of vagolytic agents (e.g., atropine), and adequate volume replacement   

"Serum cortisol levels after laparoscopic operations are often higher than after the equivalent operation performed through an open incision." Is the statement True/ False?

  • True, however there is more rapid equilibration of most stress-mediated hormone levels after laparoscopic surgery

 What is the maximal pressure range for pneumoperitoneum?

  • The abdomen is inflated with a pressure-limited insufflator. CO2 gas usually is used, with maximal pressures in the range of 14 to 15 mmHg    

References
Schwartzs 10th ed (http://amzn.to/1q10JSc)

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