This PPT is mainly on the Basic Principles of Minimal Invasive Surgery. The Final Yr. MBBS - Students shouls know the principles of Lap. surgery before going to their internship.

1. Principles of Minimal Invasive Surgery
Anesthesia
InstrumentTable
AssistantScrub
Nurse
Monitor
Mayo
Stand
Surgeon

2. Definition
 Minimal Invasive Surgery can be defined as the application of modern
technology to minimize the trauma of surgical access without
compromising the exposure of the surgical site, or the safety of the patient.

3. Other Names
“ KEYHOLE SURGERY ”
“ LAPAROSCOPIC SURGERY ”
“ MINIMAL ACCESS SURGERY ”

4. Short History
 1901 - Von Ott - First inspection of abd.cavity.
 1983 - First lap.app. – Semm, a Ger. gynae.
 1985 - First lap.Chole – Erich Muhe, a Ger. surg.
 1987 - First lap.ing.hernia repair – Ger.
 1989 - First lap.hyst. – Reich et al.
 1990 – “MIS” – Wickman & Fitzpatrick.
 1992 – “MAS” – Cuschieri.

5. Extent of MIS
 Laparoscopy.
 Thoracoscopy.
 Endoluminal endoscopy.
 Perivisceral endoscopy.
 Arthroscopy and Intra-articular Surgery.
 Combined Approach.

6. Advantages of MIS
 Decrease in wound size / wound pain
 Improved mobility
 Improved vision
 Good Instrument access
 Reduction in wound infection, dehiscence, bleeding,
herniation, nerve entrapment & adhesions

7. Limitations of MIS
 Reliance on remote vision and operating
 Loss of tactile feedback
 Dependence on hand–eye coordination
 Difficulty with haemostasis
 Reliance on new techniques
 Extraction of large specimens

8. Theatre set -up
Straight – Line Principle
Surgeon opposite to the
organ of interest
Assistant opposite to the
surgeon
Camera man same side
of the surgeon
Monitor positioning
[front / bel.eye level -
25°]

9. Triangulation - Principle
P
R
L C
S
Monitor

10. Ideal Angles

11. Tools / Instruments
- 0°/30° Laparoscope
- Light source – Halogen
lamp
- Camera
- Video-monitor
- CO 2 insufflator
- Veress needle
- Trocars
- Suction-irrigation
apparatus
- Working instruments

12. General Pre-operative Principles
Technique CO2 - Common
- Creating Pneumo.15 mm Hg
- Laparoscope inserted –
umbilical port
- Abdomen evaluated
- Organs – visualized
- Additional ports placed
- Cheaper
- Readily available
- Easily absorbed
- Released via
respiration
- Highly diffusion
coefficient

13. Electro-surgery Principles
 Inadvertent touching and grasping.
 Direct coupling between the tissue &
the instrument.
 Break in insulation.
 Direct sparking to bowel from the
diathermy probe.
 Passage of current to the bowel from
recently coagulated tissue.

14. Surgery Principles
 Meticulous care – creation of a pneumo.
 Controlled dissection of adhesions
 Adequate exposure of operative field
 Avoidance and control of bleeding
 Avoidance of organ injury
 Avoidance of diathermy damage
 Vigilance in the postoperative period

15. Preparation for MIS
 Overall fitness: card.arrh. / emph.
 Previous surgery: scars, adhesions
 Body habitus: obesity, skeletal deformity
 Normal coagulation
 Thrombo-prophylaxis
 Informed consent

16. Pneumoperitoneum - Changes

17. Operative problems
 Perforation of hollow
viscus
 Bladder Injury
 Bleeding
 From Major Vessel
 From Gall bladder bed
 From Trocar site

18. Post – operative Care
 Nausea
 Shoulder Pain
 Abdominal Pain
 Analgesia
 Oral fluids
 Oral feeding
 Drains

19. Contraindications – Relative
 Compromised cardiac status
 Peritonitis
 Multiple Abdominal Surgeries
 Bleeding disorders
 Morbid obesity
 III rd Trimester pregnancy
 Portal hypertension

20. Common - Surgeries
 Diagnostic laparoscopy
 Cholecystectomy
 Appendicectomy
 Repair of all types of Hernia
 Hysterectomy
 Tubectomies

21. References