Role of Minimal Access Surgery (laparoscopic Surgery) in the present era - PowerPoint PPT Presentation

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Role of Minimal Access Surgery (laparoscopic Surgery) in the present era

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Fortis Hospitals Examiner-Royal College of Surgeons of Edinburgh Surgical Tutor & Guide- DNB Surgery & Surgical Gastroenterology Philosophy of early/mid 20th century ... – PowerPoint PPT presentation

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Title: Role of Minimal Access Surgery (laparoscopic Surgery) in the present era


1
Advanced Minimal Access Surgery (laparoscopic
Surgery) in rare case of colovesical fistula
Dr Ramesh Agarwalla MS,FRCS(Edin) Advanced
Laparoscopic Bariatric surgeon Fortis Hospitals
Examiner-Royal College of Surgeons of
Edinburgh Surgical Tutor Guide- DNB Surgery
Surgical Gastroenterology
2
Big Surgeons Make Big Incisions
Philosophy of early/mid 20th century surgeons
3
Those maestros
  • limitations
  • Anesthesia
  • Muscle relaxation
  • Bio medical technology not fully developed.

Hence The Need For BIG INCISIONS
4
Desire to Improve
Surgeons
Technology
Minimal Invasive Surgery
  • Goal
  • Precise diagnosis and management .
  • Less/no pain.
  • Faster recuperation.
  • Wonderful cosmesis.
  • Less expensive.

5
The Ball Set Rolling
1901 - George Kelling
1st Laparoscopy
1987 Philip Mouret
1st Laparoscopic Cholecystectomy
The Ball Has Never Stopped
6
Laparoscopic Surgery / Minimal Access Surgery
  • 1st documented laparoscopic cholecystectomy in
    the world ---Philip Mouret,France,1987
  • 1st documented laparoscopic cholecystectomy in
    India---Prof T E Udwadia,Mumbai,1990
  • 1st laparoscopic cholecystectomy at Fortis
    hospital (formerly Wockhardt)---1992

7
At Fortis Hospitals
  • Silent active minimal access surgery /
    laparoscopic surgery programme since 1992
  • 1st dedicated minimal access unit in Eastern
    India
  • Performing wide spectrum of surgical procedures
    by laparoscopy
  • More than 15000 procedures

8
Benefits of Minimal Access Surgery
  • Less pain
  • Reduced hospital stay
  • Early return to normal life
  • Less wound infection dehiscence
  • Better cosmesis

9
Myths
  • Poor vision
  • Cause cardiovascular compromise
  • Incomplete operation
  • Not suitable in patients with previous surgery
  • Suitable in simple cases only

10
Laparoscopic basket
  • Gallbladder stones
  • Appendix
  • Hernia

11
Laparoscopic basket
  • Commonly done procedures
  • Expertise for the same is now available at many
    places.

12
Advanced laparoscopic procedures.
  • Horizons have expanded and more of other surgical
    procedures are being done laparoscopically
  • These advanced procedures need special expertise
    and wide array of equipment.
  • Special expertise and equipment is available in
    few select centres
  • Now we can perform almost every abdominal surgery
    laparoscopically
  • To name a few, operation on liver, pancreas,
    adrenal glands, small and large intestine can be
    conducted laparoscopically
  • Effective both for benign and malignant
    conditions

13
Advanced minimal access surgery (laparoscopic
surgery)
  • Awareness is less
  • Few dedicated centers In the country
  • Fortis is one such dedicated centre
  • Experienced surgical team
  • state of art equipment

14
Advanced minimal access surgery (laparoscopic
surgery)
  • Entering its 2nd decade of practice
  • The 1st report in the literature was in 1990
  • Numerous advantages when compared
  • with open procedures
  • Less post operative pain
  • Less ileus
  • Reduced perioperative immuno-suppression
  • Decreased hospital stay
  • Improved cosmesis
  • Earlier return to normal activity

15
Conventional surgery
16
Patient profile
  • Mr Tapan Kumar Biswas, 38 years old male
  • Symptoms recurrent abdominal pain,
  • difficulty in passing urine,
  • noticed there was stool
    matter in the urine
  • passing urine through his
    anal opening
  • Clinical condition was very ill, had urinary
    infection, fever,
  • unable to eat
    ,had severe pain in the abdomen
  • weighed only
    27kgs

17
Patient profile
  • Investigations ultrasound, CT scan revealed an
    abnormal
  • communication between the
    urinary bladder and the
  • intestine (colovesical
    fistula) due to Crohns disease
  • Treatment initially medical to improve his
    general condition to
  • withstand surgery
  • would not be able to survive
    open surgery
  • laparoscopic excision of
    fistula, repair of the urinary bladder
  • and the intestine
  • Post operative period was walking 24hrs after
    surgery
  • eating after
    48 hours
  • passing urine
    normally after 7 days

18
Crohns disease
  • Common in North America, Northern Europe,
    Uncommon disease in India
  • Slightly more common in females
  • Common between the ages of 15 and 40 years
  • Cause not known
  • Affects small and large intestine
  • Chronic inflammation of the intestine causing
    ulcerations in the intestines
  • Presents with abdominal pain, diarrhoea, fever,
    loss of weight, anaemia
  • Complications like intraabdominal abscess and
    internal fistula

19
Tapan Kumar Biswas ,38 years
  • On 3rd Post op day following lap assisted
    excision of colovesical fistula

20
Tapan Kumar Biswas ,38 years
  • On 3rd Post op day following lap assisted
    excision of colovesical fistula

21
LAPAROSCOPIC SURGERY
  • Future is BRIGHT
  • Our endeavor is
  • gt Increase awareness of the benefits
    to medical
  • non medical fraternity
  • gtEstablish structured training
    include it in
  • Postgraduate curriculum
  • gtBenefits should reach the common man

22
LAPAROSCOPIC SURGERY
  • Being poor is neither a stigma nor a reason for
    despair it is a state of existence at a
    particular moment in a countrys history
  • Patients in developing country have as much
    reason to receive benefits of reduced pain,
    early return to family work
  • Advantages are greater in a developing country
    where demand for hospital beds is greater, health
    insurance cover nonexistent early return to
    work a financial necessity

23
LAPAROSCOPIC SURGERY
  • Further advancements
  • Needloscopy
  • Computer based Surgery
  • Robotic Tele Surgery

24
LAPAROSCOPIC SURGERY
  • PAST- Big Surgeons make Big incisions
  • PRESENT- Big Surgeons make holes
  • FUTURE- Big Surgeons do nothing Robots do all

25
LAPAROSCOPIC SURGERY
  • Never stop LISTENING
  • Never stop LEARNING
  • Never stop TEACHING

26
How do you want your patient to be ..?
Like This????
27
Questions ??
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