prospects & constraints in vety laparoscopy in surgery
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TRANSCRIPT
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Welcome To Major Credit Seminar
Shahnawaz ahmad bhat
M.V.Sc student
Div. of surgery & radiology
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Prospects and Constraints
of
Veterinary Laparoscopic Surgery
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overview
Introduction. Instrumentation.Uses of laparoscopy.Why to use laparoscopy?Current status.Prospects.Constraints.Conclusion. -
laparoscopy
An endoscopic procedure designed for the visual examination, surgical procedures and biopsy of the peritoneal cavity & its organs using specialized instrument called laparoscope.
Also called Minimally invasive surgery, Key hole surgery 0r Band-Aid surgery.
- Done under general anesthesia or sedation & local infiltration.Anesthetic induction need same procedures as in conventional surgery viz. fasting(24-48hrs), water holding(8-12hrs) , preanesthesia & fluid administration.Ketamine-diazepam or xylazine are recommended for G.A.Isoflurane for avian laparoscopy.
- 1-1.5cm incisions used.Veress needle used for
pneumoperitoneum.Needle placement checked by;
Hiss test
Aspiration test
Flow test
External evaluation.
- Pressure maintained automatically by insufflators.Should be
less than 15mm Hg.
Goats/sheep 8-10mm Hg
Dogs 10-12mm Hg
Horses 12-15mm Hg.
Gas flow rate 2 L/minute.
- Gas selection transparent, colorless, non-explosive, inert, readily available, less absorbed & readily eliminated by lungs.Gases - carbon dioxide, nitrous oxide, filtered room air, helium , nitrogen , xenon & argon.
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Instrumentation
Laparoscope(small animals 2.7-5mm & large animals 10mm).Light source(xenon & halogen).Fibreoptic cable.Digital video camera.Video capturing systems with floppy & CD.Medical grade colour monitor. - Veress needle for creating pneumoperitoneumAutomatic Carbon dioxide insufflators.Gas inflation tubing.Trocar & canulas( 10-12mm & 5-8mm).Laparoscopic scissors & grasping forceps.Electrocoagulators.Irrigation & aspiration systems.Endoclip forceps, endoclips & staples.
- Image documentation system
- Medical grade monitor
- Insufflator, veress needle & insufflation tube
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- Laparoscopic forceps
- Laparoscopic forceps
- Biopsy forceps
- Disposable laproscopic forceps
- Laparoscopic scissors
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Uses of laparoscopy
Diagnosis of diseases;
by biopsy i.e. histopathology.
by direct visualization of body cavities
and organs.
Surgical treatment of diseases.
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Why to use laparoscopy?
Less post-operative morbidity/pain.Shorter hospital stay & recovery period.GIT functions rapidly returned to normal.Few intra-abdominal adhesionsLess contamination of surgical fieldLess invasiveStress indicators increase less & return to base value rapidly indicating less stress to animal. -
Current status
surgical procedures;
Exploratory laparoscopy.Ovariohysterectomy.Ovariectomy.Vasectomy.Cholecystectomy.Inguinal, femoral, umbilical hernia repair. - Gastrostomy, Gastropexy & partial gastrectomy.Complex
procedures like pyloromyotomy
& fundoplication.
Feeding tube jejunostomy, enterotomy.Small intestinal anastomosis.Colopexy, rectopexy & cystopexy.Laparoscopic splenectomy.Laparoscopic adrenalectomy. - Intestinal intussusception diagnosis & treatment in a dogs.
S.K.maiti et al 2004
Intra-abdominal vasectomy in dogs.Lap. Assisted tube cystectomy in goats.N. Kumar et al 2006
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Diagnostics;
Infertility; uterine deformities, tubal defect, endometritis, ovarian cystsChronic abdominal pain due to adhesions, endometriosisEctopic pregnancy- diagnosis & treatmentUrinary tract diseases.Neoplasia of liver, spleenAbdominal cryptorchidism Normal & abnormal anatomy of organs. - Diagnosis of intra-abdominal pathologies in
canines.Laparoscopic liver biopsies through cauterization in small
animals.
S.K.Maiti et al 2004
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Future prospects
in
laparoscopic surgery -
Sterilization of small animals
Common clinical practice in western
countries.
Both single port & 2 port techniques used.
Post surgical activity measured by
accelerometer;
25% decrease in LapOVE.
62% decrease in OOVE.
William T.N.Culp et al 2009
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Equine surgery in standing condition
- Cryptorchid castration.Inguinal hernia repair.Standing flank ovariectomy.Standing flank tubal ligation.Standing flank oviductal insemination.Laparoscopically guided per-rectal examination for teaching students.
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Laparoscopic mesh incisional hernioplasty
in horses
8-16% horses affected after median celiotomy.
Open hernioplasty-seroma,wound or mesh infection, fistula & recurrence.
Laparoscopic mesh incisional hernioplasty
Less soft tissue trauma
Lower recurence rates
Good cosmetic result
J.P.Caron 2009
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Laparoscopic embryo transfer
For genetically superior animals
Mares in athletic performance or unable to maintain pregnancy.
Done with a specially designed embryo transfer catheter.
Non-surgical method-50-60% success rate
Laparoscopic method-80-90% success rate.
Squires EL et al 1999
- Laparoscope with a specialized embryo transfer catheter.
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Laparoscopic ovum pick-up(LOPU)
For obtaining invitro fertilized zygotes in the production of transgenic goats or reproductive rescue of aged goats of high genetic value.
As a source of cytoplasm in nuclear transfer (NT) procedures.
Baldassarre H 2007
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Prepubertal propagation of superior animals & transgenic cloned goats.
The pregnancy and transgenesis rates similar to the rates obtained when using in vivo-produced zygotes
Baldassarre H et al 2003
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Gasless Laparoscopy in bovines
Diagnosis of traumatic reticuloperitonitis.
Diaphragmatic hernia.
Abomasopexy.
PIERRE-YVESMULON 2006
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Laparoscopic artificial insemination
70-80 % success rate -
Laparoscopic ultrasound(LUS)
- Primary advantage of LUS - ability to image beyond tissue boundaries. Additionally, the ability to place the transducer directly against an organ allows the use of higher frequency devices which provide better resolution.Used for staging of neoplasm
- LUS of normal liverLUS of gall bladder
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Laparoscopy in radiology
Contrast radiographic studies of biliary tract (cholecystocholangiography) & urinary tract have become common technique.Contrast agent (Iohexol , Meglumine iodipamide) directly injected into gall bladder or urinary bladder under laparoscopic guidance. -
Laparoscopic fetal surgery(fetoscopy)
Corrective procedures on fetus at a much earlier age when the wounds heal without scars.Fetuses treated for congenital conditions like cleft lips, obstructive uropathy, severe congenital diaphragmatic hernia etc.Successful operations performed in bitches, sows & ewes.Roman M Sydorak 2001
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MR-compatible laparoscope
In traditional procedures the surgeon exposes the whole operative site in order to interpret its broader anatomical context. video-guided MIS - lack of a wide field of view(FoV). Many Surgeons doubt that patient safety can be warranted using only a key hole perspective. -
MR-compatible laparoscopy
- Provides a wide FoV image of moderate
resolution.
In addition, the method provides high soft tissue contrast.P.Gross et al 2001
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Laparoscopic Surgical Robot (laprobot)
Lanfranco AR-2004 - Robotic surgery has been touted as a solution to underdeveloped
nations, whereby a single
central hospital can operate several remote machines at distant locations.
The potential for robotic surgery has strong military interest, providing mobile medical care while keeping trained doctors safe from battle. -
Augmented reality technology
- Allows a physician to see directly inside a patient, using augmented reality (AR). AR combines computer graphics with images of the real world. This uses laparoscopic range imaging, a video see-through head-mounted display (HMD), and a high-performance graphics computer to create live images that combine computer-generated imagery with the live video image of a patient.
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CAPSULE ENDOSCOPY
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Constraints
In
Laparoscopic surgery
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Technical constraints
Anesthesia hypercapnia & acidosis.Veres needle & Trocar injury.Insufflation- subcut., periperitoneal, & subfacial emphysema.Pnuemothorax, pnuemomediastinum & pnuemopericardium.
- Gas embolism.Incisional hernias.Tumor implantation at trocar sites.Lack of tactile feedback.Loss of depth perception due to 2 dimensional view on monitor.Restricted range of motion & FoV.Electrosurgical burns.Time consuming.
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Non-technical constraints.
Cost of equipment.Long procedural learning curve.High skill level needed.Lack of skilled assistance.Cumbersome maintenance of equipments.Lack of will from surgeons to use the technique. -
Conclusion
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With the development of skills, research and advancement in technology time is not far when laparoscopic surgery will replace many of the traditional surgical procedures in veterinary sciences as well like human field
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"Someday in the future, people will look back at a regular surgical incision as something archaic and barbaric
Dr. Paul A. Wetter,
Chairman of the
Society of Laparoendoscopic Surgeons
USA