LAPAROSCOPY Origin: Greek Lapara- "the soft parts of the body between the rib margins and hips- the "flank or loin " Skopein, which means "to see or view or examine." laparoscope - endoscope inserted through an incision in the abdominal wall in order to examine the abdominal organs or to perform minor surgery endoscope- a long slender medical instrument for examining the interior of a bodily organ or performing minor surgery.

LAPAROSCOPIC SURGERY Minimally invasive surgery -the smallest possible incisions. Key hole surgery –the incision to enter the abdomen Belly button surgery, scope often through umbilicus Band-Aid surgery, because the incisions so small that they can be covered with adhesive bandage strips. Endoscopic surgery, because the instrument used for minimally invasive procedures on parts of the body other than the abdomen is called an endoscope Abdominoscopy peritoneoscopy

HYSTEROSCOPE Origin: Greek Hystero-womb. Skopeo, to view Endoscope -- uterine cavity. Also called metroscope, uteroscope

HISTORY To Reduce size of incisions - dream of surgeons for years. 400 BC -Hippocrates described a rectoscope. 11th century - Albukasim, Arab physician, - speculum illuminated by a set of light reflectors-limited applications because the heat produced by candles and other artificial lights resulted in burns George Kelling did the first laparoscopy on a dog The first laparoscopy in human by the Swedish physician H. C. Jacobeus.

HISTORY Up to the 1970s, laparoscopy was mainly used by gynecologists and gastroenterologists for diagnostic purposes. Therapeutic laparoscopy introduced by gynecologists in the early 1970s. Rapid technical advances in miniaturized surgical tools, fiber optics, and video systems - new developments in minimally invasive surgery. methods reduced post-operative complications -laparoscopy and other types of minimally invasive surgery became widely used by surgeons around the world.

In the 1980s, -small, high-resolution television cameras made laparoscope more effective The first live broadcast of a laparoscopy via the Internet took place in On March 3, 1997, a computer-enhanced robotic system was used on a human for the first time by Dr. J. Himpens to perform some steps of laparoscopic surgery. HISTORY

GYNECOLOGICAL LAPAROSCOPY PROCEDURES Pelvic pain of uncertain cause Ovarian cysts Endometriosis Pelvic adhesions Ectopic pregnancy Infertility Hysterectomy Tubal ligation

VERESS NEEDLE -pneumoperitoneum

ADVANTAGES OF LAPAROSCOPY few very small incisions about a half-inch long. Instead of a 4-5 inch incision,cause less damage to body tissue, organs, and muscles so that the patient can go home sooner. recovers quickly. fewer post-op complications, less pain. has less scaring.

RISKS OF LAPAROSCOPY Generally safer than open operations. Diagnostic laparoscopy-complications 3 in 1000 Risks greater for people who are obese, smoke cigarettes, or have additional health problems Laparoscopy usually requires general anesthesia which carries certain risks. Injury to blood vessels or organs, which causes bleeding. Conversion to laparotomy

THE FUTURE Robotic Surgery principle of master slave manipulator. The da Vinci system The Zeus system These machines have interface for surgeon which deliver information through computer to robotic arm.

MASTER SLAVE MANIPULATOR Robotic devices to enter the body through its own orifices carrying medical instruments inside the body, where they would be manipulated by simple computer commands.

THE FUTURE Minimal Access Surgery techniques in cardiac -The first totally Minimal Access coronary artery bypass operation has been performed at the Imperial College (St. Mary’s) London.

HOLOGRAM PROJECTION SYSTEM Laparoscopic surgery is growing in such a speed that 3D image projection system is going to replace the conventional monitor in near future and surgeon will get a virtual image in air just above the body of patient. This new projection system will abolish all the limitation of current two dimensional image without depth perception.

THE FUTURE Newer micro-laparoscopes are about one-tenth of an inch in diameter so that some procedures can be performed through small hollow needles Make greater use of local anesthesia and sedation through an intravenous catheter. Local anesthesia will make laparoscopy even safer by further reducing the already- small number of complications that occur with general anesthesia.

“From the inability to let well alone,from too much zeal for the new and contempt for what is old, from putting knowledge before wisdom,science before art and cleverness before commonsense, treating patients as cases,from making the cure of the disease more grievous than endurance of the same,good lord deliver us” – Sir Robert Hutchison