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."

Laparoscopy is an endoscopic technique using a laparoscope that allows direct visualization of the abdominal or peritoneal cavity, including the abdominal wall; the stomach, intestines, liver, and kidneys; and the female reproductive organs such as the ovaries, fallopian tubes etc A laparoscope is a tubular fiber-optic instrument that has a miniaturized telescope at one end and a light source that illuminates the inside of the abdomen. Light and images are conducted by fine synthetic fibers contained in the length of the laparoscope. Laparoscopy can be used for abdominal examination only or to perform minimally invasive surgical procedures instead of open surgery. It is often used for gynecologic examination and surgery, and is used increasingly as a less invasive alternative for simpler abdominal surgeries.

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

EQUIPMENT & INSTRUMENTATION 1.Optics 2.Abdominal access instruments 3.Laparoscopic instruments

Optics 1.Rod lens system: 1960’s (small lenses interspresed with large distance of air);Harold Hopkin Road Lens System (1996);diameter of lens mm 2.Fiber optic cables : composed of inner core of glass of high RI & a fused sheathing of low RI Incoherent bundles have random arrangement of fibers at either end Coherent bundles have orderly arrangement of fibers 3. Light sources Tungsten bulb Xenon bulb(1000hrs)- produces white light Halogen bulb ( hrs)-produces yellow light and more heat Halide bulb(150 hrs)

Video imagining systems Essential component is CCD- is equivalent to electronic retina Comprises of pixels Minimal resolving power of video camera is determined by no. of pixel in CCD which is 400 lines of resolution per inch Three chip video camera has 700 lines per inch with improved chromatic accuracy

ABDOMINAL ACCESS INSTRUMENTS 1.Open technique : Hasson cannula 2. Closed technique: Veress needle Trocar sheath Fig:Hasson cannula

How Procedure is Performed PROCEDURE Laparoscopy is most often performed under general anesthesia in an operating room, although certain laparoscopic procedures can be performed using local or regional anesthesia. Prior to the procedure, a urinary catheter is passed into the patient’s bladder to collect urine while the abdominal cavity is being explored or surgery is being performed. A small incision is made near the navel, and a cannula is inserted to keep the incision open. The laparoscope is introduced through the cannula And then the abdominal cavity is filled with carbon dioxide to distend the abdomen, lift the abdominal wall away from underlying organs, and separate abdominal organs, (generally improving visibility for the surgeon (insufflation))

The laparoscope has a built-in camera that transmits images while the procedure is performed. The entire procedure is viewed on a video monitor over the operating table, allowing the laparoscope to be guided visually to examine organs of interest and surrounding tissues. A simple diagnostic laparoscopy usually takes about 10 to 15 minutes. Operative laparoscopy can take several hours, depending on the procedure being performed. Still photographs or a videotape of the procedure are taken to include in the medical record. After the instruments have been removed and the carbon dioxide gas has been released, dissolvable stitches are used to close each incision site. After complex surgery, a thin drain tube (catheter) may be left in the abdominal wall for 24 hours to remove excess fluid and also to allow examination of the fluid for bleeding or possible infection in the surgical site.

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

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

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.