Transcript laparoscopic surgery

ADVANCES IN
SURGERY
Samuel Vincent G. Yrastorza, MD, FPUA
DIAGNOSTICS
Has grown leaps and bounds for the past years
Symptomatic disease
- history and PE still accounts for 80-90%
in clinching the diagnosis
Asymptomatic diseases
- screening procedures detect early diseases
- e.g. colonoscopy for colon cancer
DIAGNOSTIC ADVANCES
Before
Signs and Symptoms + PE
Abdominal pain, Diarrhea
PE = abdominal mass
Diagnostic Exam/Imaging
Stool exam
Colonoscopy, Abdominal CT scan
Diagnosis
Colonic Cancer
DIAGNOSTIC ADVANCES
Presently
Reaching 40 y/o
Screening Colonoscopy
Colonic Cancer
Without any signs or
symptoms of disease
Small colonic mass noted
and biopsy done
DIAGNOSTIC ADVANCES
CT Scan
- Has become more sensitive and specific
- Diagnostic modality of choice for a majority of surgical cases
with the advent of
- 3D reconstruction
- CT angiography
DIAGNOSTIC ADVANCES
CT Scan
prototype
EMI CT scan
256 slice CT scan
IMAGING
CT before
256 slice with 3D reconstruction
COLON
IMAGING
Colonoscopy
256 slice with 3D reconstruction
IMAGING
CT before
128 slice with 3D reconstruction
KIDNEYS
IMAGING
Conventional
angiogram
CT angiogram
Radiotherapy
Brachytherapy
- Greek brachy meaning “short”
- radioactive source placed inside or next to the area of treatment
- not just for adjunctive therapy or pallation
- as first line treatment for various forms of cancer
- commonly used for prostate cancer, cervical cancer , head and neck
cancer
- radioactive sources
- strontium plaque
- iridium wires
- iodine 125 seeds
PROSTATE BRACHYTHERAPY
PROSTATE BRACHYTHERAPY
PROSTATE BRACHYTHERAPY
- for early and localized cancer
- not for locally advanced or metastatic prostate cancer
- comparable result to radical prostatectomy
- out patient procedure
- lesser complications than radical prostatectomy
- uses iodine 125 seeds
LOCALIZED PROSTATE CA
TREATMENT
brachytherapy
Radical prostatectomy
CRYOTHERAPY
Probes/needles directed at organ or tissue
Freezing ---- thawing---- freezing
cellular disruption
cell death
CRYOTHERAPY
Used for
- benign and malignant skin
conditions
- early and localized cancers
- liver
- prostate
- hemorrhoids
CRYOTHERAPY
Used for
- benign and malignant skin
conditions
- early and localized cancers
- liver
- prostate (widespread use)
- hemorrhoids
CRYOTHERAPY
ice balls
RADIOFREQUENCY ABLATION
RFA probe (needle) placed inside the tumor
(guided by CT scan or ultrasound or through open procedures)
Radiofrequency waves passed
through probe into tumor
increased in temperature within tumor
tumor necrosis
RADIOFREQUENCY ABLATION
Indications
- tumors of the lung, liver, bone
- used for primary and metastatic
tumors
- recurrent atrial fibrillation and
supraventricular tachycardia
- varicose veins
RADIOFREQUENCY ABLATION
RFA probe
(needle)
RFA generator
RADIOFREQUENCY ABLATION
RADIOFREQUENCY ABLATION
Percutaneous approach
Laparoscopic approach
Open approach
HIGH INTENSITY FOCUS
ULTRASOUND (HIFU)
HIFU
directed at tissue/tumor (by ultrasound or MRI)
increase temperature at target tissue/tumor
tissue/tumor destruction
HIGH INTENSITY FOCUS
ULTRASOUND (HIFU)
used for:
- uterine fibroids
- solid tumor of the brain, bone, breast, liver, pancreas,
rectum, kidney, testes, prostate
- earliest and widest use = for prostate cancer
- atrial fibrillation, arrhythmia
HIGH INTENSITY FOCUS
ULTRASOUND (HIFU)
SURGICAL PROCEDURES
- Trend toward less invasive procedures
The “old way”
NOW
LAPAROSCOPIC SURGERY
-
Minimally invasive surgery
Minimal access surgery
Key hole surgery
Pinhole surgery
Band-aid surgery
*** part of a broader field of ENDOSCOPY
LAPAROSCOPIC SURGERY
Access
LAPAROSCOPIC SURGERY
Used for:
- diagnostic
- cancer surgery
- donor organ harvest ( donor nephrectomy)
- vascular surgeries
- practically any abdominal surgery
LAPAROSCOPIC SURGERY
Advantages
- smaller incisions (smaller scars)
- fast recovery (short hospital stay)
- better visualization of abdminal structures
LAPAROSCOPIC SURGERY
Disadvantages
- more expensive
- requires expertise
- steep learning curve
- longer operating time (gap is slowly closing
with that of open surgery)
ARTHROSCOPIC SURGERY
- Cystoscopic surgery of the joints
- Similar advantages and disadvantages as laparoscopy
arthroscopic
Open Knee
surgery
THORACOSCOPIC SURGERY
- Cystoscopic surgery of the THORAX
- Similar advantages and disadvantages as laparoscopy
- Instruments basically the same
Open thoracic surgery
thoracoscopic
Others
Cranioscopy???
Not enough space
Microlaparoscopy
- 3mm port instead of the usual 5 and 10 mm ports
- Smaller instruments
- Lesser pain and scar
ROBOTIC SURGERY
ROBOTIC SURGERY
ROBOTIC SURGERY
ROBOTIC SURGERY
ROBOTIC SURGERY
Telementoring
- Teaching/mentoring through the internet
- “out of school students”
- Open universities
Telementoring
Telementoring
- Surgical training though internet or other forms of
telecommunications
Telesurgery
Stem Cell Therapy
- Use of stem cells to treat certain diseases
- To create new tissues/organs to replace/augment the
existing ones
Stem Cell Therapy
- Use of stem cells to treat certain diseases
- To create new tissues/organs to replace/augment the
existing ones
DM type 1
New pancreatic cells
transplanted into patient
Stem Cell Therapy
Stem cells
- unspecialized cells capable of renewing
themselves through cell division
- can be induced to become tissue or organ
specific cells
- in gut and bone marrow
= stem cells regularly divide to repair
and replace worn out or damages tissues
- pancreas and heart
= stem cells divide only under special
conditions
Stem Cell Therapy
Categories
1) Non embryonic
- somatic or adult stem cell
2) Embryonic
- use of human embryo
Stem Cell Therapy
Non embryonic
e.g. Bone Marrow transplant
- for luekemia
- replacing the old marrow with new Bone Marrow
- new marrow will produce new and normal blood cells
(leukocytes, macrophages etc)
Stem Cell Therapy
Embryonic
Stem Cell Therapy
The Promise of stem cells
1) Understanding the development of specialized cells
and eventually the evolution of diseases
2) Possibility of renewable source of replacement cells
and tissues to treat diseases
What Else?
Penile Transplant???!!
END