Natalie Beatrice Horasia – 01073170054
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Laparotomy &
Laparocopy
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INTRODUCTION
Surgery
A profession defined by its authority to cure by means of bodily
invasion.
Over the past two centuries
Become radically more effective, and its violence substantially reduced
Branch of medicine that is concerned with the treatment of injuries,
diseases, and other disorders by manual and instrumental means.
Involves the management of
Acute injuries
illnesses
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INTRODUCTION
Started really early as early as 6,500 BC
which some skulls are found with holes cut in their skull.
1,500 BC
The ancient Egyptians have some knowledge of anatomy from
mummification.
Use clamps, saws, forceps, scalpels and scissors, and even antiseptic
from honey.
Modern Surgery
The first successful laparotomy was performed without anesthesia by
Ephraim McDowell in 1809 in Danville, Kentucky.
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INTRODUCTION
Modern Surgery
The first hysterectomy performed was in 1843 in England.
In 1885, there was the first successful appendectomy performed, in
Iowa.
Around this time
Use of anesthesia was already publicly used.
The patient was conscious but felt not pain using ether during the
procedure to remove a tumor in his neck.
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INTRODUCTION
Modern Surgery
Laparoscopic surgery,
Initially introduced at the beginning of 1900 by Dimitri Ott, Georg
Kelling and Hans Christian Jacobeus
Von Ott inspected the abdominal cavity of a pregnant woman in 1901
Georg Kelling performed a procedure, called “koelioscopie”, closer to the
definition of modern laparoscopy.
In the same year, Jacobeus published his first report of what he called
“Laparothorakoskopie”.
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INTRODUCTION
Modern Surgery
In 1911, first laparoscopy at John Hopkins which was using 12 mm
proctoscope into epigastric incision on one of patients to stage pancreatic
cancer.
In 1920, Zollikofer discovered the benefit of CO2 gas for inffulation.
In 1938, Janos Veress developed a paring loaded needle for the induction
of pneumoperitoneum.
In 1974, Dr. Harrith M. Hasson, MD working in Chicago, proposed a blunt
mini – laparotomy
Permitted direct visualization of the trocar entrance into the peritoneal cavity
Hasson’ technique.
In 2007, the first natural orifice translumenal endoscopic surgery was
performed.
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LAPAROTOMY
Definition
Greek
λᾰπάρᾱ ("lapara") "the
soft part of the body
between the ribs and hip,
flank,“
"τομή“ (“-tomy“) "a
(surgical) cut.“
Surgical procedure involving a
large incision through the
abdominal wall to gain acces
into the abdominal cavity.
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LAPAROTOMY
May be performed to
determine the cause of a
patient’s symptoms or to
establish the extent of a
disease.
Therapeutic and/or
diagnostic aim.
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LAPAROTOMY
This procedure is done Adhesions
on many indications Diverculitis
mainly in the digestive
Intestinal perforation
and gynecology, such as:
Intestinal obstruction
Trauma of abdomen
(blunt or sharp trauma) Uterine myom
Peritonitis Ectopic pregnancy, etc.
Appendicitis
Cancer of the abdominal
organs
Pancreatitis
Abscesses
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LAPAROTOMY
The surgeon may explore the abdominal
cavity for disease or trauma.
Organs in question will be examined for
evidence of infection, inflammation,
perforation, abnormal growth, or other
conditions.
Any fluid surrounding the abdominal
organs will be inspected; presence of
blood, bile or other fluids may indicate
specific diseases or injuries.
Consists of many types of procedures,
such as:
Adrenalectomy, appendectomy,
gastrectomy, hysterectomy, colostomy,
nephrectomy, salpingoophorectomy,
etc.
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LAPAROTOMY - Incision
Vertical incision
Midline incision
Almost all operations in the
abdomen and retroperitoneum can
through this universally acceptable
incision.
Advantages
It is almost bloodless
No muscle fibres are divided, no
nerves are injured
It affords good access to the
upper abdominal viscera, and it
is very quick to make as well as
to close. Skin, fat, linea alba
and peritoneum are divided in
that order().
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LAPAROTOMY - Incision
Paramedian incision.
2 theoretical advantages.
The first is that it offsets the
vertical incision to the right or
left
Providing access to the
lateral structures such as the
spleen or the kidney.
The second advantage is that
closure is theoretically more
secure because the rectus can
act as a buttress between the
reapproximated posterior and
anterior fascial planes.
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LAPAROTOMY - Incision
The skin incision is placed to 2 – 5
cm lateral to the midline over the
medial aspect of the bulging
transverse convexity of the rectus
muscle.
Disadvantages
Tends to weaken and strip off the
muscle from its lateral vascular and
nerve supply resulting in atrophy of
the muscle medial to the incision
Laborious and difficult to extend
superiorly as is limited by costal
margin, and it doesn’t give good
access to contralateral structures(
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LAPAROTOMY - Incision
Kocher’s Incision
Theodore Kocher originally
described the subcostal incision
Excellent exposure to the gall
bladder and biliary tract and can be
made on the left side to afford
access to spleen.
It is of particular value in obese and
muscular patients.
The subcostal incision is started at
the midline 2 – 5 cm below the
xiphoid and extends downwards,
outwards and parallel to and about
2.5 cm below the costal margin.
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LAPAROTOMY - Incision
Kocher’s Incision
Special attention
For control of the branches of
the superior epigastric vessels,
which lie posterior to and
under the lateral portion of the
rectus muscle.
The small eighth thoracic
nerve will almost invariably be
divided
The large ninth nerve must be
seen and preserved to prevent
weakening of the abdominal
musculature.
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LAPAROTOMY - Incision
Kocher’s Incision
Chevron (Roof top Modification)
Be continued across the midline into a
double Kocher incision or roof top approach
Provides excellent access to upper
abdomen particularly in those with broad
costal margin.
This is useful in carrying out total
gastrectony, operations for renovascular
hypertension, liver transplantation, and
bilateral adrenalectomy, etc(
Mercedes Benz Modification
Bilateral low Kocher’s incision with an
upper midline up to and through the
xiphisternum.
xcellent access to upper abdominal viscera
and, in particular to all the diaphragmatic
hiatuses.
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LAPAROTOMY - Incision
Thoracoabdominal incision
Either right or left, converts the pleural
and peritoneal cavities into one
common cavity
Whether upper midline, upper
paramedian, or upper oblique can be
easily extended into either the right or
left chest for better exposure.
The right incision
Useful in elective and emergency
hepatic resections.
The left incision
Useful in resection of the lower end of
the esophagus and proximal portion of
the stomach.
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LAPAROTOMY - Complication
Thoracoabdominal incision
Either right or left, converts the pleural
and peritoneal cavities into one
common cavity
Whether upper midline, upper
paramedian, or upper oblique can be
easily extended into either the right or
left chest for better exposure.
The right incision
Useful in elective and emergency
hepatic resections.
The left incision
Useful in resection of the lower end of
the esophagus and proximal portion of
the stomach.
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LAPAROSCOPY
Definitions
Greek
λᾰπάρᾱ ("lapara") "the
soft part of the body
between the ribs and hip,
flank,“
Σκοπέω (“skopoe“) “To
see”
Operation performed in
the abdomen or pelvis through
small incisions (usually 0.5–
1.5 cm) with the aid of a camera.
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LAPAROSCOPY – Abdominal Access
HASSON TECHNIQUE VERRES TECHNIQUE
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LAPAROSCOPY – Advances Access
SILS NOTES
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DIFFERENCES (HYSTERECTOMY)
LAPAROTOMY LAPAROSCOPY