Remove a gall bladder (gall bladder) endoscopic Laparascopic Cholysistectomy
It all started with the French surgeon Philippe Morier Philippe MOURET year in 1987 where he announced the time of the first successful operation to remove a gall bladder (gall bladder) by laparoscopic surgery, the aim of such surgery is to reduce mortality to less than 5 per cent compared to conventional surgery.
With the passage of time and with the surgeons to master this new technology took laparoscopic surgery to expand and now demonstrate and achieve its goals, not only in reducing the mortality rate or minimize the duration of hospitalization, and resumption of professional activity as soon as it is today the best way to eradicate the vesicles bile (gall) .
Second: A historical perspective
In 1987 conducted a French surgeon Philippe Morier first remove a gall bladder (gall bladder) (bitterness) of endoscopic woman who was suffering from a disease Women and gall bladder stones (gall bladder) under direct visual control by the surgeon and where he enjoyed 20 years of experience in the exploration of the human body Laparoscopic especially the abdomen and hand used in this process, special surgical tools Balnsaiip and obstetrics.
Stop the surgeon to the left of the patient's thighs tight and enter Alambazl, will be clarified later, was a difficult process which has suffered two wounds and almost completely changed his view of what he would have wished, but he soon optimism at the first visit to his patient after the operation so that he found sitting on the edge of the bed painted, and asked him: Why did not Tkhalsoni of gall bladder stones (gall bladder)?
Philippe Morier families wounds to his team mate Francois Dubois success of the operation were applied to other patients after the introduction of some changes by the empirical studies from May 1988. A special screening of the film with this technology in Atlanta in 1989 and hailed this development in surgery that day and taken to resort to this surgery in the eradication of gall bladder stones (gall bladder) continues to increase, surgeons train them have been circulated in most university hospitals and private.
III: surgical techniques
The principles of the process:
Hardly changed and the conduct of this process compared to the traditional way, they are performed on patients under general anesthesia machines with a hook to monitor heart rate to avoid absorption of organic carbon through the peritoneum "Albirituan" or lack of oxygen saturation of the body in the case of pulmonary gas reimbursement. That requires general anesthesia and quality of the patient and Irkhaih to reduce the high pressure within the abdominal cavity.
Remove a gall bladder (gall bladder) endoscopic Laparascopic Cholysistectomy
Remove a gall bladder (gall bladder) endoscopic Laparascopic Cholysistectomy
Figure 1: showing repositioning Alambazl
Figure 2: Control show in Milan and show the area is under the liver
The patient lies on his back above the operating table in two different ways:
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French-style frensh position
Surgeon takes place between the thighs of the patient Mufrqtin from each other and be the Assistant to the left of the patient.
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American way
The patient can remain taut thighs, and take the surgeon and his assistant places at the left.
Remains the French way is the most widely used in Europe.
Is pumped into the gas emissions after the initial hole near the umbilical Veress needle FERCE after making sure that the needle is in good position within the abdominal cavity, and by means of preventive precautions, and we pump gas so that the pressure within the abdominal cavity between 12 and 15 mm Hg for extended my stomach is easy to enter Alambazl and the procedure in appropriate situations. The volume of gas to be injected varies according to the structure of the patient and generally ranges between 2 and 4 liters. Immediately after the first hole was a little bit near the navel and enter Mbzl 10 mm into the abdominal cavity to be a strong light source through the "camera." Some surgical teams prove Alambzl several points surgery. Tend surgical table so that moving the feet slightly down. Is checked the entire abdominal cavity and its members well before the introduction of Alambazl the other three. Be the second slot in the left side of the abdomen Koshah hypochondre gauche is the main driver for the surgery. A third slot in the right-hand Alhverp Aharagafip Mbzl III. Slot under the latter, the end of the sternum enters the bar way to control the movement and Milan during liver surgery.
Begin the process of explaining gall bladder (gall bladder) by Dissected electric scalpel or scissors, or by custom to do so.
Remove a gall bladder (gall bladder) endoscopic Laparascopic Cholysistectomy remove a gall bladder (gall bladder) endoscopic Laparascopic Cholysistectomy
Photographs 3 and 4 illustrate the back of the autopsy peritonitis bitter
Not control the movement of the left liver and Milan by Mbzl Palpateur and at the same time the introduction of serum in the abdominal cavity to wash and the liquidation of the operation or absorption of blood. Shall be maintained and install the gall bladder (gall bladder) tongs.
Remove a gall bladder (gall bladder) endoscopic Laparascopic Cholysistectomy
Remove a gall bladder (gall bladder) endoscopic Laparascopic Cholysistectomy
Figure 5: Identification of the search for the artery and bile duct in autopsy peritonitis from the bottom to the top
Picture 6: Identify clearly the artery and bile duct
Do not differ in the later stages of this process on the other as in conventional surgery, and the Search for the bile duct by opening the front fascia sheets artère cystique artery bile and rear, and some surgical teams, select the camera to increase the biliary tract and liver basic "internal and external" cholangiographie per -opératoire, not in order to avoid bile duct injuries, but to confirm the diagnosis immediately.
Often there are two ways:
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The first method relies on the identification and autopsy bile duct basic le cholédoque
One of the main purposes of the elimination of the confusion in not differentiating between bile duct basic and others. This technique is not without the possibility of wound canal bile basic and we do not need to do so because the operation was aimed mainly gall bladder stones (gall bladder).
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The second method adopted by Dubois et Al and relies on identifying bile duct when entering the vesicle without an autopsy the main channel.
Networking is bile duct surgical buckle Clip "made of titanium or absorbed over time" and the two sides and preferably some surgeons today linked by a surgical thread, and the artery bile Vicbk buckle surgical side. He also showed that it is not dismissed or explained by any member to make sure the elements of the triangle Kalou.
The anatomy gall bladder (gall bladder) are being gradually from bottom to top, entirely separated when placed behind the liver waiting for input in a special bag to be placed where épiploon or Altherb. Then be sure the curd from sticking Sac liver, and can be relaxing Drainage for the area of operation under the liver by Ohvod, according to the course of surgery.
Sac withdraw cleared after putting them in a plastic bag and graduated from the slot near the navel or the hole in the left side of the body "slot Koshah left," according to surgical teams, in order to prevent the spread of yellow within the abdominal cavity, or to prevent the spread of cancer cells in the case of cancer, gall bladder (gall bladder) hidden. Empty then the abdominal cavity of carbon dioxide and fill slots by surgical thread slow absorption and two levels of slots for women with the 10 mm. Currently being sought on the possibility of the development of machines for holes less than 5 mm to minimize the collateral damage of the abdominal cavity.
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Inflammation of the gall bladder (gall bladder) and proximity to a sharp steep:
An acute inflammation of the bile vesicle ratio in the prestigious surgical reminders, so you can make the process of eradicating Sac in the first 72 hours or after a week of treatment with antibiotics and painkillers. In the first case, "Acute" the surrounding tissue immersed spina topical œdème vesicle membranes may rupture at the slightest contact and bleeding profusely.
In the second case "proximity acute inflammation" We find significant fibrosis, with a shrinking tissue, and it is difficult to define or differentiate between the different anatomical components topical and abound in such cases the wounds sewer main bile and blood special section of the right hepatic artery.
And the process somewhat difficult comparison to make in the normal situation, so it is advisable that the patient is in the hands of a surgeon trainee, and the security of the patient would prefer not to persist in completing the process if the circumstances laparoscopic surgery is difficult and can be used to the traditional way to complete the process. It is necessary to involve a syringe and pacifier of effluent high in the process.
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Frequently in such operations, gall bladder rupture (bitterness) and the possibility of losing or forgetting the stones inside the stomach before you start the process, so many surgeons resort to empty the vesicle injection Veress
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In the case of rupture or open the vesicle must be placed in a plastic bag.
As in conventional surgery can leave part of the vesicle special edge conjoined liver, with emphasis on Takterha Balambda electricity after the completion of the process.
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Better to leave Ohvod Drain under the liver and in view of the characteristic hemorrhagic, infective for such
Operations.
IV: Results
1.
Shift towards traditional surgery:
It is a great transformation during the surgery to laparoscopic surgery, the traditional difficulties encountered by the surgeon (such as infections, bleeding and sticking to each other anatomical parts), or certain diseases, which are detected by the surgeon during the operation (such as gallbladder cancer, Anbthat métastase), wound channel bile, bleeding receptacle bloody can not easily controlled or laparoscopic repair.
Must be that the transition from arthroscopic surgery to conventional surgery quickly and does not bring any risk to the patient. Such cases occur in less than 10 per cent, according to studies, and may reach 20-38 per cent in cases of inflammation of the gall bladder (gall bladder) syndrome, according to the interval between the onset of the disease and the date of programming process. It is also important to note that the transformation process can not in any way be considered as one of the complications and should be considered as a complement to surgery in some other way for the benefit of the patient.
2.
After surgery:
With the exception of the small muscle tears, most of the studies demonstrated that the inflammatory response and immune important concern than conventional surgery, and only part of the immune peritonitis incite a small percentage in laparoscopic surgery.
The benefits of this surgery to reduce pain after the operation, except for some shoulder pain associated with absorbing carbon dioxide gas may continue until the third day of the operation. Reduced the rate of hospitalization for 4 days. The patient for the exercise of his work and his sporting a very short time, and this has contributed to the emphasis on the development of this technology.
3.
Complications:
Two recent studies made sure there are complications remove a gall bladder (gall bladder) the first laparoscopic France included 4624 patients, and the second by the interests of the U.S. Department of Defense included the 9130 case remove a gall bladder (gall bladder) endoscopy.
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Mortality 0.2 and 0.3 per cent, respectively, including 4 deaths in the first study, and 5 deaths in the second study directly linked to machines binoculars (holes bowel, bleeding or the payment of pneumonia).
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Complications in the French study is 4.9 to 6 per cent, taking into account the age and clinical symptoms causes complications after the operation if the key exception of obesity, so you do not have any effect on complications.
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Biliary tract injuries: a serious complication and costly in the process remove a gall bladder (gall bladder) endoscopy, especially if the injury is at the level of the main channel.
These complications occur in 0.3-0.6 per cent of cases, ie, an estimated 1500 - 3000 patients per year. In the United States held about 500000 eradication gall bladder (gall bladder) endoscopic annually.
The mortality rate associated with biliary tract injuries, ranging between 0 - 6 per cent. If these wounds, the surgeon discovered during the restoration process can be wound and relaxing the main bile duct Ohvod Kahr and allowing for a temporary diversion of bile out of the body, or to switch to conventional surgery and a liver Tfmm with the central part of the small intestine at a y.
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Intestinal Holes: estimated at about 0.9 per cent in the study, and mainly aimed at the small intestine and duodenum in some cases, the colon, and the reason for the burns caused by the electric scalpel. Diagnosis is usually after the process so that the patient suffers from the abscess, peritonitis or fistula Fistule between the colon and skin
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Injuries and great vessels: they are rare but are listed in most studies, and if they occur require some sort of courage and coolness surgeon, it occurs when you enter FERCE injection, or during the introduction of Mbzl without control, or at autopsy triangle Kalou to distinguish between the artery and bile duct.
In a study by Deziel et Al on 77,604 patients who underwent the operation there were only 83 cases
Injuries caused large blood vessels in 5 deaths.
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Loss of gallstones: This unique feature of laparoscopic surgery, especially after rupture of membranes, gall bladder (gall bladder) If flammable or during the autopsy.
If this happens and lost frescoes of the stones within the abdominal cavity, it is rare complications such as abscess within the cavity, but all the empirical studies referred to the relative risk only, and is leading in some cases to shift to traditional surgery.
4.
The financial cost:
There is no difference between the major financial laparoscopic surgery and traditional surgery in the eradication of gall bladder (gall bladder). And remain the property that are characteristic of this surgery is to lower the patient's stay in hospital and practice in order to work less and thus contribute to reducing the financial costs and economic burdens on institutions.
Fifth: The contraceptive use of arthroscopic surgery in the eradication of gall bladder (gall bladder)
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Uncertainty in the presence of cancer, gall bladder (gall bladder) due to the risk of leakage and the spread of cancer cells.
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A Cavernome portal
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The problems of blood clotting.
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Case surgery.
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Situational barriers, such as respiratory problems or heart attacks.
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Process can be performed on pregnant women when necessary and remains tripartite first period of pregnancy the appropriate time for that
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Asilbp discussion
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1 / Marek in the matter, frankly?
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2 / Marek in this way (good / bad)?
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3 / Marek in the equipment Almstnkhaddmp?
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4 / Marek in the process?
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Free space for your pen ..........................
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