Surgical Investigations
Written by Rhiana Devadasan
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75) Surgical endoscopy - principles. Laparoscopy - technique, indications, contraindications. Broncho scopy. VATS.
76) Laparoscopic (mini-invasive) surgery - history, development, principles. Advantages and disadvantages. Instruments and equipment. Types of laparoscopic surgeries.
77) Laparocentesis. Thoracocentesis. Puncture biopsy.
78) Robot-assisted surgery. Telesurgery.
Surgical Endoscopy
Surgical endoscopy: a type of endoscopy that involves the use of an endoscope through small incisions or natural body openings in order to diagnose & treat disease.
(aka Minimally Invasive Surgery - MIS)
Endoscope: a long thing flexible tube w/ a light & tiny video camera attached to the end, which transmits an image to a monitor. : the medical instrument used for visual examination of the interior of a body cavity or hollow organ (such as the stomach, colon or bladder).
Components
- Flexible tube
- Lens system (camera)
- Light delivery system (fibre optics)
- Probe or suction device
Procedure:
- IV line is started.
- Pain medication & sedative is administered.
- Blood pressure, pulse and oxygen is monitored during the procedure.
- Patient's mouth & throat are anaesthetised w/ local anesthetic (e.g. via a spray OR by gargling w/ anesthetic sol.).
- Patient is asked to lie on left side.
- Supportive mouthpiece is placed in mouth.
- Sometimes supplemental oxygen is administered via nasal cannula.
- Endoscope is inserted through mouth and moved slowly and carefully down the pharynx and oesophagus, into the stomach or duodenum.
- Air may be introduced to flatten the mucosal lining & improve visibility.
- Sample of tissue may be collected (biopsy for later examination) or endoscope could be used to actively treat a problem (e.g. a bleeding ulcer, stretch open a stricture/narrowing in esophagus or stomach).
- Examination should last for around 10-20 minutes.
- Patient is monitored after the procedure.
Uses:
- To make/confirm a diagnosis through visualisation (following indicative symptoms)
- Biopsies (for further investigation) - e.g. to distinguish between benign and cancerous tissues; to detect presence of H.pylori, etc.
- Surveillance /monitoring of conditions (e.g. ulcers, post-gastric surgery, Barrett's oesophagus/ metaplasia of lower esophageal cells)
- Surgery (therapeutic procedures performed to actively treat the problem)
Examples of uses:
- Find tumors (malignancies)
- Inflammation
- Infections
- Ulcers
- Find internal bleeding
- Better prevention
Indications (symptoms)
- Upper abdominal pain
- Nausea
- Vomiting
- Dysphagia (difficulty swallowing)
- Bleeding (hematemesis)
- Swelling