laparoscopia diagnostica curs
TRANSCRIPT
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LAPAROSCOPIA DIAGNOSTICALAPAROSCOPIA DIAGNOSTICAcurs curs
V. Prunoiu V. Prunoiu
Institutul Oncologic Bucuresti “Al. Trestioreanu”Clinica de Chirurgie Generala si OncologicaSef Clinica Prof. Dr. E. Bratucu
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LAPAROSCOPIA DIAGNOSTICALAPAROSCOPIA DIAGNOSTICADEFINITIEDEFINITIE:: procedura chirurgicala minim invaziva care procedura chirurgicala minim invaziva care permite examinarea organelor intraabdominale si determinarea permite examinarea organelor intraabdominale si determinarea patologiei lor patologiei lor
Imagini ale ficatului, stomacului, intestinului, veziculei biliare, Imagini ale ficatului, stomacului, intestinului, veziculei biliare, splinei, peritoneului, diafragmului si organelor pelvine ce pot splinei, peritoneului, diafragmului si organelor pelvine ce pot fi vazute pe un monitor dupa introducerea unui telescop in fi vazute pe un monitor dupa introducerea unui telescop in abdomenabdomen
Realizarea altor investigatii: colecisto-colangiografia sau Realizarea altor investigatii: colecisto-colangiografia sau ecografia laparoscopicaecografia laparoscopica
Manipularea si biopsia viscerelor este posibila practicand mici Manipularea si biopsia viscerelor este posibila practicand mici incizii suplimentareincizii suplimentare
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LAPAROSCOPIA DIAGNOSTICALAPAROSCOPIA DIAGNOSTICA
Laparoscopia diagnostica, datorita procentului scazut al mortalitatii si morbiditatii, a devenit o metoda de investigatie care, in numeroase situatii, este superioara altor metode de diagnostic ( ecografie, tomografie computerizata, rezonanta magnetica nucleara ).
In clinica noastra, in ultimii 3 ani, s-au efectuat peste 100 de laparoscopii diagnostice, multe dintre acestea urmate de o interventie laparoscopica in scop terapeutic curativ sau paleativ.
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LAPAROSCOPIA DIAGNOSTICALAPAROSCOPIA DIAGNOSTICA
A fost introdusa in 1901, cand Kelling, a realizat o A fost introdusa in 1901, cand Kelling, a realizat o peritoneoscopie la un caine si pe care a denumit-o peritoneoscopie la un caine si pe care a denumit-o “celioscopie”“celioscopie”
Internistul suedez Jacobaeusc este creditat cu prima Internistul suedez Jacobaeusc este creditat cu prima laparoscopie diagnostica la om in 1910; el a descris aceasta laparoscopie diagnostica la om in 1910; el a descris aceasta aplicatie la pacientii cu ascita si pentru diagnosticul precoce in aplicatie la pacientii cu ascita si pentru diagnosticul precoce in leziunile maligneleziunile maligne
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LAPAROSCOPIA DIAGNOSTICALAPAROSCOPIA DIAGNOSTICA
Kelling 1901
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LAPAROSCOPIA DIAGNOSTICALAPAROSCOPIA DIAGNOSTICAINDICATII INDICATII :: Ascite Ascite de etiologie neprecizata;de etiologie neprecizata; Diagnosticul diferential in Diagnosticul diferential in suferinte abdominale cronice de etiologie suferinte abdominale cronice de etiologie
neelucidata;neelucidata; Diagnosticul Diagnosticul cirozei hepaticecirozei hepatice ( biopsie ); ( biopsie ); OncologieOncologie::
- - vizualizarea directa a leziuniivizualizarea directa a leziunii;;-- recoltarea de material biologic pentru examenul citologic si histopatologic recoltarea de material biologic pentru examenul citologic si histopatologic;;- - stadializarea preoperatorie a unor cancerestadializarea preoperatorie a unor cancere;;- - diagnosticul limfoamelordiagnosticul limfoamelor; ; - - second-look –ul dupa interventiile chirurgicalesecond-look –ul dupa interventiile chirurgicale;;
UrgenteUrgente : :Abdomenul traumatic ( contuziile abdominale )Abdomenul traumatic ( contuziile abdominale )Dg. sindromului dureros de fosa iliaca dreapta la femeiDg. sindromului dureros de fosa iliaca dreapta la femeiAbdomenul acut chirurgicalAbdomenul acut chirurgical
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LAPAROSCOPIA DIAGNOSTICALAPAROSCOPIA DIAGNOSTICACONTRAINDICATII CONTRAINDICATII :: Absolute Absolute
CI anesteziei generaleCI anesteziei generaleCiroza decompensata Ciroza decompensata Coagulopatiile severe Coagulopatiile severe Infectiile peretelui abdominalInfectiile peretelui abdominal
RelativeRelative Distensia marcata a abdomenului in ultimul trimestru al sarcinii sau in Distensia marcata a abdomenului in ultimul trimestru al sarcinii sau in
ocluzia intestinalaocluzia intestinala Herniile si eventratiile voluminoase Herniile si eventratiile voluminoase Peritonitele neglijatePeritonitele neglijate Coagulopatiile corectabileCoagulopatiile corectabile Proces aderential postoperatorProces aderential postoperator
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LAPAROSCOPIA DIAGNOSTICALAPAROSCOPIA DIAGNOSTICA
AVANTAJE :AVANTAJE :
Cosmetice Cosmetice Traumatizarea minima a tesuturilorTraumatizarea minima a tesuturilor Dureri postoperatorii minimeDureri postoperatorii minime Complicatii intra si postoperatorii mai scazuteComplicatii intra si postoperatorii mai scazute Intoarcerea rapida la muncaIntoarcerea rapida la munca O buna vizualizare a spatiilor paracolice si a cavitatii O buna vizualizare a spatiilor paracolice si a cavitatii
pelvinepelvine
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LAPAROSCOPIA DIAGNOSTICALAPAROSCOPIA DIAGNOSTICAANESTEZIA :ANESTEZIA : AG + IOTAG + IOT
INSTRUMENTAR :INSTRUMENTAR : Ac Veress, trocare de 10 mm, de 5 mm, pense de Ac Veress, trocare de 10 mm, de 5 mm, pense de prehensiune, carlig electrod, pensa de biopsie, laparoscop de 30prehensiune, carlig electrod, pensa de biopsie, laparoscop de 30 ْْ , aspirator., aspirator.
PNEUMOPERITONEU :PNEUMOPERITONEU : trocare de 10 mm supra-subombilical, de 5 trocare de 10 mm supra-subombilical, de 5 mm suprapubian, fose iliace, hipocondru.mm suprapubian, fose iliace, hipocondru.
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LAPAROSCOPIA LAPAROSCOPIA DIAGNOSTICADIAGNOSTICA
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LAPAROSCOPIA LAPAROSCOPIA DIAGNOSTICADIAGNOSTICA
INSPECTIE : INSPECTIE :
organele abdominale pentru precizarea patologiei ( biopsie )organele abdominale pentru precizarea patologiei ( biopsie )
cavitatea abdominala pentru fluide si recoltarea de probe pentru cavitatea abdominala pentru fluide si recoltarea de probe pentru laborator ( biochimie, citologie sau bacteriologie )laborator ( biochimie, citologie sau bacteriologie )
lavaj peritoneal si adeziolizalavaj peritoneal si adezioliza
in scop terapeuticin scop terapeutic
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LAPAROSCOPIA DIAGNOSTICALAPAROSCOPIA DIAGNOSTICA
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LAPAROSCOPIA DIAGNOSTICALAPAROSCOPIA DIAGNOSTICA
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LAPAROSCOPIA DIAGNOSTICALAPAROSCOPIA DIAGNOSTICA
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PELVIS NORMAL
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LAPAROSCOPIA DIAGNOSTICALAPAROSCOPIA DIAGNOSTICA
AFECTIUNI CRONICE : PERITONEALEAFECTIUNI CRONICE : PERITONEALE CARCINOMATOZA PERITONEALACARCINOMATOZA PERITONEALA
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LAPAROSCOPIA DIAGNOSTICALAPAROSCOPIA DIAGNOSTICA
AFECTIUNI CRONICE : PERITONEALEAFECTIUNI CRONICE : PERITONEALE TUBERCULOZATUBERCULOZA
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LAPAROSCOPIA DIAGNOSTICALAPAROSCOPIA DIAGNOSTICA
AFECTIUNI CRONICE : PERITONEALEAFECTIUNI CRONICE : PERITONEALE PSEUDOMIXOM ( mucocel apendicular ) – boala PSEUDOMIXOM ( mucocel apendicular ) – boala
gelatinoasa a peritoneuluigelatinoasa a peritoneului
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LAPAROSCOPIA DIAGNOSTICALAPAROSCOPIA DIAGNOSTICA
AFECTIUNI CRONICE : FICATULAFECTIUNI CRONICE : FICATUL
CIROZA HEPATICACIROZA HEPATICA
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LAPAROSCOPIA DIAGNOSTICALAPAROSCOPIA DIAGNOSTICA
AFECTIUNI CRONICE : FICATULAFECTIUNI CRONICE : FICATUL
STEATOZA HEPATICASTEATOZA HEPATICA
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LAPAROSCOPIA DIAGNOSTICALAPAROSCOPIA DIAGNOSTICA
AFECTIUNI CRONICE : FICATULAFECTIUNI CRONICE : FICATUL
HEMANGIOMULHEMANGIOMUL
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LAPAROSCOPIA DIAGNOSTICALAPAROSCOPIA DIAGNOSTICA
AFECTIUNI CRONICE : FICATULAFECTIUNI CRONICE : FICATUL METASTAZE HEPATICE, TUMORA HEPATICAMETASTAZE HEPATICE, TUMORA HEPATICA
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LAPAROSCOPIA DIAGNOSTICALAPAROSCOPIA DIAGNOSTICA
AFECTIUNI CRONICE : FICATULAFECTIUNI CRONICE : FICATUL
CHIST BILIAR (SEROS)CHIST BILIAR (SEROS)
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LAPAROSCOPIA DIAGNOSTICALAPAROSCOPIA DIAGNOSTICA
AFECTIUNI CRONICE : STOMACULAFECTIUNI CRONICE : STOMACUL CANCERUL GASTRIC - STADIALIZARECANCERUL GASTRIC - STADIALIZARE
Metastaze cancer gastric
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LAPAROSCOPIA DIAGNOSTICALAPAROSCOPIA DIAGNOSTICA
AFECTIUNI CRONICE : SPLINAAFECTIUNI CRONICE : SPLINA
SPLENOMEGALIE SPLENOMEGALIE (LIMFOM)(LIMFOM)
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LAPAROSCOPIA DIAGNOSTICALAPAROSCOPIA DIAGNOSTICA
AFECTIUNI ACUTE NETRAUMATICEAFECTIUNI ACUTE NETRAUMATICE
APENDICITAAPENDICITA
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LAPAROSCOPIA DIAGNOSTICALAPAROSCOPIA DIAGNOSTICA
AFECTIUNI ACUTE NETRAUMATICEAFECTIUNI ACUTE NETRAUMATICE PANCREATITA ACUTA HEMORAGICAPANCREATITA ACUTA HEMORAGICA
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LAPAROSCOPIA DIAGNOSTICALAPAROSCOPIA DIAGNOSTICA
AFECTIUNI ACUTE NETRAUMATICEAFECTIUNI ACUTE NETRAUMATICE COLECISTITA ACUTACOLECISTITA ACUTA
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LAPAROSCOPIA DIAGNOSTICALAPAROSCOPIA DIAGNOSTICA
AFECTIUNI ACUTE NETRAUMATICEAFECTIUNI ACUTE NETRAUMATICE INFARCTUL ENTERO-MEZENTERICINFARCTUL ENTERO-MEZENTERIC
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LAPAROSCOPIA DIAGNOSTICALAPAROSCOPIA DIAGNOSTICA
AFECTIUNI ACUTE NETRAUMATICEAFECTIUNI ACUTE NETRAUMATICE ULCER DUODENAL PERFORATULCER DUODENAL PERFORAT
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LAPAROSCOPIA DIAGNOSTICALAPAROSCOPIA DIAGNOSTICA
AFECTIUNI ACUTE NETRAUMATICEAFECTIUNI ACUTE NETRAUMATICE OCLUZIA INTESTINALAOCLUZIA INTESTINALA
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LAPAROSCOPIA DIAGNOSTICALAPAROSCOPIA DIAGNOSTICA
AFECTIUNI GINECOLOGICEAFECTIUNI GINECOLOGICE CHISTE OVARIENE (TORSIONATE, HEMORAGICE)CHISTE OVARIENE (TORSIONATE, HEMORAGICE)
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CHIST FOLICULAR
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CHIST OVARIAN HEMORAGIC
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LAPAROSCOPIA DIAGNOSTICALAPAROSCOPIA DIAGNOSTICA
AFECTIUNI GINECOLOGICEAFECTIUNI GINECOLOGICE BOALA INFLAMATORIE PELVINABOALA INFLAMATORIE PELVINA
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LAPAROSCOPIA DIAGNOSTICALAPAROSCOPIA DIAGNOSTICA
AFECTIUNI GINECOLOGICEAFECTIUNI GINECOLOGICE SALPINGITA ACUTASALPINGITA ACUTA
NECROZA TUBARA
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HIDROSALPINX
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LAPAROSCOPIA DIAGNOSTICALAPAROSCOPIA DIAGNOSTICA
AFECTIUNI GINECOLOGICEAFECTIUNI GINECOLOGICE SARCINA ECTOPICASARCINA ECTOPICA
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SARCINA ECTOPICA
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LAPAROSCOPIA DIAGNOSTICALAPAROSCOPIA DIAGNOSTICA
AFECTIUNI GINECOLOGICEAFECTIUNI GINECOLOGICE ENDOMETRIOZAENDOMETRIOZA
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LAPAROSCOPIA DIAGNOSTICALAPAROSCOPIA DIAGNOSTICA
AFECTIUNI GINECOLOGICEAFECTIUNI GINECOLOGICE FIBROMATOZA UTERINAFIBROMATOZA UTERINA
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LAPAROSCOPIA DIAGNOSTICALAPAROSCOPIA DIAGNOSTICA
ABDOMEN ACUT POSTTRAUMATICABDOMEN ACUT POSTTRAUMATIC HERNIE DIAFRAGMATICAHERNIE DIAFRAGMATICA
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LAPAROSCOPIA DIAGNOSTICALAPAROSCOPIA DIAGNOSTICA
CONCLUZIE :- Recomandam includerea laparoscopiei diagnostice in protocolul diagnostic al unor afectiuni, - Metoda permite scaderea costului actului medical, - Scutirea bolnavului de suferinte inutile, - In cazul neoplaziilor care depasesc momentul terapiei radicale, evitarea unei interventii chirurgicale inoportune, - Laparoscopia diagnostica trebuie sa intre in activitatea curenta a oricarui serviciu de chirurgie generala
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LAPAROSCOPIA DIAGNOSTICALAPAROSCOPIA DIAGNOSTICA
colecistectomie mediată pe colecistectomie mediată pe calea endoscopiei calea endoscopiei transgastrice - transgastrice - tehnica tehnica NOTES NOTES (transluminal (transluminal endoscopic surgery) - endoscopic surgery) - colecistectomie colecistectomie transgastricătransgastrică sau sau prin alte prin alte orificii naturale: vagin orificii naturale: vagin //anus.anus.
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LAPAROSCOPIA DIAGNOSTICALAPAROSCOPIA DIAGNOSTICA
tehnica SILStehnica SILS (single-(single-incision laparoscopic incision laparoscopic surgery)surgery) - - introducerea trocarelor de introducerea trocarelor de lucru şi a camerei video lucru şi a camerei video printr-un singur orificiu (o printr-un singur orificiu (o singură incizie, de obicei la singură incizie, de obicei la nivelul ombilicului) nivelul ombilicului)
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NOTIUNI DE TERAPIE MINIM INVAZIVA
PROCEDURI : Endoscopie ( ERCP + PS )Chirurgie laparoscopica (robotica)RFA, microunde, HIFU, laser, chemoembolizare, ablatia cu
etanol, criochirurgie, Chirurgie toracoscopicaChirurgie artroscopicaMica chirurgieChirurgie vasculara (angioplastie)Cateterizare coronarianaStereotactic surgery ( implantare de electrozi cerebrali )
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NOTIUNI DE TERAPIE MINIM INVAZIVA- ERCP+PS
Endoscopic retrograde Endoscopic retrograde cholangiopancreatography cholangiopancreatography (ERCP)(ERCP)
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NOTIUNI DE TERAPIE MINIM INVAZIVA- ERCP+PS
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NOTIUNI DE TERAPIE MINIM INVAZIVA - RFA
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NOTIUNI DE TERAPIE MINIM INVAZIVA - RFA
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NOTIUNI DE TERAPIE MINIM INVAZIVA
BENEFICII : Trauma mai mica pentru pacient Spitalizare de scurta durata Complicatii postchirurgicale reduse
RISCURI : Sangerare Infectii Traumatisme de organe interne Traumatisme vasculare
ECHIPAMENT : Fibre optice Camere video Instrumente chirurgicale speciale
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