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Minimally Invasive Surgical Techniques and Instruments David Ramsay What is Minimally Invasive Surgery? Minimally invasive surgery is a surgical procedure in which operations are performed through very small incisions using specially designed surgical instruments and endoscopes. Endoscope
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What is Minimally Invasive Surgery? • Minimally invasive surgery is a surgical procedure in which operations are performed through very small incisions using specially designed surgical instruments and endoscopes.
Endoscope • An endoscope is a small tube-like surgical instrument that is made up of three parts: • A light source • A Camera • A port through which surgical instruments can pass • May also be a wireless light and camera capsule
Endoscopy • An endoscopy is a surgical procedure that uses an endoscope. • In an endoscopy a surgeon starts by making a small incision, usually one centimeter to one inch in length then inserts the endoscope and proceeds with the steps of the operation • An endoscopy may also use natural anatomical openings in the body, such as the esophagus or nasal passageway.
Benefits of an Endoscopy over an open surgical procedure • Significantly less post-operation pain • Reduced scar tissue • Faster recovery time • Less time spent in the intensive care unit post-operation • Reduced chances of surgical infection
Heart Surgery • There are two main minimally invasive surgical procedures for a coronary artery bypass: • Port-Access Coronary Artery Bypass (PACAB) • Minimally Invasive Coronary Artery Bypass (MIDCAB)
Port-Access Coronary Artery Bypass • In a PACAB surgery the heart is stopped and blood is pumped through an oxygenator, in a cardiopulmonary bypass. • Then a surgeon makes small incisions in the chest. Using a special endoscope arteries or veins are taken from either the chest or the leg and are surgically grafted to the heart to bypass the blocked coronary artery. • The surgeon uses a small camera on the endoscope to perform the procedure instead of directly viewing it.
Minimally Invasive Coronary Artery Bypass • In a MIDCAB procedure the patient is not put on a cardiopulmonary bypass system. This procedure can only be done when one or two arteries need to be bypassed. • Small incisions are made and endoscopes are used, an incision is also made directly over the artery being bypassed so the surgeon can view it directly. • Then the grafts are sewn into place using endoscopes .
Benefits of MIDCAB Surgery • Lower risk of post-operation bleeding, stroke, and chest wound infections • Avg hospital stay for MIDCAB is 3 days • Avg hospital stay for PACAB is 6-8 days
Atherosclerosis • Atherosclerosis is when plaque from blood cholesterol builds up on the inside lining of blood vessels. • Over time the plaque build-up can become so severe that it will eventually cut off the blood flow to portions of the body which can lead to a lack of oxygen in tissues, leading to necrosis or tissue death. • Atherosclerosis also greatly increases the chance of the formation of blood clots in blood vessels.
Angioplasty • Angioplasty is an endoscopic procedure to restore blood flow through a blood vessel that has been effected from Atherosclerosis. • When a surgeon performs an Angioplasty procedure they inflate a surgical balloon on the end of an endoscope to stretch out the blood vessel and place a stent in it to effectively restore blood flow and trigger the healing response for the body. • Blood vessels have three major layers, the thin smooth inner layer, the muscular elastic middle layer and the external layer made up of connective tissue.
Angioplasty Procedure of the leg • The surgeon starts by making a very small incision in the upper thigh. • Then they feed an endoscope with an angioplasty balloon and a stent on the end of it down through the femoral artery. • When the endoscope reaches the plaque build up inside of the blood vessel the balloon is inflated which causes a controlled injury on the blood vessel, this triggers the body’s healing process as well as compresses and breaks apart the plaque build up. • The stent is also put into place with the inflation of the balloon and this keeps the blood vessel open and ensures a restored blood flow.
Benefits of a Minimally Invasive Angioplasty • Because there is no major incision made during the operation tissue damage is minimized, muscles and tendons do not get damaged during the operation. • Post-operation pain is dramatically reduced • Recovery time is greatly reduced as well as required hospital stay • Scarring is reduced significantly
Robot assisted Surgery • Robot and or computer assisted surgical procedures are operations where a very precise robot, or computer program, or both are utilized to help a surgeon perform a surgical procedure. • An example of a Surgical Robot: • The Da Vinci® Surgical System
Da Vinci® Surgical System • The Da Vinci® system is a four armed robotic surgical system that allows a surgeon to operate on the patient at a distance in a work station. • It only needs to make a one centimeter to one inch incision for each instrument. • It is comprised of four major parts: • The Surgeon’s Console • The Patient Side Cart • The Detachable Instruments • The 3-D Vision System
Da Vinci® Surgeon’s Console • Set up several feet away from the operating table. • Contains all of the controls the surgeon needs as well as the magnified 3-dimensional image of the surgical field. • The surgeon can operate in a one cubic foot area.
Da Vinci® Patient Side Cart • The part of the system that performs the surgical procedure. • It has four arms; One endoscopic arm with a special 3-d magnified camera. The endoscope is automatically self heated to prevent lens fogging. • The other three arms are instrument arms. • The system can monitor tool to tool contact to make sure that the surgeon can solely focus on the visual area while they perform the procedure.
Da Vinci® Detachable Instruments • The main Instrument is the EndoWrist®. • It is able to mimic the seven degrees of motion of the human hand, with the advantage of being able to rotate in a full 360 degree arc. • Each arm has a specific purpose for each procedure, which may include suturing or clamping. • The movement software is able to filter out hand tremors and scale movements for very precise pinpoint surgical procedures. • The surgeon is also able to control how much force is applied, from fractions of an ounce to several pounds of force if necessary. • Carbon dioxide can also be pumped into the body cavity to make more room for the arms to work.
Da Vinci® Imaging System • The Imaging system uses an enhanced endoscope with a special miniature 3-D camera. • The system magnifies the work space and provides over a thousand frames per second of imagery and filters out each individual frame to eliminate background noise • The endoscope is able to heat itself to prevent the camera lens from fogging up and blinding the surgeon during the procedure. • The surgeon is able to switch views by simply hitting a foot pedal in his station.
Da Vinci® Safety Protocols • The surgeon’s head must remain inside of the viewing console at all times, or the system will be put into a locked mode. • During the procedure the robotic arms cannot pivot or change position at or above the incision to prevent unintentional tearing • The system has a backup battery that allows the system to run for twenty minutes which gives the hospital enough time to restore power. • Each instrument contains a computer chip to determine when it needs to be replaced and to ensure only tools designed to work with the Da Vinci® system are used.
Da Vinci® Benefits • Each Da Vinci® System costs the hospital about $1 Million dollars, But the procedure is generally covered by Medicare for patients • The system reduces hospital stay by about half which in turn reduces the hospital costs by about 33% • Fewer days are required in the intensive care unit due to decreased pain and increased recovery time. • Leaves a very small surgical scar from the procedure. • Can be used for many different procedures. • In heart procedures: • Patients spend 4.5 less days in the hospital post-op • Save $9,000 per heart valve for every procedure • 3.5 days are spent in the ICU after open surgery, 1.2 days are spent in the ICU following a Da Vinci® surgery.
References • http://lessinvasive.com/ • http://lessinvasive.com/cardiology.html • http://www.kirkseyvascular.com/angioplastyandstenting.htm • http://biomed.brown.edu/Courses/BI108/BI108_2005_Groups/04/davinci.html • http://www.bing.com/health/article/mayo-119453/Endoscopy?q=endoscopy&FORM=K1RE5