Laparoscopic Training Course For Surgeon, Gynecologist, Urologist and Pediatric Surgeon.

Laparoscopic or “minimal Access Surgery” is a highly specialized technique for performing surgery of abdomen. In the past, this surgical technique was commonly used only for gynaecologic surgery, for diagnostic laparoscopy in cases of infertility and for gall bladder surgery. Over the last 10 years the use of this specialized surgical technique has expanded into intestinal surgery. In traditional “open” surgery the surgeon uses a single incision to enter into the abdomen. Laparoscopic surgery uses several 0.5-1cm incisions. Each incision is called a “port.” At each port a tubular instrument known as a trochar and cannulla is inserted. Specialized instruments and a special telescope known as a laparoscope are passed through the port during the procedure. At the beginning of the procedure, the patient’s abdomen is inflated with carbon dioxide gas to provide a working and viewing space for the laparoscopic surgeon. The laparoscope transmits images from the abdominal cavity to high-resolution video monitors through a digitally advanced camera system in the operating room. During the operation the surgeon watches detailed images of the abdomen on the high resolution monitor. This system allows the surgeon to perform the same operations as traditional surgery but with smaller multiple incisions.However recently single incision laparoscopic surgery is also evolved.

In certain situations a minimal access surgeon may choose to use a special type of port that is large enough to insert a hand known as Hand Port. When a hand port is used the surgical technique is called “hand assisted laparoscopic surgery”. The incision required for the hand port is generally 5.5 cm and hence larger than the other laparoscopic incisions, but is usually smaller than the incision required for traditional surgery.

Advantages of laparoscopic surgery?

Compared to traditional open surgery, patients often experience less pain, an earlier recovery, and less scarring with laparoscopic surgery.

Operations which can be performed using laparoscopic surgery?

Most of the abdominal advanced surgeries can be performed using the laparoscopic technique in experienced hand. These include surgery for gallbladder, duodenal perforation, appendicitis, Crohn’s disease, ulcerative colitis, diverticulitis, cancer, rectal prolapse and severe constipation.

In the past there had been concern raised about the safety of laparoscopic surgery for radical cancer operations. But recently several studies involving hundreds of patients have shown that laparoscopic surgery is safe for certain ­colorectal cancers.

How safe is laparoscopic surgery?

Laparoscopic surgery is as very safe as traditional open surgery. At the beginning of a laparoscopic operation the laparoscope is inserted through a small incision near the umbilicus, Either superior crease or inferior crease of umbilicus. The laparoscopic surgeon initially inspects the abdomen by doing diagnostic laparoscopy to determine whether laparoscopic surgery may be safely performed. If there is a large amount of inflammation or if the surgeon encounters other factors that is risky and prevent a clear view of the structures the surgeon may need to make a larger incision in order to complete the operation safely by converting laparoscopic surgery into open surgery.

Any intestinal or abdominal laparoscopic surgery is associated with certain risks such as complications related anaesthesia and bleeding or infectious complications. The risk of any operation is determined in part by the nature of the specific operation and hidden risk factor within the patient itself. An individual’s general health and other medical conditions are also factors that affect the risk of any operation. Patient should discuss with your surgeon your individual risk for any operation. World Laparoscopy Hospital, Gurgaon is very reach in this concern because for poor and needy patient surgery is completely free at World Laparoscopy Hospital.

Single incision laparoscopic surgery (SILS) or Single port access (SPA) surgery, also known as laparoscopic endoscopic single-site surgery (LESS), umbilical surgery (OPUS) or single port incision less conventional equipment-utilizing surgery (SPICES) or natural orifice transumbilical surgery (NOTUS), or Embryonic Natural Orifice transumbilical surgery (E-NOTES) is an advanced minimally invasive surgical procedure in which the surgeon operates almost exclusively through a single entry point, typically the patient’s navel. SPA surgical procedures are like many laparoscopic surgeries in that the patient is under general anaesthesia, insufflated and laparoscopic visualization is utilized.The World Laparoscopy Hospital in NCR Delhi is the first hospital in Haryana and only the third in the India to perform a single-port, natural orifice gallbladder surgery through the navel for gallbladder stone disease. During the procedure, surgeons use a single opening in the umbilicus as they manipulate a camera and two laparoscopic instruments to separate the gallbladder from its attachments in the abdomen. The gallbladder is then removed through that same opening. Only a tiny bandage is required to close the navel, and there are no scars.

Single-incision laparoscopic surgery employs the same tools and techniques as conventional laparoscopic surgery and can be used in both men and women. The only difference is a specially-designed port that accommodates the tools.

World Laparoscopy Hospital surgeons have always been leaders in minimally invasive surgery,” says Dr R K Mishra, Director of the World Laparoscopy Hospital and professor of TGO University. “This procedure signals another step forward for our nationally single incision surgery and elevates our efforts to provide the best surgical care while improving patient recovery.”

Dr. Mishra says that single incision laparoscopic surgery should not only for simple surgery like cholecystectomy but should also be used for surgery like donor nephrectomy and for donor who have already decided to give the gift of life and are willing to go through surgery to help a person in need, the possibility of coming through the surgery without scars is a secondary benefit.


 

Endoscopy is now unavoidable part of practice of physician and practice of endoscopy must respect the ethical aspects of medicine. The principles of humanism must be reinforced when professor is teaching endoscopy to their students. A well-organized, structured training is essential if we are to ensure that procedures are performed in a safe and effective manner without creating complication to our patients. The most difficult period of training in endoscopy is with the novice endoscopist, so we recommend the introduction of a structured pre-endoscopy training curriculum. The good training program in endoscopy should ideally include introductory lectures and courses, the use of didactic videos and training in endoscopy on a computer-based simulator.

Prof. R.K. Mishra performing endoscopic surgery

Prof. R.K. Mishra performing endoscopic surgery

This should be followed by hand eye coordination of endoscope on animal followed by exposure in operation theatre. The international organizations of endoscopic physician advocate ‘train the trainers’ international courses to encourage a uniform approach to the teaching of endoscopy. The endoscopic trainer themselves should be properly qualified so that they can train art and science of endoscopy to their students. If the trainer themselves are trained then their aim will be to educate skilled endoscopists in the principles of teaching, which should be thoroughly grounded in the ethics of our profession.

 

Medical education is time consuming and very expensive. An endoscopic fellowship is particularly difficult due to the invasive endoscopic procedures. To learn endoscopy adds a potential risk for the patients. Many studies have proved that endoscopic training on simulators could reduce both the learning curvature and the critical life threatening mistakes. Endoscopic training is generally long and very much expensive. The introduction of sophisticated simulators as GI virtual reality simulator has made possible to evaluate a training program based on a simulator device. Many prospective studies has been performed to validate the use of a computer-based simulator in the endoscopic fellowship.

 

 

These simulators are based on the production of a three-dimensional geometric model. The texture of the GI tract is videotaped during a real endoscopic procedure and manipulated by a computer. The computer also stores information related to the endoscope movement during the procedure. Information about the location of the endoscope is transmitted form sensors located in the endoscope. The tactile feedback is based on both the motion model and the characteristics of GI tract. The electronically designed virtual reality three dimensional effect gives a very nice learning environment for a physician. It is just like a pilot learning first on simulator how to take off and land the air craft. All these effects are finally manipulated by the computer and give a realistic effect: in real-time. The endoscopy is performed in a mannequin using a real endoscope. Steering and torque of the endoscope is therefore possible and there are suction and inflation buttons as well. The surgeon can feel the tactile sensation when he will push hard the intestinal wall. All these effects made the simulator endoscopic procedure similar to the reality. 

 

 

Endoscopy is now unavoidable part of practice of physician and practice of endoscopy must respect the ethical aspects of medicine. The principles of humanism must be reinforced when professor is teaching endoscopy to their students. A well-organized, structured training is essential if we are to ensure that procedures are performed in a safe and effective manner without creating complication to our patients. The most difficult period of training in endoscopy is with the novice endoscopist, so we recommend the introduction of a structured pre-endoscopy training curriculum. The good training program in endoscopy should ideally include introductory lectures and courses, the use of didactic videos and training in endoscopy on a computer-based simulator. This should be followed by hand eye coordination of endoscope on animal followed by exposure in operation theatre. The international organizations of endoscopic physician advocate ‘train the trainers’ international courses to encourage a uniform approach to the teaching of endoscopy. The endoscopic trainer themselves should be properly qualified so that they can train art and science of endoscopy to their students. If the trainer themselves are trained then their aim will be to educate skilled endoscopists in the principles of teaching, which should be thoroughly grounded in the ethics of our profession.

Medical education is time consuming and very expensive. An endoscopic fellowship is particularly difficult due to the invasive endoscopic procedures. To learn endoscopy adds a potential risk for the patients. Many studies have proved that endoscopic training on simulators could reduce both the learning curvature and the critical life threatening mistakes. Endoscopic training is generally long and very much expensive. The introduction of sophisticated simulators as GI virtual reality simulator has made possible to evaluate a training program based on a simulator device. Many prospective studies has been performed to validate the use of a computer-based simulator in the endoscopic fellowship.

These simulators are based on the production of a three-dimensional geometric model. The texture of the GI tract is videotaped during a real endoscopic procedure and manipulated by a computer. The computer also stores information related to the endoscope movement during the procedure. Information about the location of the endoscope is transmitted form sensors located in the endoscope. The tactile feedback is based on both the motion model and the characteristics of GI tract. The electronically designed virtual reality three dimensional effect gives a very nice learning environment for a physician. It is just like a pilot learning first on simulator how to take off and land the air craft. All these effects are finally manipulated by the computer and give a realistic effect: in real-time. The endoscopy is performed in a mannequin using a real endoscope. Steering and torque of the endoscope is therefore possible and there are suction and inflation buttons as well. The surgeon can feel the tactile sensation when he will push hard the intestinal wall. All these effects made the simulator endoscopic procedure similar to the reality.