Minimally Invasive Surgical Techniques and Instruments

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Minimally Invasive Surgical Techniques and
Instruments

• David Ramsay

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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.

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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

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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.

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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

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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)

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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.

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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 .

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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

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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.

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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.

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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 bodys 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.

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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

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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

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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 Surgeons Console
• The Patient Side Cart
• The Detachable Instruments
• The 3-D Vision System

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Da Vinci Surgeons 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.

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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.

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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.

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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.

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Da Vinci Safety Protocols

• The surgeons 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.

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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.

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References

• http//lessinvasive.com/
• http//lessinvasive.com/cardiology.html
• http//www.kirkseyvascular.com/angioplastyandstent
  ing.htm
• http//biomed.brown.edu/Courses/BI108/BI108_2005_G
  roups/04/davinci.html
• http//www.bing.com/health/article/mayo-119453/End
  oscopy?qendoscopyFORMK1RE5