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NEW ADVANCES IN LAPAROSCOPIC SURGERY

what is laparoscopic surgery/advances in laparoscopic and robotic surgery laparoscopic surgery for (i) liver, (ii) pancreas, (iii) bile duct, (iv) endocrine tumors (v) other laparoscopic procedures

Limitations of traditional laparoscopic surgery
The major limitation of standard laparoscopic techniques have been the following:  The human hand is a wonderful structure and provides multitude of different functions during open surgery. This function is absent during standard laparoscopic surgery since the abdomen is closed and the procedure is performed with long surgical instruments inserted from the outside into the abdomen. Two dimensional image of the laparoscope: The image transmitted by the laparoscopic camera that surgeon utilizes as his eyes is a two dimensional image. For some procedures this is a major limitation because of the poor depth perception that is associated with two dimensional images. Retraction of internal organs: During open surgery insertion of the hand into the abdomen allows the surgeon to move the intestine and other organs away from the site of the surgery. During standard laparoscopic surgery the hand is not introduced into the abdomen and introducing long thin instruments into the abdomen performs the surgery. Retraction of internal organs is often a major problem for some procedures. Limitation of instruments: the standard instruments in laparoscopic surgery are long thin instruments. These instruments are poorly suited for many complex laparoscopic procedures.   

New technologies for advance laparoscopic surgery
Development of new instruments and innovation in technique is required for widespread use of advanced laparoscopy for the treatment of abdominal conditions. New technologies may overcome many of the limitations (noted above) of standard laparoscopic techniques. We have utilized the new technologies to develop laparoscopic operations for the pancreas, liver and the bile duct. Two new technologies that are particularly promising are: hand access devices and robotic surgery.

Hand access devices
The human hand performs many functions during surgery that are difficult to reproduce with laparoscopic instruments. The loss of the ability to place the hand into the abdomen during traditional laparoscopic surgery has limited the use of laparoscopy for complex abdominal surgery on the pancreas, liver and bile duct. New laparoscopic hand-access devices that allows the surgeon to place a hand into the

The physician operates two masters (similar to joysticks) that control the two mechanical arms on the robot. illness or surgical treatment of conditions such as head and neck cancer. Surgeons nowadays borrow bits of bone.usc.edu/divisions/tumor/pancreasdiseases/web%20pages/laparoscopic%20surgery /adv%20in%20lap%20surg.html The new face of surgery A high-tech engineering technique offers promise to reconstructive surgery Jul 15th 2010 | from the print edition y y FACIAL reconstructive surgery gets a bad rap.abdomen during laparoscopic surgery and perform many of the different functions with the hand that were previously possible only during open surgery. Robot-assisted surgery utilizing the Da Vinci computer robot system Da VinciŒ is a computer-assisted robotic system that expands a surgeon's capability to operate within the abdomen in a less invasive way during laparoscopic surgery. The arms eliminate any hand tremor by the surgeon and offer motion scaling ± allowing extremely precise movements within the patient. In most cases such procedures are needed because of severe bone loss due to injury. and manually craft them into something akin to the missing facial fragments. bile duct and the liver. working a few feet from the operating table while seated at a computer console with a three-dimensional view of the operating field. We have utilized this new device to develop a variety of laparoscopic pancreatic.surgery. distal pancreatectomy and liver resection that were not possible previously by standard laparoscopic techniques. Yet unlike much other plastic surgery it is no vanity-inspired whim. However. The surgeon is remote from the patient. the area around the nose and mouth is one of the . The mechanical arms are armed with specialized instruments with hand-like movements which carry out the surgery through tiny holes in the patient¶s abdomen. http://www. typically from the patient¶s hip or shin. Da VinciŒ system allows greater precision and better visualization compared to standard laparoscopic surgery. The operations with the Da Vinci System are performed with no direct mechanical connection between the surgeon and the patient. liver and biliary procedures such as the Whipple operation. Refashioning the front of the skull is horrendously tricky. The USC University Hospital is the first hospital in Southern California to perform robotically-assisted surgery using the da VinciŒ Surgical System. We are presently exploring the role of this new technology for complex operations on the pancreas.

these new parts need not look anything like precise replicas of the natural bone structure.) So far. ³Topological optimisation´. if Alok Sutradhar of Ohio State University has his way.most complicated parts of the human skeleton. crucially. unimpaired function. using titatium as the building-block. As a result. withstands expected loads. the team have created successful virtual constructs. as when we chew. it generates patient-specific designs to fill in the missing bits. uses complex algorithms to conjure up a shape that best satisfies a set of structural constraints: it fits into a prescribed space. such as for a defect resulting from a gun-shot injury. The idea is to provide a stable foundation on which to place any prostheses and soft tissue used to reconstruct the patient¶s pre-injury look. he has teamed up with plastic surgeons and engineers to find an alternative approach. swallow. It is also subject to constant mechanical stress. current surgical methods guarantee neither a desired cosmetic effect nor. When the software is fed a magnetic-resonance image of an injured skull with some bones struck out. cavity-filled patchwork of facial bones interspersed with blood vessels and nerves. . as the process is known. comprising plenty of small and delicate bones with a unique internal structure. which they describe in the Proceedings of the National Academy of Sciences. (Though in a spine-tingling tribute to evolution¶s cleverness. In other words. and does all this using the least amount of material. So long as all the physiological and anatomic parameters are met. it is ideally suited to take on the challenge of recreating the intricate stress-prone. This may be about to change. speak or even breathe. makes allowances for movement. A reconstructive-surgery researcher with a background in 3-D computer modelling and aerospace-material design. In this section y y y y y Keeping cool and green Stiletto stiffness »The new face of surgery Battling grannies Robo raider Reprints Related topics y y y y y Medicine Surgery Health and fitness National Academy of Sciences Proceedings of the National Academy of Sciences As befits such an interdisciplinary bunch. the first digital designs of the bones surrounding the sinus cavity actually bore a striking resemblance to an uninjured human skull. the new method deploys a technique hitherto reserved for high-performance mechanical engineering. The next step is to perform experiments on real-life skull models.

according to Dr Sutradhar.com/releases/2011/07/110705123348. another team member from Ohio State University. dexterity and manoeuvrability. Without this robotic system. The robotic arms. it may be possible for such a surgical system to be controlled remotely from another part of the world. has had some initial success in this field.Despite being light and strong. was inserted through the patient's mouth to the stomach.sciencedaily. By controlling an external console. the metal remains a foreign substance which could wreak havoc in a part of the body vulnerable to all manner of infections. This new procedure -. making it unsuitable for actual surgery. The combined diameter of both arms is up to 16 mm. After the surgery is done. has the capacity to "feel" how hard or soft the delicate tissues of the stomach and intestines are.economist. http://www. Apart from speeding up the operation process and leaving no scars. which are living tissue. And as researchers know all too well. Current robotic keyhole surgeries still require a small cut at the stomach area to enable a rigid robotic endoscope to enter and do the surgery. This new flexible robotic endoscope does not require any external incision. Nonetheless. 2011) ² Patients with gastric tumours in their stomach will no longer have to suffer an eight-hour long surgery.htm . jumping through bureaucratic hoops can be harder than the science itself. mends the hole in the stomach wall and exits out of the mouth again. maintain the desired shape after they have been formed and implanted. the robot is easily modified to perform many other procedures within the digestive tract.was successfully performed on patients suffering from gastric tumours A flexible endoscope (small tube inserted in intestinal tracts) which had small robotic arms. this robotic procedure is also significantly cheaper than normal surgery thanks to its precision. and enters through the mouth instead. Michael Miller. while the surgeon monitored it on a computer screen. and pancreas to perform intricate surgery. In future. It may come a time when a patient goes for surgery and all he or she needs do is open their mouth. it slides back into the stomach. a patient is likely to undergo open surgery to remove the tumour.the world's first flexible endoscopy robotic surgery in the stomach -. Using joystick and buttons to control the robotic arms. kidney. the surgeon is able to make the robot perform intricate surgical procedures. Dr Sutradhar¶s ultimate aim is to use the method to construct a scaffold on which real bone could be grown. the team remain optimistic²not least because the biomaterial with which they are planning to grow bone tissue has already received regulatory approval for human use. One of the main challenges will be to ensure that the bones. which is up to six milimeters in diameter. This novel procedure also opens up new possibilities for surgery: the robot is able to cut a small hole in the stomach wall to get access to other organs like the liver. the surgeon then removed the cancerous tumour and the patient went home after the operation.com/node/16588705 New Technology Enables Quick and Scarless Surgery for Stomach Tumors ScienceDaily (July 5. though a viable bone-growing process is still some years away. but instead can look forward to a short day surgery which last a few minutes to an hour without the need for hospitalisation. http://www. so doctors at the console can vary the pressure accordingly.