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Equipment

Find all the surgical interventions, lectures, experts opinions, debates, webinars and operative techniques per specialty.


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Laparoscopic equipment and instrumentation in 2017
This two-part presentation outlines the principles and methods of functioning of the main medico-technical devices required to perform laparoscopic surgery.
The first part deals with the laparoscopic unit components including the insufflator, light sources, the evolution of cameras and screens, as well as scopes used in laparoscopic surgery. For each component, operating principles, technological developments, malfunctions and their management are discussed.
The second part presents operating modalities based on novel innovative energy technologies which are used to control tissues. Their operating modalities, specific risks and prevention means are envisaged. This relates in the first place to the evolution of the use of high frequency currents delivering monopolar and bipolar currents within tissues. New ways of management of these currents with tissue vessel-sealing processes are also discussed. Finally, the principles, use and risks of the new means of dissection and tissue sealing with ultrasonic devices are addressed.
The operating principles and the specific risks of all these systems are not well known to surgeons. In case they are not correctly used, they represent new risks and surgeons should be aware of it.
In conclusion, ergonomic choices of conventional instrumentation in minimally invasive surgery are outlined.
D Mutter
Lecture
1 year ago
2754 views
560 likes
0 comments
06:01
Laparoscopic equipment and instrumentation in 2017
This two-part presentation outlines the principles and methods of functioning of the main medico-technical devices required to perform laparoscopic surgery.
The first part deals with the laparoscopic unit components including the insufflator, light sources, the evolution of cameras and screens, as well as scopes used in laparoscopic surgery. For each component, operating principles, technological developments, malfunctions and their management are discussed.
The second part presents operating modalities based on novel innovative energy technologies which are used to control tissues. Their operating modalities, specific risks and prevention means are envisaged. This relates in the first place to the evolution of the use of high frequency currents delivering monopolar and bipolar currents within tissues. New ways of management of these currents with tissue vessel-sealing processes are also discussed. Finally, the principles, use and risks of the new means of dissection and tissue sealing with ultrasonic devices are addressed.
The operating principles and the specific risks of all these systems are not well known to surgeons. In case they are not correctly used, they represent new risks and surgeons should be aware of it.
In conclusion, ergonomic choices of conventional instrumentation in minimally invasive surgery are outlined.
Techniques for dissection and haemostasis
Not only does surgical tissue dissection require control of main vessels but it also mandates hemostasis of capillaries located in dissection areas. Surgeons can use mechanical means of tissue control, clips, staples, and sutures. They can also use physical means including radiofrequency-induced tissue fusion (electrocautery to achieve division and coagulation) and ultrasound.

The principles of these systems rely on an increased temperature of tissues through a molecular agitation or mechanical means conducive to the dessication of tissues, the fusion of proteins, and to a series of coagulations and divisions.

The use of such effective systems can be associated with specific complications. Consequently, it is mandatory for surgeons to know the principles and risks related to their use. Indeed, surgeons will be the end-users of such devices and of their effects.
They must be able to inform their patients and prevent the occurrence of accidents which may result in intraoperative or postoperative complications for which they can be directly blamed.

In this presentation, the principles of tissue control systems, their potential risks, as well as the prevention of any related accidents are outlined. Electrosurgery and ultrasound use will be respectively addressed along with indications and specific risks associated with their use.

Techniques and principles of the new applications of electrocautery controlled by electronic systems (e.g., LigaSure™ vessel-sealing device, Covidien-Valleylab, ultrasound fusion devices such as Sonicision™, Covidien-Valleylab) are described, as well as their benefits and limitations. The specificities and privileged indications for the use of such systems will be detailed. Finally, standard instruments indispensable for laparoscopic interventions will be addressed.
D Mutter
Lecture
3 years ago
3059 views
112 likes
0 comments
41:05
Techniques for dissection and haemostasis
Not only does surgical tissue dissection require control of main vessels but it also mandates hemostasis of capillaries located in dissection areas. Surgeons can use mechanical means of tissue control, clips, staples, and sutures. They can also use physical means including radiofrequency-induced tissue fusion (electrocautery to achieve division and coagulation) and ultrasound.

The principles of these systems rely on an increased temperature of tissues through a molecular agitation or mechanical means conducive to the dessication of tissues, the fusion of proteins, and to a series of coagulations and divisions.

The use of such effective systems can be associated with specific complications. Consequently, it is mandatory for surgeons to know the principles and risks related to their use. Indeed, surgeons will be the end-users of such devices and of their effects.
They must be able to inform their patients and prevent the occurrence of accidents which may result in intraoperative or postoperative complications for which they can be directly blamed.

In this presentation, the principles of tissue control systems, their potential risks, as well as the prevention of any related accidents are outlined. Electrosurgery and ultrasound use will be respectively addressed along with indications and specific risks associated with their use.

Techniques and principles of the new applications of electrocautery controlled by electronic systems (e.g., LigaSure™ vessel-sealing device, Covidien-Valleylab, ultrasound fusion devices such as Sonicision™, Covidien-Valleylab) are described, as well as their benefits and limitations. The specificities and privileged indications for the use of such systems will be detailed. Finally, standard instruments indispensable for laparoscopic interventions will be addressed.
Instrumentation for laparoscopic surgery in 2014
The performance of surgical procedures using laparoscopy changes the surgeon’s vision of the operative field. The surgeon works with direct vision using a monitor, hence visualizing the operative field in optimal conditions. The surgeon’s working space is limited to the abdominal cavity, and the surgeon no longer has to focus on the entire operating theater.

This implies that an original operative area made up of the abdominal cavity, for digestive surgeons, must be created. The creation of this working space is achieved by means of controlled carbon dioxide insufflation into the abdominal cavity.

The operative image will be conveyed once the operative field has been lit up using a white light source (named cold light as it provides a 6000K color corresponding to sunlight color). The image is first captured by a camera which transforms colors into digital data through Charge-Coupled Device (CCD) captors. It will then be transmitted through a digital screen. This method of image creation depends on the quality and technique of each part of this chain. The quality of surgical video images has evolved rapidly over the years as there have been tremendous advances in computer science and video technologies. In 2014, the current standard is the HD camera, which conveys an accurate image through a HD monitor. Scopes have been steadily improving, image quality has been enhanced, especially when it comes to brightness and definition. Tomorrow, the image will be stereoscopic and 4K, hence pushing the standards of image-guided surgery forward.

All the components of this "image sequence" will be taken into consideration in order to offer surgeons not only the possibility to have basic knowledge of instrumentation to maximize their choice of brand-new armamentarium but also to understand the technical malfunctions likely to alter surgical image quality so as to make up for such shortcomings.
D Mutter
Lecture
3 years ago
4140 views
71 likes
0 comments
34:47
Instrumentation for laparoscopic surgery in 2014
The performance of surgical procedures using laparoscopy changes the surgeon’s vision of the operative field. The surgeon works with direct vision using a monitor, hence visualizing the operative field in optimal conditions. The surgeon’s working space is limited to the abdominal cavity, and the surgeon no longer has to focus on the entire operating theater.

This implies that an original operative area made up of the abdominal cavity, for digestive surgeons, must be created. The creation of this working space is achieved by means of controlled carbon dioxide insufflation into the abdominal cavity.

The operative image will be conveyed once the operative field has been lit up using a white light source (named cold light as it provides a 6000K color corresponding to sunlight color). The image is first captured by a camera which transforms colors into digital data through Charge-Coupled Device (CCD) captors. It will then be transmitted through a digital screen. This method of image creation depends on the quality and technique of each part of this chain. The quality of surgical video images has evolved rapidly over the years as there have been tremendous advances in computer science and video technologies. In 2014, the current standard is the HD camera, which conveys an accurate image through a HD monitor. Scopes have been steadily improving, image quality has been enhanced, especially when it comes to brightness and definition. Tomorrow, the image will be stereoscopic and 4K, hence pushing the standards of image-guided surgery forward.

All the components of this "image sequence" will be taken into consideration in order to offer surgeons not only the possibility to have basic knowledge of instrumentation to maximize their choice of brand-new armamentarium but also to understand the technical malfunctions likely to alter surgical image quality so as to make up for such shortcomings.
Computer-assisted robotic cholecystectomy
Minimally invasive techniques have revolutionized operative surgery. In gastrointestinal surgery, the robotic system is applied to a wide range of procedures. Cholecystectomy, Nissen fundoplication and Heller myotomy are among the most frequently performed procedures. Most studies reported that robotic gastrointestinal surgery is feasible and safe, provides improved dexterity, better visualization, reduced fatigue and high levels of precision when compared to conventional laparoscopic surgery, but costs are high. This video shows a robotic-assisted cholecystectomy performed in teleconference with India. It is a very interesting video that makes us reflect how many could be the possible future applications of computer-assisted robotic surgery.
J Leroy, M Smith-Savu, J Marescaux
Surgical intervention
13 years ago
5793 views
54 likes
0 comments
15:43
Computer-assisted robotic cholecystectomy
Minimally invasive techniques have revolutionized operative surgery. In gastrointestinal surgery, the robotic system is applied to a wide range of procedures. Cholecystectomy, Nissen fundoplication and Heller myotomy are among the most frequently performed procedures. Most studies reported that robotic gastrointestinal surgery is feasible and safe, provides improved dexterity, better visualization, reduced fatigue and high levels of precision when compared to conventional laparoscopic surgery, but costs are high. This video shows a robotic-assisted cholecystectomy performed in teleconference with India. It is a very interesting video that makes us reflect how many could be the possible future applications of computer-assisted robotic surgery.