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BEDAH LAPAROSCOPI
–minimally invasive surgery (MIS)
–keyhole surgery
– pinhole surgery
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BEDAH LAPAROSCOPI
• Teknik Operasi modern
• Operasi pada Rongga Abdomen/Perut
• Menggunakan Telescope
• Melalui Lobang /irisan kecil
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Elemen Penting Bedah Laparoscopi
– Lensa Telescopic dihubungkan dengan video camera(single chip or three chip).
– Sistem kabel fiber optic dihubungkan dengan 'cold' light source (halogen or xenon), untuk menerangi medan operasi
– 5 mm or 10 mm cannula or trocar
– Abdomen di insufflated/dikembangkan dengan gas carbon dioxide gas untuk membentuk rongga untuk operasi
– Menggunakan Gas CO2, dapat diserap tubuh dan dibuang melalu respirasi,tidak mudah meledak
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SEJARAH
KELLING 1901 (JERMAN)
MELAKUKAN “COELIOSCOPY” DENGAN PNEUMO PERITONEUM UDARA LAPAROSKOPI DIAGNOSTIK.
PNEUMO PERITONEUM CARBON DIOXIDE(1924)
DISERTAI KEMAJUAN SISTEM LENSA DAN ELEKTRO COAGULASI.
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TAHUN 1964 DIMULAI ERA MODERN
LAPAROSKOPI, ANTARA LAIN:
– “SURGICAL COLD LIGHT”
– EXTRA CORPOREAL LIGHT SOURCE
– VIDEO SYSTEM
– FLEXIBLE GLASS FIBERS
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DE KOK 1977 (NETHERLAND)
LAPAROSKOPIK APPENDEKTOMI
MÜHE 1985 (JERMAN)
LAPAROSKOPIK CHOLECYSTECTOMY
INDONESIA 1992
IBRAHIM A, HERMANSJUR
KABUPATEN MALANG FEBRUARI 2006
YUDA
RSUD KEPANJEN JUNI 2008
YUDA
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“MINIMALLY INVASIVE”
DIAGNOSIS DAN TERAPETIK
• LAPAROSKOPI
• CERVICAL ENDOSCOPY (PARATHYROIDS)
• RETROPERITONEAL (GINJAL, ADRENAL)
• PREPERITONEAL (HERNIA)
• THORACOSCOPY
• ARTHROSCOPY
• GASTRO-COLONOSCOPY (ENDOSCOPI)
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INDIKASI LAPAROSCOPI
• DIAGNOSTIK
• Pemeriksaan dan Biopsi Hepar
• Pemeriksaan kandung empedu /Penyebab Obtruksi Joundice
• Menetapkan etiologi tumor-tumor abdomen
• Menilai kemungkinan operasi danmenetapkan staging tumor ganas, sertadalam batas tertentu menetapkan metastasis dalam abdomen
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INDIKASI LAPAROSCOPI
• TERAPI
– Cholesistektomi
– Appendektomi
– Hernia Repair
– Kasus 2 Ginekologi
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Kontraindikasi
• Absolute :– Syok Hipovolemik
– Kelainan Cardiovascular
• Relatif :– Peritonitis
– Hernia diafrakmatika
– COPD
– Riwayat opersi berulang Rongga Perut
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KEUNTUNGAN
• LUKA OPERASI LEBIH KECIL
• REAKSI INFLAMASI / IMMUNOLOGI LEBIH RINGAN
• NYERI PASCA BEDAH KURANG
• KOSMETIK LEBIH BAIK
• ADHESI LEBIH RENDAH/SEDIKIT
• VISUALISASI LEBIH LUAS (HIATUS ESOFAGUS)
• “RECOVERY” LEBIH CEPAT
• “HOSPITAL STAY” SINGKAT
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“TACTILE CONTROL” HILANG
PERLU ADAPTASI SPESIFIK ANTARA MATA DAN GERAKAN TANGAN
KERUGIAN
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• “FINANCIAL COST↑“
• COST EFFECTIVENESS?
BIAYA
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PNEUMOPERITONEUM
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PNEUMOPERITONEUM
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INSERSI LAPAROSCOPE
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KEMUNGKINAN KOMPLIKASI
1. PNEUMOTHORAX2. PERDARAHAN3. PERFORASI 4. INFEKSI5. CIDERA USUS6. CIDERA VASKULER7. EMBOLI CO28. KENAIKAN KADAR CO2 DARAH9. PENURUNAN VENOUS RETURN10.CIDERA KANDUNG KENCING
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PERALATAN (EQUIPMENT)
• Iluminasi, sistim video kamera, TV monitor• CO2 Insuflator• Electrosurgical Unit :
- Monopolar- Bipolar
• Suction Irrigation Unit• Unit-unit lain misalnya : - Ultrasound
- Laser- C-arm/Flouroskopi
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INSTRUMENT
• Veress Needle• Trocar• Scissor• Grasper• Coagulation Instrument• Suction Irrigation Tube• Clips Applier• Needle Holder• Stapler
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APPENDEKTOMI
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Laparoscopi Appendektomi
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CHOLESISTEKTOMI
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ROBOTIK LAPAROSCOPI
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KESIMPULAN
1. “MINIMAL INVASIVE SURGERY” DALAM PERKEMBANGANNYA AKHIR-AKHIR INI MAKIN JELAS MENUNJUKKAN KEUNGGULANNYA DARI “CONVENTIONAL OPEN METHOD”.
2. LAPAROSCOPIC CHOLECYSTECTOMY DAN APPENDEKTOMI GOLD STANDARD
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