insisi hipkabi baru 2
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INSISI DAN PENYIAPANINSISI DAN PENYIAPANPASIEN DI KAMAR PASIEN DI KAMAR
OPERASIOPERASI
Dr Cosmas Gora Triaswhoro SPBDDr Cosmas Gora Triaswhoro SPBD
HIPKABI HIPKABI
JANUARI 2014JANUARI 2014
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TUJUAN
• MENYIAPKAN PASIEN DIKAMAR OPERASI
• MENYIAPKAN POSISI PASIEN• MENYIAPKAN POSISI
OPERATOR,ASISTEN,INSTRUMEN• MENYIAPKAN LAPANGAN OPERASI• MENGENAL BBRP INSISI OPERASI
DISESUAIKAN DG INSTRUMENTASI
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LATAR BELAKANG
*KEBUTUHAN PASIEN: MAUNYA LEBIH AMAN DAN LBH ENAK*OPERATOR/AHLI BEDAH :
LEBIH NYAMAN/AMAN/ TEHNOLOGI TERBARU
*ANASTESI : TEHNOLOGI TERBARU/TINGGI*PERAWAT KM BEDAH: LEBIH NYAMAN/AMAN ,SIMPLE
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PENYIAPAN
PASIEN
• PSIKIS ---- TIDAK TAKUT/AMAN/NYAMAN/PERCAYA
• POSISI --- TEPAT/NYAMAN BUAT OPERATOR/ANASTESI/PASIEN
• DAERAH OPERASI --- BERSIH DARI KOTORAN, RAMBUT & CUKUP EXPOSE
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INSISI
• IRISAN PADA KULIT MERUPAKAN AWAL DIMULAINYA OPERASI
• MERUPAKAN PINTU MASUK KE DAERAH OPERASI YG DITUJU
• SIAP UTK DIPERLEBAR BILA DIPERLUKAN
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INSISI INSISI DIUSAHAKANDIUSAHAKAN
• DAERAH YG MINIMAL TRAUMA DAERAH YG MINIMAL TRAUMA POSTOP NYAPOSTOP NYA
• DAERAH YG TERSEMBUNYIDAERAH YG TERSEMBUNYI• SECARA KOSMETIK TAK MENGGANGGUSECARA KOSMETIK TAK MENGGANGGU• JANGAN TERLALU BANYAK INSISIJANGAN TERLALU BANYAK INSISI• JANGAN MEMBUAT SKAR/CACADJANGAN MEMBUAT SKAR/CACAD
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PILIHAN INSISI
• TGT JENIS/MACAM OPERASI• KEBIASAAN OPERATOR• PALING AMAN DAN EFISIEN• OPERASI
EMERGENCY/TIDAK (BEDA APPROACH NYA)
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MACAM INSISI
• INSISI MEDIANA/MIDLINE EPIGASTRIK/SUB UMBILIKAL• INSISI PARA MEDIAN• INSISI PARA REKTAL• INSISI KOCHKER• INSISI MC BURNEY/GRIDIRON• INSISI PFANENSTIEL DLL.
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PENYEMBUHAN LUKA
• 1.SECARA PRIMER• 2.SECARA SEKUNDER• 3.DELAYED PRIMARY CLOSURE
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PENYEMBUHAN LUKA
• MENIT2 AWAL--HEMOSTASIS --- INFLAMASI SEL KE DAERAH LUKA – TANDA2 RADANG
• HARI BERIKUT – PROSES ANGIO GENESIS DAN FIBROPLASTY – TANDA RADANG MENURUN
• DLM 2 MINGGU SDH CUKUP KUAT• DLM BBRP BLN – KEKUATAN NORMAL
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KONTAMINASI LUKA
• CLEAN OPERASI --- HERNIA,FAM• MINIMAL KONT. --- BUKA USUS HA
LUS TANPA OBSTR/HISTEREKTOMI• KONT. BERAT– BUKA KOLON• INFECTED – PERITONITIS/APP-ABSES
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• MENGETAHUI JADWAL OPERASI• TAHU RENCANA JENIS OPERASI• MENGENAL INSTRUMEN DG
BAIK • MENGENAL OPERATOR DG BAIK• MENGENAL OK DG BAIK
YG PERLUDIPERHATIKAN
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• SIAPKAN ALAT2 WALAU BLM TENTU DIPERGUNAKAN
• ALAT NON STERIL SLL DICOBA SBLM DIPERGUNAKAN
• MENGENAL ISTILAH2 YG BIASA DIPERGUNAKAN DI OK TSB
• BANTU OPERATOR TANPA MENGGURUI
• MEMPERLAKUKAN PASIEN SBG MANUSIA SEUTUHNYA
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Statements
• Big surgeons make big incision
• It makes no sense to look through a key hole when you can open the door
• MIS with smaller incisions and less soft tissue disruption is appealing
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Open Surgery
• Advantages of Open surgery:– Precision
– Ergonomic
– Intuitive
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Minimally Invasive Surgery( Laparoscopy )
• MIS is any procedure that is less invasive than open surgery used for the same purpose.
• A MIS procedure typically involves use of laparoscopic devices and remote-control manipulation .
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Keunggulan Laparoscopy• Rasa nyeri berkurang• Stress response
menurun• Menghindari Adhesi• Mengurangi infeksi
• Virtual reality training
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Benefits of Laparoscopy
• Increased post operative comfort,
• Reduced hospital stay,
• Quicker return to normal physical activities and ultimately a quicker return to work.
• Improved cosmesis
• Reduced wound complications associated with large scars
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Robotics in Surgery
• Limitations of Open surgery:– Pain
– Blood loss
– Scarring
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Robotic SurgeryDa Vinci Surgical team
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Telesurgery
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NOTES
• Natural Orifice Transluminal Endoscopic Surgery
• Surgery without scars
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NOTES
• Controversies• Minimally invasive or
minimally incision?• Transgastric -
appendicectomy • Transvaginal-
cholecystectomy
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DAFTAR REFERENSI
• 1.BENGT H.ZEDERFELDT & THOMAS K.HUNT : WOUND CLOSURE , DAVIS & GECK , 1990
• 2.HAMILTON BAILEYS : EMERGENCY SURGERY , JOHN WRIGHT & SONS LTD , 1986
• 3.M.E FOSTER & G.MORRIS STIFF : BASIC SURGICAL OPERATIONS, HARCOURT PUBLISHERS LIMITED , 2000
• 4.ZOLTANSZABO,PHD,FICS : SURGICAL TECHNOLOGY , UNIVERSAL MEDICAL PRESS,INC , 1994