腔镜技术课件

Minimallyinvasivesurgery

微创外科

21世纪外科发展方向移植外科微创外科修复外科肿瘤的分子生物学治疗J.PERISSATOperatingroom1896

ProfessorTerrierParis腹腔镜外科新进展1901sKeilling腹腔镜外科新进展1910JacobeususedNitzeendoscopefordiagnosticlaparoscopy腹腔镜外科新进展1930KalkdualpunctureliverbiopsyJ.PERISSATProfessorofGynaecologyKiehl

Pr.KurtSemmLaparoscopiccholecystectomy

EmblematicoperationFirstlandmarksofthelaparoscopicrevolution

Precursor:EMühe1985

Pioneers:Ph.Mouret1987F.Dubois-J.Perissat1988B.McHerman1988E.J.Reddick1988腹腔镜外科新进展1987Mouret

世界首例腹腔镜胆囊切除术J.PERISSATJ.PERISSAT

已经成为金标准的腹腔镜手术腹腔镜外科新进展胆囊切除术脾切除术疝修补术抗食管反流手术肾上腺切除术LaparoscopiccholecystectomyLaparoscopicsplenectomyLaparoscopicherniarepaireLaparoscopicfundoplicationLaparoscopicadrenectomy疝修补Herniarepair腹腔镜NISSEN手术腹腔镜NISSEN手术目前已经渐趋成熟即将成为金标准手术腹腔镜外科新进展结直肠切除术甲状腺切除术胰尾部切除术腹腔镜结直肠手术

直肠前切除术

左半结肠切除术右半结肠切除术横结肠切除术 全结肠切除术 乙结肠切除术 mile’s术 结肠固定术

腹壁切口—开腹

腹壁切口—腹腔镜腹腔镜结直肠手术右半结肠切除术右半结肠切除术

直肠切除范围

标本的取出与切除腹部切口

腹壁切口腔镜甲状腺切除术腹腔镜外科新进展腔镜甲状腺切除术

正在探索的手术腹腔镜外科新进展胃癌根治术胰十二指肠头部切除术血管外科手术胃切除术腹腔镜胰十二指肠切除术GlobalperspectiveoffuturedevelopmentinEndolaparoscopicSurgery

Surgeryinitshistoricalperspective

OpenSurgery:Alonglastingjourney:from400to1990TheOdysseyoftheSurgeon’shandsInsidehumanbodyHomericpoem

20thCentury

TwoWorldWarsBirthandimprovementofVascularsurgeryThoracicsurgeryNeurosurgeryPlasticsurgeryResuscitation(Intensivecareunits)GlobalperspectiveoffuturedevelopmentinEndolaparoscopicSurgery

Surgeryinitshistoricalperspective

TheDilemma:

Howtomakeharmlesstheaccessofthesurgeon’shandsinsidethepatient’sbodyGlobalperspectiveoffuturedevelopmentinEndolaparoscopicSurgery

Surgeryinitshistoricalperspective

ThespectacularAchievement:From1950tonowadays

EndoftheDilemma:Harmlessaccessofthesurgeon’shandsinsideeverycornersofthepatient’sbodyThepricetopaythedrawbacksoflargeopeningsGlobalperspectiveoffuturedevelopmentinEndolaparoscopicSurgery

Surgeryinitshistoricalperspective20thCentury1990TheTurningPointUnnecessarypresenceofSurgeons'handsinsideHumanBodyJ.PERISSATLaparoscopicSurgerytheturningpointintheHistoryofSurgeryEndoscopyinitshistoricalperspective:

Endoscopy(tolookinsideancientGreek)Fromantiquityto1900endoluminalexplorationSince1901Laparoscopy(exploration)InterventionalEndolaparoscopySince1970J.PERISSATGlobalperspectiveoffuturedevelopmentinEndolaparoscopicSurgeryLaparoscopicsugery15yearslaterLessonslearnedLaparoscopicSurgerytheturningpointintheHistoryofSurgery

LAPAROSCOPICSURGERY

ForDIGESTIVEDISEASES

Logicallearningprogression

STEP1:-Exploratorylaparoscopy+biopsies -Appendectomy;peritonitis-(gynaecologicemergencies)-Cholecystectomy+IOC

CompletemasteryofSuturing-knottingSTEP2:-Gastroesophagealreflux-InguinalHerniarepair-LaparoscopicapproachoftheCBD-Splenectomy;(Adrenalectomy)

MostadvancedproceduresSTEP3:-Colorectalsurgery-Oesophagus&Stomachsurgery-MajorPancreaticresections-Majorhepaticresections

LaparoscopicSurgery

NewSpaces

Pleuralcavity

ThoracicSurgery

RetroperitonealSpaces

OrthopaedicSurgeryUrologyEndocrineSurgeryVascularSurgery

InterfasciasSpaces

HeadandNeckSurgeryPlasticSurgeryLaparoscopicSurgery

NewTechniques-NewInstrumentsTwoMainTrendsHumancraftsmanship HightechnologiesAdaptationfrom -ComputersOpenproceduresto -ImagingLaparoscopicones -Teleteaching -Robots…..未来？？？J.PERISSATOpérationLindberghSeptember9th2001JacquesMarescauxLaparoscopicSurgerytheturningpointintheHistoryofSurgery

Surgeryinitshistoricalperspective

ThecredibleFutureIntracorporealnavigatorsPercutaneousapproach

LaparoscopicsurgeonsInterventionalradiologists

IntraluminalapproachInterventionalflexibleendoscopistsLaparoscopicSurgerytheturningpointintheHistoryofSurgery

Surgeryinitshistoricalperspective

ThecredibleFutureHowtodealwith?:Changingourminds,educationalprograms: Changingourhealthinstitutions:

InstitutesofHighTechnologyforMIS

Updatingourhospitalorganisation

FutureofsurgeryOpensurgeryM.I.S.InstitutesofHighTechnologiesOncologyTransplantationTraumaAllsurgicalunitsDailypracticePermanentEducation

BenigndisordersFutureOrganisationEndoUnitM.I.T.CentreInt.RadiologyLap.Surg.X.Ray.Dept.GastroenterologicaldepartmentSurgicalDept.Up-datedEvolutionM.I.T.CentreforDigestivediseasesEndoscopicunitInterventionalRadiologyLap.Surg.X.Ray.Dept.TransplantUnitOpensurgeryGastroenterologicaldepartmentUp-datedEvolutionM.I.T.CentreforDigestivediseasesEndoscopicunitInterventionalRadiologyLap.Surg.TransplantUnitOpensurgeryX.Ray.Dept.GastroenterologicaldepartmentOdysseyofSurgeons'hands21stCentury2000to2……….TheReignofMinimalyinvasiveSurgeryAndotherinterventionaltechniquesSurgeons'h