腔镜技术上海第二医科大学附属瑞金医院课件文档资料.ppt

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1、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.PERISSAT,Operating room 1896,Professor Terrier Paris,1901s Keilling,腹腔镜外科新进展,1910 Jacobeus used Nitze endoscope for diagnostic laparoscopy,腹腔镜外科新进展,1930 Kalk dual puncture liver biopsy,腹腔镜外科新进展,J.PERISSAT,Professor of GynaecologyKiehl,Pr.Kurt Semm,Laparoscopic cho

2、lecystectomy,Emblematic operationFirst landmarks of the laparoscopic revolution Precursor:E Mhe 1985 Pioneers:Ph.Mouret 1987 F.Dubois-J.Perissat 1988 B.Mc Herman 1988 E.J.Reddick 1988,腹腔镜外科新进展,1987 Mouret 世界首例腹腔镜 胆囊切除术,J.PERISSAT,J.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,Laparosco

3、pic cholecystectomyLaparoscopic splenectomyLaparoscopic hernia repaireLaparoscopic fundoplicationLaparoscopic adrenectomy,疝修补Hernia repair,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,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 miles术 结肠固定术,腹腔镜结直肠手术,腹壁切口开腹,腹壁切口腹腔镜,腹腔镜结直肠手术,右

4、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,Global perspective of future development in Endolaparoscopic Surgery Surgery in its historical perspective,Open Surgery:A long lasting journey:from 400 to 1990The Odyssey of th

5、e Surgeons handsInside human bodyHomeric poem,20th CenturyTwo World Wars,Birth and improvement ofVascular surgeryThoracic surgeryNeurosurgeryPlastic surgeryResuscitation(Intensive care units),Global perspective of future development in Endolaparoscopic Surgery Surgery in its historical perspective,T

6、he Dilemma:How to make harmless the access of the surgeons hands inside the patients body,Global perspective of future development in Endolaparoscopic Surgery Surgery in its historical perspective,The spectacular Achievement:From 1950 to nowadays End of the Dilemma:Harmless access of the surgeons ha

7、nds inside every corners of the patients body The price to pay the drawbacks of large openings,Global perspective of future development in Endolaparoscopic Surgery Surgery in its historical perspective,20th Century1990The Turning PointUnnecessary presence of Surgeons handsinside Human Body,J.PERISSA

8、T,Laparoscopic Surgery the turning point in the History of Surgery,Endoscopy in its historical perspective:Endoscopy(to look inside ancient Greek)From antiquity to 1900 endoluminal explorationSince 1901 Laparoscopy(exploration)Interventional EndolaparoscopySince 1970,J.PERISSAT,Global perspective of

9、 future development in Endolaparoscopic Surgery,Laparoscopic sugery 15 years later Lessons learned,Laparoscopic Surgery the turning point in the History of Surgery,LAPAROSCOPIC SURGERYFor DIGESTIVE DISEASESLogical learning progression,STEP 1:-Exploratory laparoscopy+biopsies-Appendectomy;peritonitis

10、-(gynaecologic emergencies)-Cholecystectomy+IOCComplete mastery of Suturing-knottingSTEP 2:-Gastroesophageal reflux-Inguinal Hernia repair-Laparoscopic approach of the CBD-Splenectomy;(Adrenalectomy)Most advanced proceduresSTEP 3:-Colorectal surgery-Oesophagus&Stomach surgery-Major Pancreatic resect

11、ions-Major hepatic resections,Laparoscopic SurgeryNew Spaces,Pleural cavity Thoracic Surgery Retroperitoneal Spaces Orthopaedic Surgery Urology Endocrine Surgery Vascular Surgery Interfascias Spaces Head and Neck Surgery Plastic Surgery,Laparoscopic SurgeryNew Techniques-New Instruments,Two Main Tre

12、ndsHuman craftsmanship High technologiesAdaptation from-ComputersOpen procedures to-ImagingLaparoscopic ones-Teleteaching-Robots.,未来？,J.PERISSAT,Opration Lindbergh September 9th 2001,Jacques Marescaux,Laparoscopic Surgery the turning point in the History of Surgery Surgery in its historical perspect

13、ive,The credible FutureIntracorporeal navigators Percutaneous approach Laparoscopic surgeons Interventional radiologists Intraluminal approach Interventional flexible endoscopists,Laparoscopic Surgery the turning point in the History of Surgery Surgery in its historical perspective,The credible Futu

14、reHow to deal with?:Changing our minds,educational programs:Changing our health institutions:Institutes of High Technology for MIS Updating our hospital organisation,Future of surgery,Open surgery M.I.S.Institutes of High TechnologiesOncologyTransplantationTraumaAll surgical unitsDaily practice,Perm

15、anent Education,Benign disorders,Future Organisation,Endo Unit,M.I.T.Centre,Int.Radiology,Lap.Surg.,X.Ray.Dept.,Gastroenterologicaldepartment,SurgicalDept.,Up-dated Evolution,M.I.T.Centre for Digestivediseases,Endoscopicunit,InterventionalRadiology,Lap.Surg.,X.Ray.Dept.,TransplantUnitOpensurgery,Gas

16、troenterologicaldepartment,Up-dated Evolution,M.I.T.Centre for Digestivediseases,Endoscopicunit,InterventionalRadiology,Lap.Surg.,TransplantUnitOpensurgery,X.Ray.Dept.,Gastroenterologicaldepartment,Odyssey of Surgeons hands,21st Century2000 to 2.The Reign of Minimaly invasive SurgeryAnd other interv

17、entional techniquesSurgeons hands and Patients Body more and more remote,Australopythecus apharensis,Homo erectus,Homo abilis,Homo sapiens,Homo laparoscopicus(sapiens,sapiens),-5 M.Y.,-3 M.Y.,-1 M.Y.,-130000to1990,Today,Laparoscopic Surgery the turning point in the History of Surgery,Endolaparoscopi

18、c Surgery in its ethical perspectiveYou will treat your King better than your patientsI cant my Lord I cantWhy cant you I treat them allLike Kings and Queens my LordAmbroise Par,Laparoscopic Surgery the turning point in the History of Surgery,The Odyssey of Surgeonshands,Minimally Invasive Surgery,1990The turning point,Hands on Training for future Trainers,谢 谢,