Abstract Pikesscalpls摘要派克手术刀精选文档.ppt

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1、Insufflator,Insufflator,The electronic CO2 insufflator is used to achieve the necessary work space by distending the abdominal wall and depressing the hollow organsBecause its automatic,the insufflating pressure can be presetThe insufflator activates gas flow volumes can be set to values ranging fro

2、m 0-9.9 l/mmThe important indicators of insufflators:preset pressure,actual pressure,flow rate and total gas usedQuadromanometric parameters,Electrocautery,Electrocautery,this machine supports monopolar&bipolar cauteryAlso APC(argon plasma coagulator),Light source,Light source,The light source such

3、as 250 watt halogen lamp has a condenser systemBut,the Xenon lamp(cold light source)gives better visual clarityThe light intensity can be regulated manually or automaticallyHigh intensity Xenon lamp gives better visual and photographic clarity,Camera,Camera,2 types:single chip,3 chipHigh resolution,

4、small&light weight,optimal sharpness,excellent color reproductionSingle chip used for routine lap surgeriesBut for video reproduction,3 chip is betterNow,digital 3 chip cameras are also available,Harmonic scalpel,Harmonic scalpel,Harmonic probe,Harmonic scalpel,The basic mechanism is by tamponading&

5、coapting with a denatured protein coagulumMechanical energy at 55,500 vibrations/secDisrupts hydrogen bonds&forms a coagulumTemperature created is only 80-100 C,compared to electrocautery 200-300 C which also causes collateral damage&tissue necrosisNo charring or melting of tissuesThe fastest sealin

6、g instrument,Ligasure,Ligasure,Vessel sealing system Unique combination of pressure&energy to create vessel fusion by melting the collagen&elastin in the walls reforming into a permanent,plastic like sealThis seal can withstand 3 times normal systolic blood pressureLeast lateral thermal damage 1mmTh

7、e slowest sealing instrument,Enseal,Enseal,Adjusts energy through each tissue bundleThis electrode consists of millions of nanometer sized conductive particles embedded in a temperature-sensitive materialEach of these particles acts like a discrete thermostatic switch to regulate the amount of curre

8、ntThe vessel walls are fused through compression,protein denaturation&then renaturation,Sterrad,Sterrad,Uses hydrogen peroxide vapor&low temperature gas plasma to sterilize most devices quickly with no toxic residuesTakes about 75 mins for wrapped&dry instrumentsRadio frequency energy is applied to

9、the chamber via an RF amplifier,inducing the plasma stateReactive species are generated from the hydrogen peroxide reacting with materialsUpon completion of sterilization,instruments are dry for immaediate use or sterile storage,Cidex tray,Harmonic Ace,Bowel holding Forceps,manipulating bowel during

10、 diagnostic lap transmediastinal endodissection during transhiatal esophagectomy,Bowel holding curved Forceps,Maryland dissector,basic instrument for dissection Calots dissection,isolation of vascular pedicles,hernia dissection,Blunt Grasper,used during dissection with Maryland usually left hand ins

11、trument during suturing,Toothed Grasper,for retracting gallbladder,extraction of gallbladder,Toothed Grasper,holding thick,edematous gallbladders removal of foreign bodies,Babcock,retraction of large bowel in anterior resection,colectomies,rectopexy,stomach retraction in Hellers myotomy,fundoplicati

12、on,sleeve gastrectomy,Right angle Forceps,dissecting Calots,vascular pedicles,Biopsy Forceps,for metastatic deposit collection,liver biopsies,stone retrieval,Clip applicator,occlusion of cystic artery&duct occlusion of veins during anterior resection 2 sizes:5&10 mm 2 types:titanium&absorbable,Hook,

13、2 shapes:J&L for peritoneal dissection of Calots removal of GB from liver bed,Suction coagulator,can be used as both suction&monopolar cautery cautery can be used for drilling through distended GB,ovarian cysts,Palpation probe,can be used for retracting liver lobes,Trocars,pathway to the abdomen blu

14、nt&sharp tips sizes:3,5,10 mm,Reducers,used to reduce size of trocars from 10 to 5 mm used to remove gauzes from abdomen types:tube&clip,Telescope,invented by British physicist Hopkins in 1952 rod lens system sizes:0.8 to 14 mm diameter viewing:forward 0,angled 30&45,Ligaclip,used to clip large vess

15、els preloaded clips,Endoshears,used to cut,coagulate as monopolar very useful in hernia dissection,Optical trocar,has a clear shaft&conical tip telescope can be inserted into the trocar&pushed through abdominal layers under visual guidance used when expecting adhesions,Suture passer,used for port cl

16、osure suture carried through instrument&passed through the wound for closure,Punction needle,Modified Sugarbakers cardiomyotomy scissors,used for cardiomyotomy for achalasia cardia,Loop passer,extracorporeal knot placed through this passer used for tying base of appendix,Abdominal specula,used for dilating the port site to extract GB extract small lesions,foreign bodies,gauze,Uterine manipulator,Liver retractor,