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腹腔镜手术

2020 年 6 月 02 日

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4 分钟阅读

腹腔镜手术

Insight into minimally invasive surgery.

Laparoscopic surgery is an operation performed within the abdominal or pelvic cavity using small incisions with the aid of a camera. Laparoscopy which is a minimally invasive procedure which allows the surgeon to see inside of the body in real-time, without open surgery

Laparoscopy is a revolutionary procedure which has seen the greatest advance in surgery that benefits both the patients and the doctors. It is almost the same as the open surgery procedure but using a different method of access. Due to improved patient outcomes, in the last two decades, laparoscopic surgery has been adopted by various surgical sub-specialities, including gastrointestinal surgery, gynecologic surgery, cardiology, orthopaedics and urology.

Did you know Laparoscopy invented by George Kelling in 1901, in Germany?

腹腔镜设备

通常在腹腔镜手术中使用,使外科医生能够通过小切口(一般在 3 至 5 毫米之间)进行手术。

内窥镜设备

Comprise flexible tubes attached to cameras and lights. Aids the surgeon in the use of the laparoscopic devices during the surgery to oversee the entire surgical procedure.

Developments in laparoscopic instrumentation and procedures are still ongoing, both in the application of vision system and the automation of instruments. The camera is an important component in laparoscopic surgery as it acts as the eyes of the surgeon. Recent advances have been made in enhancing the experience of surgeons through 3D technologies, improving the image quality and the field of vision of endoscopic cameras.

Applications have been developed, enabling multiple views for surgeons using 3D technology. The endoscope 3D visualization system provides customized 3D image with adjustable disparity to serve the very different eye movements and visual of each surgeon at very different operating environment. The fusion of advanced 3D technology provides flexible depth perception adjustment to accommodate doctors during surgery. The 3D images come in handy for the surgeons to perform more precisely and safely. Moreover, it shortens the operating time significantly.

Robots since the year 2000 have been used in operating theaters to facilitate laparoscopic surgeries in various disciplines. It was first approved for prostatectomy and has become the mainstream procedure of minimally invasive surgery of localized prostate cancers in USA and United Kingdom. For surgeons, the recognized advantages of robotic laparoscopic surgery include 3D vision, ten-fold magnification, Endo-wrist technology and tremor reduction. They are thus enabling the surgeon with better control and higher precision to work beyond the limitation of conventional open surgery. Thus, delivering better outcomes for the patients.

InfoMed spoke with Dr Md Hamsan bin Abdul Wahab, Consultant General Surgeon, Columbia Asia Hospital -Klang on laparoscopic surgery to get his perspective on the procedure.

什么是腹腔镜手术?

Dr Hamsan: Laparoscopic surgery is a surgical technique in which the surgeon uses a series of small incisions in the patient to insert a camera to view the surgical field, along with the necessary tools for the surgical procedure or is a type of surgery that uses smaller cuts than you might expect.

什么情况下腹腔镜手术比开腹手术更好?

Hamsan 医生:如今,大多数择期手术,尤其是胆囊手术、妇科手术、疝气手术、关节手术或胃或十二指肠溃疡穿孔、阑尾炎等急诊手术,都适合采用腹腔镜手术。与传统手术相比,腹腔镜手术有以下几个优势。因为它涉及的切割较少:

  • You have smaller scars.
  • You get out of the hospital quicker.
  • You’ll feel less pain while the scars heal, and they heal quicker.
  • You get back to your normal activities sooner.
  • You may have less internal scarring.

When would you recommend your patients for surgical intervention?

Hamsan 医生:这取决于患者所患的疾病、病理、症状,以及腹腔镜手术对患者的风险和益处。

您的专业兴趣是什么?

Hamsan 医生:我的专长是腹腔镜胆囊切除术、阑尾切除术、胃或十二指肠溃疡穿孔、疝气,以及因先前手术或腹部感染引起的粘连绞痛的粘连溶解术。

您的手术中有多少是微创手术?

哈姆森博士: 约 25

腹腔镜手术后需要多长时间恢复?

Hamsan 医生:大多数腹腔镜手术的恢复时间较短,平均约为 2 至 5 天,具体取决于手术类型。

是否所有患者都适合腹腔镜手术?

Hamsan 医生:并非所有患者都适合腹腔镜手术。这取决于病人的风险和并发症。

Can you perform most of the minimally invasive surgeries as a day-care procedure?

Hamsan 医生:这取决于病人的类型和风险,一般来说,大多数低风险病人的腹腔镜手术都可以在日间进行。

腹腔镜手术的恢复速度会更快吗?

Hamsan 医生:是的,正如我前面提到的,腹腔镜手术比开腹手术恢复得更快。

微创手术成本效益更高,疗效更好。您的观点?

Hamsan博士:对于有适当治疗指征的患者,微创手术的总体费用明显低于开放手术。2011 年发表在《SAS 期刊》上的一项研究显示,微创经椎间孔腰椎椎体融合术的平均费用为 14,183 美元,而开放式腰椎融合术的费用为 18,633 美元。

微创手术可在门诊环境下进行,包括非住院手术中心,其费用通常低于住院费用。省去住院时间,降低并发症和再次手术的风险,为腹腔镜手术节省了大量成本。

What are the risks in laparoscopy surgeries, and how do you mitigate them?

Hamsan博士:腹腔镜手术的风险可分为两类,即麻醉风险和手术风险。对于麻醉风险,通常是患有多种并发症的患者,他们需要在手术前首先由医生对病情进行优化和稳定,这些患者需要麻醉师、重症监护室重症服务人员、理疗师和营养师等多学科人员的术前和术后护理支持。对于伤口感染等手术风险,患者将在术前和术后服用抗生素。使用良好的手术技巧和能量设备(如谐波手术刀)可以最大限度地减少出血。

近期将推出哪些新的腹腔镜服务?

Hamsan 医生:在一些国家,机器人腹腔镜已成为腹腔镜手术的趋势,但在马来西亚,只有某些医疗中心拥有机器人设备。

腹腔镜技术的进步能否进一步改善手术效果?

Hamsan 博士:自 32 年前首次开展腹腔镜手术以来,已有证据表明腹腔镜手术在多种手术中优于开腹手术,先进的腹腔镜手术已扩展到肝切除术、胰腺切除术、泌尿外科和妇科。考虑到时间、专业知识和腹腔镜手术的进步,这一革命性手术将在未来几年继续发展,以改善手术效果。这种持续的发展将提高外科医生的经验和能力,使他们能够有效地完成任务,并使病人能够负担得起。

我们是否可以认为微创手术正朝着精准手术的方向发展?

Hamsan 博士:一般来说,腹腔镜或微创手术正朝着精准手术的方向发展。

机器人技术在腹腔镜手术中的应用。您的观点?

Hamsan 博士:使用机器人手术是一种更精确、更有效的手术方式,但需要对操作人员进行培训,学习曲线各不相同,而且对任何医疗中心来说,投资成本都很高。

最新手术技术的进展如何?

Hamsan 博士:腹腔镜手术的发展总是与技术和新手术器械的进步同步进行。腹腔镜视觉系统已经取得了长足的进步,包括视角和视野的改善以及图像的清晰度。

腹腔镜手术的额外好处

  • 降低术后静脉血栓栓塞的风险。
  • 减少并发症。
  • 降低感染风险。
  • 减少出血,从而降低需要输血的几率。

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2020 年 6 月 02 日

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4 分钟阅读

腹腔镜手术

Md Hamsan Bin Abdul Wahab 博士

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