Video teratas | Medical Videos - Watch Free Medical and Surgery Videos

Rumah

Video teratas

Sepanjang waktu

Hari ini

Minggu ini

Bulan ini

Tahun ini

WARNING: Graphic Medical Procedure - Selective Dorsal Rhizotomy Surgery Surgeon 441 Tampilan • 3 bertahun-tahun yang lalu

Dr. Debbie Song at Gillette Children's describes in detail selective rhizotomy surgery.

A selective dorsal rhizotomy is an operation performed to treat spasticity. It is thought that high tone and spasticity arise from abnormal signals that are transmitted through sensory or dorsal nerve roots to the spinal cord. In a selective dorsal rhizotomy we identify and cut portions of the dorsal nerve roots that carry abnormal signals thereby disrupting the mechanisms that lead to spasticity. Potential patients go through a rigorous assessment that includes an in-depth gait and motion analysis as well as a physical therapy evaluation.

They are evaluated by a multidisciplinary team that includes a pediatric rehabilitation doctor, a neurosurgeon, and an orthopedist, Appropriate patient selection is vital. Ideal candidates for selective dorsal rhizotomy are children who are between four and ten years of age, have a history of being born prematurely, and have a diagnosis of diplegia cerebral palsy. These patients usually walk independently or with the assistance of crutches or a walker. They typically function at a level one, two, or three in the gross motor function classification system or gmfcs. A selective dorsal rhizotomy involves the coordinated efforts of the neurosurgery, physiatry, anesthesia and nursing teams. The operation entails making an incision in the lower back that is approximately six to eight inches long. We perform what we call a laminoplasty in which we remove the back part of the spinal elements from the lumbar one or l1 to l5 levels. At the end of the procedure the bone is put back on. We identify and open up the Dural sac that contain the spinal fluid spinal cord and nerve roots. Once the Dural sac is opened ,we expose the lumbar and upper sacral nerve roots that transmit information to and from the muscles of the lower extremities.

At each level we isolate the dorsal nerve root, which in turn is separated into as many as 30 smaller thread light fruitlets.

Each rootlet is then electrically stimulated. Specialized members of the physiatry team look for abnormal responses in the muscles of the legs as each rootless is being stimulated. If an abnormal response is observed then the rootlet is cut.

If a normal response is observed, then the rootlet is not cut. We usually end up cutting approximately 20 to 40 percent of the rootlets. The Dural sac is sutured closed and the l1 through l5 spinal elements are put back into anatomic position, thus restoring normal spinal alignment. The overlying tissues and skin are then closed and the patient is awoken from surgery. The entire operation takes between four and five hours. A crucial component to the success of our rhizotomy program is the extensive rehabilitation course following surgery. With their tone significantly reduced after a rhizotomy, patients relearn how to use their muscles to walk more efficiently through stretching, strengthening, and gait training. Approximately one to two years after a rhizotomy patients undergo repeat gait and motion analysis. The orthopedic surgeons assess the need for interventions to correct bone deformities, muscle contractures, poor motor control, impaired balance, or other problems related to cerebral palsy.

At Gillette we work closely with patients and families to ensure that our selective dorsal rhizotomy program meets their goals for enhancing their function and improving their quality of life.

VISIT https://www.gillettechildrens.org/ to learn more

0:00 Why choose selective dorsal rhizotomy?
0:56 Who is a good candidate for selective dorsal rhizotomy?
1:31 What does a selective dorsal rhizotomy entail?
3:26 What is recovery from selective dorsal rhizotomy like?

Laparoscopic Hysterectomy Surgeon 177 Tampilan • 2 bertahun-tahun yang lalu

It used to be when a woman needed a hysterectomy she could expect full abdominal surgery with a long recovery time. Dr. Melissa Lee uses less invasive methods that can cut the patients downtime in half.

"We were trained in more laparoscopic and minimally invasive cases so of course that's what I'm more comfortable with doing right now."

She sees a new generation of patients opting for laparoscopic surgery.

"Laparoscopy is the use of small cameras with small incisions and instruments that are guided by the hand, and you're able to see directly into the abdomen without actually fully opening the abdomen," says Dr. Lee, an obstetrician-gynecologist with Lee Memorial Health System.

Nowadays, even a large mass or uterus can be removed using the slender tools.

"There are multiple different laparoscopic instruments that you can use. Whether they're blunt dissections or just dissectors that hold and retract back or actual scissors or cutting instruments, there are multiple different options," says Dr. Lee.

While a standard abdominal hysterectomy requires a four to eight inch incision, the laparoscope needs only a quarter to half inch. It's enough to make a big difference in terms of recovery.

"They're able to get up and move around faster. They're able to recover faster, their pain level and their need for pain medicine is much lower," says Dr. Lee.

The laparoscopic procedure also cuts down on scarring and more importantly, shortens the hospital stay. The trend now is home within 24 hours.

"Where the patient is done early in the morning, they're doing well they're tolerating oral intake they're able to getup and move around. And those patients a lot of times will feel comfortable to go home that same nigh after a major surgery," says Dr. Lee.

New studies show women who've had a laparoscopic hysterectomy viewed their quality of life as better than those who had an open abdominal procedure, making this a good option for the right patient.

View More Health Matters video segments at leememorial.org/healthmatters/

Lee Memorial Health System in Fort Myers, FL is the largest network of medical care facilities in Southwest Florida and is highly respected for its expertise, innovation and quality of care. For nearly a century, we've been providing our community with everything from primary care treatment to highly specialized care services and robotic assisted surgeries.

Visit leememorial.org

What Is Laparoscopy? Surgeon 233 Tampilan • 2 bertahun-tahun yang lalu

.

Chapters

0:00 Introduction
1:04 Why do doctors perform laparoscopy?
2:11 How is laparoscopy performed?
3:22 Result
3:47 Risk of laparoscopy

Laparoscopy (from Ancient Greek λαπάρα (lapára) 'flank, side', and σκοπέω (skopéō) 'to see') is an operation performed in the abdomen or pelvis using small incisions (usually 0.5–1.5 cm) with the aid of a camera. The laparoscope aids diagnosis or therapeutic interventions with a few small cuts in the abdomen.[1]

Laparoscopic surgery, also called minimally invasive procedure, bandaid surgery, or keyhole surgery, is a modern surgical technique. There are a number of advantages to the patient with laparoscopic surgery versus an exploratory laparotomy. These include reduced pain due to smaller incisions, reduced hemorrhaging, and shorter recovery time. The key element is the use of a laparoscope, a long fiber optic cable system that allows viewing of the affected area by snaking the cable from a more distant, but more easily accessible location.

Laparoscopic surgery includes operations within the abdominal or pelvic cavities, whereas keyhole surgery performed on the thoracic or chest cavity is called thoracoscopic surgery. Specific surgical instruments used in laparoscopic surgery include obstetrical forceps, scissors, probes, dissectors, hooks, and retractors. Laparoscopic and thoracoscopic surgery belong to the broader field of endoscopy. The first laparoscopic procedure was performed by German surgeon Georg Kelling in 1901. There are two types of laparoscope:[2]

A telescopic rod lens system, usually connected to a video camera (single-chip or three-chip)
A digital laparoscope where a miniature digital video camera is placed at the end of the laparoscope, eliminating the rod lens system

The mechanism mentioned in the second type is mainly used to improve the image quality of flexible endoscopes, replacing conventional fiberscopes. Nevertheless, laparoscopes are rigid endoscopes. Rigidity is required in clinical practice. The rod-lens-based laparoscopes dominate overwhelmingly in practice, due to their fine optical resolution (50 µm typically, dependent on the aperture size used in the objective lens), and the image quality can be better than that of the digital camera if necessary. The second type of laparoscope is very rare in the laparoscope market and in hospitals.[citation needed]

Also attached is a fiber optic cable system connected to a "cold" light source (halogen or xenon) to illuminate the operative field, which is inserted through a 5 mm or 10 mm cannula or trocar. The abdomen is usually insufflated with carbon dioxide gas. This elevates the abdominal wall above the internal organs to create a working and viewing space. CO2 is used because it is common to the human body and can be absorbed by tissue and removed by the respiratory system. It is also non-flammable, which is important because electrosurgical devices are commonly used in laparoscopic procedures.[3]
Procedures
Surgeons perform laparoscopic stomach surgery.
Patient position

During the laparoscopic procedure, the position of the patient is either in Trendelenburg position or in reverse Trendelenburg. These positions have an effect on cardiopulmonary function. In Trendelenburg's position, there is an increased preload due to an increase in the venous return from lower extremities. This position results in cephalic shifting of the viscera, which accentuates the pressure on the diaphragm. In the case of reverse Trendelenburg position, pulmonary function tends to improve as there is a caudal shifting of viscera, which improves tidal volume by a decrease in the pressure on the diaphragm. This position also decreases the preload on the heart and causes a decrease in the venous return leading to hypotension. The pooling of blood in the lower extremities increases the stasis and predisposes the patient to develop deep vein thrombosis (DVT).[4]
Gallbladder

Rather than a minimum 20 cm incision as in traditional (open) cholecystectomy, four incisions of 0.5–1.0 cm, or more recently, a single incision of 1.5–2.0 cm,[5] will be sufficient to perform a laparoscopic removal of a gallbladder. Since the gallbladder is similar to a small balloon that stores and releases bile, it can usually be removed from the abdomen by suctioning out the bile and then removing the deflated gallbladder through the 1 cm incision at the patient's navel. The length of postoperative stay in the hospital is minimal, and same-day discharges are possible in cases of early morning procedures.[citation needed]
Colon and kidney

Laparoscopic Cholecystectomy Fully Explained Skin-to-Skin Video with Near Infrared Cholangiography Surgeon 283 Tampilan • 2 bertahun-tahun yang lalu

This video demonstrates Laparoscopic Cholecystectomy Fully Explained Skin-to-Skin Video with Near Infrared Cholangiography performed by Dr R K Mishra at World Laparoscopy Hospital. A laparoscopic cholecystectomy is a minimally invasive surgical procedure that involves removing the gallbladder. It is typically performed using small incisions in the abdomen, through which a laparoscope (a thin tube with a camera and light) and surgical instruments are inserted. The surgeon uses the laparoscope to visualize the inside of the abdomen and to guide the instruments in removing the gallbladder.

Near-infrared cholangiography is a technique that uses a special camera and fluorescent dye to visualize the bile ducts during surgery. The dye is injected into the cystic duct (the tube that connects the gallbladder to the bile ducts) and the camera detects the fluorescence emitted by the dye, allowing the surgeon to see the bile ducts more clearly.

The combination of laparoscopic cholecystectomy and near-infrared cholangiography has become a standard of care in many hospitals and surgical centers. It allows for a more precise and efficient surgery, reducing the risk of complications such as bile duct injury.

The use of indocyanine green (ICG) with near-infrared imaging during laparoscopic cholecystectomy has several advantages. Here are some of them:

Better visualization of the biliary anatomy: ICG with near-infrared imaging allows for better visualization of the biliary anatomy during surgery. This helps the surgeon identify important structures, such as the cystic duct and the common bile duct, and avoid injuring them.

Reduced risk of bile duct injury: With better visualization of the biliary anatomy, the risk of bile duct injury during surgery is reduced. Bile duct injury is a serious complication that can occur during laparoscopic cholecystectomy and can lead to long-term health problems.

Improved surgical precision: ICG with near-infrared imaging also improves surgical precision. The surgeon can better see the tissues and structures being operated on, which can help reduce the risk of bleeding and other complications.

Shorter operating time: The use of ICG with near-infrared imaging can shorten the operating time for laparoscopic cholecystectomy. This is because the surgeon can more quickly and accurately identify the biliary anatomy, which can help streamline the surgery.

Overall, the use of ICG with near-infrared imaging is a valuable tool in laparoscopic cholecystectomy that can improve surgical outcomes and reduce the risk of complications.

Like any surgical procedure, laparoscopic cholecystectomy (gallbladder removal) has potential complications. Here are some of the most common ones:

Bleeding: Bleeding during or after the surgery is a possible complication of laparoscopic cholecystectomy. Most cases are minor and can be easily controlled, but in rare cases, significant bleeding may require a blood transfusion or even additional surgery.

Infection: Any surgical procedure carries a risk of infection. After laparoscopic cholecystectomy, there is a risk of infection at the site of the incisions or within the abdomen. Symptoms may include fever, pain, redness, or drainage from the incision sites.

Bile leakage: In some cases, a small amount of bile may leak from the bile ducts into the abdominal cavity after gallbladder removal. This can cause abdominal pain, fever, and sometimes requires further surgery or treatment.

Injury to nearby organs: During the surgery, there is a small risk of unintentional injury to nearby organs such as the liver, intestines, or bile ducts. This can cause additional complications and may require further treatment.

Adverse reactions to anesthesia: As with any surgery requiring general anesthesia, there is a small risk of adverse reactions to the anesthesia, such as an allergic reaction, respiratory problems, or heart complications.

Most patients recover without complications following a laparoscopic cholecystectomy, but it is important to discuss any concerns or questions with your surgeon beforehand.

Contact us
World Laparoscopy Hospital
Cyber City, Gurugram, NCR Delhi
INDIA : +919811416838

World Laparoscopy Training Institute
Bld.No: 27, DHCC, Dubai
UAE : +971525857874

World Laparoscopy Training Institute
8320 Inv Dr, Tallahassee, Florida
USA : +1 321 250 7653

Regenerate response

Showing 34 out of 36

Video teratas Sepanjang waktu Hari ini Minggu ini Bulan ini Tahun ini

Bahasa

Video teratas

Sepanjang waktu

Hari ini

Minggu ini

Bulan ini

Tahun ini