腔镜技术.ppt

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.PERISSAT,Operatingroom1896,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,1930Kalkdualpunctureliverbiopsy,J.PERISSAT,ProfessorofGynaecologyKiehl,Pr.KurtSemm,Laparoscopiccholecystectomy,EmblematicoperationFirstlandmarksofthelaparoscopicrevolutionPrecursor:EMhe1985Pioneers: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.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,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miles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,GlobalperspectiveoffuturedevelopmentinEndolaparoscopicSurgerySurgeryinitshistoricalperspective,OpenSurgery:Alonglastingjourney:from400to1990TheOdysseyoftheSurgeonshandsInsidehumanbodyHomericpoem,20thCenturyTwoWorldWars,BirthandimprovementofVascularsurgeryThoracicsurgeryNeurosurgeryPlasticsurgeryResuscitation(Intensivecareunits),GlobalperspectiveoffuturedevelopmentinEndolaparoscopicSurgerySurgeryinitshistoricalperspective,TheDilemma:Howtomakeharmlesstheaccessofthesurgeonshandsinsidethepatientsbody,GlobalperspectiveoffuturedevelopmentinEndolaparoscopicSurgerySurgeryinitshistoricalperspective,ThespectacularAchievement:From1950tonowadaysEndoftheDilemma:HarmlessaccessofthesurgeonshandsinsideeverycornersofthepatientsbodyThepricetopaythedrawbacksoflargeopenings,GlobalperspectiveoffuturedevelopmentinEndolaparoscopicSurgerySurgeryinitshistoricalperspective,20thCentury1990TheTurningPointUnnecessarypresenceofSurgeonshandsinsideHumanBody,J.PERISSAT,LaparoscopicSurgerytheturningpointintheHistoryofSurgery,Endoscopyinitshistoricalperspective:Endoscopy(tolookinsideancientGreek)Fromantiquityto1900endoluminalexplorationSince1901Laparoscopy(exploration)InterventionalEndolaparoscopySince1970,J.PERISSAT,GlobalperspectiveoffuturedevelopmentinEndolaparoscopicSurgery,Laparoscopicsugery15yearslaterLessonslearned,LaparoscopicSurgerytheturningpointintheHistoryofSurgery,LAPAROSCOPICSURGERYForDIGESTIVEDISEASESLogicallearningprogression,STEP1:-Exploratorylaparoscopy+biopsies-Appendectomy;peritonitis-(gynaecologicemergencies)-Cholecystectomy+IOCCompletemasteryofSuturing-knottingSTEP2:-Gastroesophagealreflux-InguinalHerniarepair-LaparoscopicapproachoftheCBD-Splenectomy;(Adrenalectomy)MostadvancedproceduresSTEP3:-Colorectalsurgery-Oesophagus&Stomachsurgery-MajorPancreaticresections-Majorhepaticresections,LaparoscopicSurgeryNewSpaces,PleuralcavityThoracicSurgeryRetroperitonealSpacesOrthopaedicSurgeryUrologyEndocrineSurgeryVascularSurgeryInterfasciasSpacesHeadandNeckSurgeryPlasticSurgery,LaparoscopicSurgeryNewTechniques-NewInstruments,TwoMainTrendsHumancraftsmanshipHightechnologiesAdaptationfrom-ComputersOpenproceduresto-ImagingLaparoscopicones-Teleteaching-Robots.,未来？,J.PERISSAT,OprationLindberghSeptember9th2001,JacquesMarescaux,LaparoscopicSurgerytheturningpointintheHistoryofSurgerySurgeryinitshistoricalperspective,ThecredibleFutureIntracorporealnavigatorsPercutaneousapproachLaparoscopicsurgeonsInterventionalradiologistsIntraluminalapproachInterventionalflexibleendoscopists,LaparoscopicSurgerytheturningpointintheHistoryofSurgerySurgeryinitshistoricalperspective,ThecredibleFutureHowtodealwith?:Changingourminds,educationalprograms:Changingourhealthinstitutions:InstitutesofHighTechnologyforMISUpdatingourhospitalorganisation,Futureofsurgery,OpensurgeryM.I.S.InstitutesofHighTechnologiesOncologyTransplantationTraumaAllsurgicalunitsDailypractice,PermanentEducation,Benigndisorders,FutureOrganisation,EndoUnit,M.I.T.Centre,Int.Radiology,Lap.Surg.,X.Ray.Dept.,Gastroenterologicaldepartment,SurgicalDept.,Up-datedEvolution,M.I.T.CentreforDigestivediseases,Endoscopicunit,InterventionalRadiology,Lap.Surg.,X.Ray.Dept.,TransplantUnitOpensurgery,Gastroenterologicaldepartment,Up-datedEvolution,M.I.T.CentreforDigestivediseases,Endoscopicunit,InterventionalRadiology,Lap.Surg.,TransplantUnitOpensurgery,X.Ray.Dept.,Gastroenterologicaldepartment,OdysseyofSurgeonshands,21stCentury2000to2.TheReignofMinimalyinvasiveSurgeryAndotherinterventionaltechniquesSurgeonshandsandPatientsBodymoreandmoreremote,Australopythecusapharensis,Homoerectus,Homoabilis,Homosapiens,Homolaparoscopicus(sapiens,sapiens),-5M.Y.,-3M.Y.,-1M.Y.,-130000to1990,Today,LaparoscopicSurgerytheturningpointintheHistoryofSurgery,EndolaparoscopicSurgeryinitsethicalperspectiveYouwilltreatyourKingbettertha