146

Surgicol Procedures lncluding Minimol Access Procedures

Gostrointestinot Surgery

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prone for an anterior lesion): The special rectoscope is inserted and secured. Carbon dioxide pressure of 150 mbar is maintained. Employing various grasping and electrosurgical cutting instruments, the lesion is circumscribei and excised. Depending on the size and depth ofthe defect thus created, after hemostasis is obtained, suture repair is then undertaken. Clips are used to secure the suture ends rather than standard knots' If the procedure cannot easily be accomplish^ed, a standard'surgical procedure may have to be performed'

lnstrumentotion
Slgcla.l o.perating rect:scope with binocular optics with :1t-1f:" video adaptation) and n"><lUr" sideport vrewrng Endoscopic grasping instruments Iindoscopic suction-electrosurgical, irrigator Endoscopic hook and mlcrosclssors

Preporotion of the Potient The patient is in prone, lithotomy, or lateral.positioning, depending upon the orientation of the lesion' A Folef catheter ii inserted. Apply electrosurgical dispersive'pad.
Skin Preporotion

Endoscopic needle driver Endoscopic clip applicators Endoscopic t-eaching arm (flexible or rigid) may be attached to direct viewing of via"o *""i#Uc ". -Endoscopic camera

SpeciolNotes
combination unit is positioned on surseon's left side. It is controlled by ;t;;;;;eon the using ttre double footswitch. - Theoptic irrigator, controlled by a single footswitch, is used by the assistant. ?he light source, monitor, and camera control system are positioned on the surgeon's right side. ---Th"- U-shaped doubte Uuff ioinf Clnu'itin arm; is at_ tached to the table with the V_gro;u;.il;; il;;";i mately 20 cm below the anus. The surgeon sits on an adjustable chair. The scrub person,sits.on the geon, and passes instruments from"the "lgfrlU"iri"a the surffiI.
I|ETVIORRHOIDECTOMY

the

endoscopic

Preparation is minimal. Cleanse the area from the

levei of the umbilicus to the level of midthighs' Discard each sponge after wiPing the anus.

Droping Drapes used for transuretheral resection with integrated pouches and oPenings

Equipment Stirrups with padding for lithotomy Padding for elbows and ankles Pillow for between the legs in lateral position Martin arm (self-securing adjustable retractor mount)

Definition

Endoscopiic combination unit (monitors intrarectal pressure, provides gas insufflation to.maintain desit"d ptes"nte with connections for optic rinsing and suction)

Ercision ofthe veins ofthe anus and associated overly_ ine skin and anoderm 1e"t"r"afyj aJil,i*,r. _"__ Drane (internally).
Dfiscussion

Electrosurgical unit Monitor (l)

VCR (optional) Speciaf roller pump suction device (e.$.'. Wolf) (functioni without causing total decompression)

ondrtrons such as fissure (anal ulcer)

of the hemor_ rioidal tissues including ;h" within. Hemorrhoids pay be_ tr6ated ""i*s"i';;# ;ilh ".;;.;;iiu.,t ur,"t

Eemonhoidectomy refers to the removal

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