Abstract-Pikes---scalpels摘要派克-手术刀教学课件

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1、Free Powerpoint TemplatesPage 1Free Powerpoint TemplatesInstruments Dr.Robin GeorgeMS,FMAS,DMAS Free Powerpoint TemplatesPage 2Insufflator Free Powerpoint TemplatesPage 3Insufflator The electronic CO2 insufflator is used to achieve the necessary work space by distending the abdominal wall and depres

2、sing the hollow organsBecause its automatic,the insufflating pressure can be presetThe insufflator activates&delivers gas when intrabdominal pressure falls because of gas escape or leakage from the portsCan be continuously varied from 0-30mm Hg;gas flow volumes can be set to values ranging from 0-9.

3、9 l/mmThe important indicators of insufflators:preset pressure,actual pressure,flow rate and total gas usedQuadromanometric parameters Free Powerpoint TemplatesPage 4Electrocautery Free Powerpoint TemplatesPage 5Electrocautery this machine supports monopolar&bipolar cauteryAlso APC(argon plasma coag

4、ulator)Free Powerpoint TemplatesPage 6Light sourceFree Powerpoint TemplatesPage 7Light sourceThe light source such 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 intensi

5、ty Xenon lamp gives better visual and photographic clarityFree Powerpoint TemplatesPage 8Camera Free Powerpoint TemplatesPage 9Camera 2 types:single chip,3 chipHigh resolution,small&light weight,optimal sharpness,excellent color reproductionSingle chip used for routine lap surgeriesBut for video rep

6、roduction,3 chip is betterNow,digital 3 chip cameras are also availableFree Powerpoint TemplatesPage 10Harmonic scalpelFree Powerpoint TemplatesPage 11Harmonic scalpelFree Powerpoint TemplatesPage 12Harmonic probeFree Powerpoint TemplatesPage 13Harmonic scalpel The basic mechanism is by tamponading&

7、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

8、g instrumentFree Powerpoint TemplatesPage 14Ligasure Free Powerpoint TemplatesPage 15Ligasure 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 n

9、ormal systolic blood pressureLeast lateral thermal damage 1mmThe slowest sealing instrument Free Powerpoint TemplatesPage 16Enseal Free Powerpoint TemplatesPage 17Enseal Adjusts energy through each tissue bundleThis electrode consists of millions of nanometer sized conductive particles embedded in a

10、 temperature-sensitive materialEach of these particles acts like a discrete thermostatic switch to regulate the amount of currentThe vessel walls are fused through compression,protein denaturation&then renaturation Free Powerpoint TemplatesPage 18Sterrad Free Powerpoint TemplatesPage 19Sterrad Uses

11、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 the chamber via an RF amplifier,inducing the plasma stateReactive species are generated from the hydrogen per

12、oxide reacting with materialsUpon completion of sterilization,instruments are dry for immaediate use or sterile storageFree Powerpoint TemplatesPage 20Cidex trayFree Powerpoint TemplatesPage 21Harmonic AceFree Powerpoint TemplatesPage 22Bowel holding Forceps manipulating bowel during diagnostic lap

13、transmediastinal endodissection during transhiatal esophagectomy Free Powerpoint TemplatesPage 23Bowel holding curved ForcepsFree Powerpoint TemplatesPage 24Maryland dissector basic instrument for dissection Calots dissection,isolation of vascular pedicles,hernia dissectionFree Powerpoint TemplatesP

14、age 25Blunt Grasper used during dissection with Maryland usually left hand instrument during suturingFree Powerpoint TemplatesPage 26Toothed Grasper for retracting gallbladder,extraction of gallbladderFree Powerpoint TemplatesPage 27Toothed Grasper holding thick,edematous gallbladders removal of for

15、eign bodiesFree Powerpoint TemplatesPage 28Babcock retraction of large bowel in anterior resection,colectomies,rectopexy,stomach retraction in Hellers myotomy,fundoplication,sleeve gastrectomyFree Powerpoint TemplatesPage 29Right angle Forceps dissecting Calots,vascular pediclesFree Powerpoint Templ

16、atesPage 30Biopsy Forceps for metastatic deposit collection,liver biopsies,stone retrievalFree Powerpoint TemplatesPage 31Clip applicator occlusion of cystic artery&duct occlusion of veins during anterior resection 2 sizes:5&10 mm 2 types:titanium&absorbableFree Powerpoint TemplatesPage 32Hook 2 sha

17、pes:J&L for peritoneal dissection of Calots removal of GB from liver bedFree Powerpoint TemplatesPage 33Suction coagulator can be used as both suction&monopolar cautery cautery can be used for drilling through distended GB,ovarian cystsFree Powerpoint TemplatesPage 34Palpation probe can be used for

18、retracting liver lobesFree Powerpoint TemplatesPage 35Trocars pathway to the abdomen blunt&sharp tips sizes:3,5,10 mmFree Powerpoint TemplatesPage 36Reducers used to reduce size of trocars from 10 to 5 mm used to remove gauzes from abdomen types:tube&clipFree Powerpoint TemplatesPage 37Telescope inv

19、ented by British physicist Hopkins in 1952 rod lens system sizes:0.8 to 14 mm diameter viewing:forward 0,angled 30&45Free Powerpoint TemplatesPage 38Ligaclip used to clip large vessels preloaded clips Free Powerpoint TemplatesPage 39Endoshears used to cut,coagulate as monopolar very useful in hernia

20、 dissectionFree Powerpoint TemplatesPage 40Optical trocar has a clear shaft&conical tip telescope can be inserted into the trocar&pushed through abdominal layers under visual guidance used when expecting adhesionsFree Powerpoint TemplatesPage 41Suture passer used for port closure suture carried thro

21、ugh instrument&passed through the wound for closureFree Powerpoint TemplatesPage 42Punction needleFree Powerpoint TemplatesPage 43Modified Sugarbakers cardiomyotomy scissors used for cardiomyotomy for achalasia cardiaFree Powerpoint TemplatesPage 44Loop passer extracorporeal knot placed through this

22、 passer used for tying base of appendixFree Powerpoint TemplatesPage 45Abdominal specula used for dilating the port site to extract GB extract small lesions,foreign bodies,gauzeFree Powerpoint TemplatesPage 46Uterine manipulatorFree Powerpoint TemplatesPage 47Liver retractorFree Powerpoint TemplatesPage 48 谢谢你的阅读v知识就是财富v丰富你的人生 Thank you拯畏怖汾关炉烹霉躲渠早膘岸缅兰辆坐蔬光膊列板哮瞥疹傻俘源拯割宜跟三叉神经痛-治疗三叉神经痛-治疗