Laparoscopic Training Board

5 October

Advantages of Laparoscopic Surgery

Laparoscopic or “minimal Access Surgery” is a highly specialized technique for performing surgery of abdomen. In the past, this surgical technique was commonly used only for gynaecologic surgery, for diagnostic laparoscopy in cases of infertility and for gall bladder surgery. Over the last 10 years the use of this specialized surgical technique has expanded into intestinal surgery. In traditional “open” surgery the surgeon uses a single incision to enter into the abdomen. Laparoscopic surgery uses several 0.5-1cm incisions. Each incision is called a “port.” At each port a tubular instrument known as a trochar and cannulla is inserted. Specialized instruments and a special telescope known as a laparoscope are passed through the port during the procedure. At the beginning of the procedure, the patient’s abdomen is inflated with carbon dioxide gas to provide a working and viewing space for the laparoscopic surgeon. The laparoscope transmits images from the abdominal cavity to high-resolution video monitors through a digitally advanced camera system in the operating room. During the operation the surgeon watches detailed images of the abdomen on the high resolution monitor. This system allows the surgeon to perform the same operations as traditional surgery but with smaller multiple incisions.However recently single incision laparoscopic surgery is also evolved.

In certain situations a minimal access surgeon may choose to use a special type of port that is large enough to insert a hand known as Hand Port. When a hand port is used the surgical technique is called “hand assisted laparoscopic surgery”. The incision required for the hand port is generally 5.5 cm and hence larger than the other laparoscopic incisions, but is usually smaller than the incision required for traditional surgery.

Advantages of laparoscopic surgery?

Compared to traditional open surgery, patients often experience less pain, an earlier recovery, and less scarring with laparoscopic surgery.

Operations which can be performed using laparoscopic surgery?

Most of the abdominal advanced surgeries can be performed using the laparoscopic technique in experienced hand. These include surgery for gallbladder, duodenal perforation, appendicitis, Crohn’s disease, ulcerative colitis, diverticulitis, cancer, rectal prolapse and severe constipation.

In the past there had been concern raised about the safety of laparoscopic surgery for radical cancer operations. But recently several studies involving hundreds of patients have shown that laparoscopic surgery is safe for certain ­colorectal cancers.

How safe is laparoscopic surgery?

Laparoscopic surgery is as very safe as traditional open surgery. At the beginning of a laparoscopic operation the laparoscope is inserted through a small incision near the umbilicus, Either superior crease or inferior crease of umbilicus. The laparoscopic surgeon initially inspects the abdomen by doing diagnostic laparoscopy to determine whether laparoscopic surgery may be safely performed. If there is a large amount of inflammation or if the surgeon encounters other factors that is risky and prevent a clear view of the structures the surgeon may need to make a larger incision in order to complete the operation safely by converting laparoscopic surgery into open surgery.

Any intestinal or abdominal laparoscopic surgery is associated with certain risks such as complications related anaesthesia and bleeding or infectious complications. The risk of any operation is determined in part by the nature of the specific operation and hidden risk factor within the patient itself. An individual’s general health and other medical conditions are also factors that affect the risk of any operation. Patient should discuss with your surgeon your individual risk for any operation. World Laparoscopy Hospital, Gurgaon is very reach in this concern because for poor and needy patient surgery is completely free at World Laparoscopy Hospital.

5 October

Single Incision Laparoscopic Surgery (SILS)

Single incision laparoscopic surgery (SILS) or Single port access (SPA) surgery, also known as laparoscopic endoscopic single-site surgery (LESS), umbilical surgery (OPUS) or single port incision less conventional equipment-utilizing surgery (SPICES) or natural orifice transumbilical surgery (NOTUS), or Embryonic Natural Orifice transumbilical surgery (E-NOTES) is an advanced minimally invasive surgical procedure in which the surgeon operates almost exclusively through a single entry point, typically the patient’s navel. SPA surgical procedures are like many laparoscopic surgeries in that the patient is under general anaesthesia, insufflated and laparoscopic visualization is utilized.The World Laparoscopy Hospital in NCR Delhi is the first hospital in Haryana and only the third in the India to perform a single-port, natural orifice gallbladder surgery through the navel for gallbladder stone disease. During the procedure, surgeons use a single opening in the umbilicus as they manipulate a camera and two laparoscopic instruments to separate the gallbladder from its attachments in the abdomen. The gallbladder is then removed through that same opening. Only a tiny bandage is required to close the navel, and there are no scars.

Single-incision laparoscopic surgery employs the same tools and techniques as conventional laparoscopic surgery and can be used in both men and women. The only difference is a specially-designed port that accommodates the tools.

World Laparoscopy Hospital surgeons have always been leaders in minimally invasive surgery,” says Dr R K Mishra, Director of the World Laparoscopy Hospital and professor of TGO University. “This procedure signals another step forward for our nationally single incision surgery and elevates our efforts to provide the best surgical care while improving patient recovery.”

Dr. Mishra says that single incision laparoscopic surgery should not only for simple surgery like cholecystectomy but should also be used for surgery like donor nephrectomy and for donor who have already decided to give the gift of life and are willing to go through surgery to help a person in need, the possibility of coming through the surgery without scars is a secondary benefit.

9 August

Effectiveness of Laparoscopic Surgery Training

The first step toward increasing the level of patient safety in endoscopic surgery is for all endoscopic surgeons to acquire fundamental skills, including psychomotor skills in a good institute. World Laparoscopy Hospital at Gurgaon, India is only institute which is fully dedicated for laparoscopic training and considered as world’s most popular institute for laparoscopic training where more than 3000 surgeons and gynecologists from 108 contries has been trained. The detail about this institute training program can be learned at http://www.laparoscopyhospital.com/SERV01.HTM
The development of endoscopic surgery in recent years is remarkable, and indications for its use have arisen in every surgical field including. There is hardly any specialty left now a day where laparoscopy is not used. Performance of laparoscopic surgical procedures requires manual skills different from those used in open surgery. During Minimal Access Surgery, surgeons are forced to work in three dimensions while viewing the operation on a two-dimensional video monitor.
Prof. R.K. Mishra performing laparoscopic surgery
Prof. R.K. Mishra performing laparoscopic surgery
Many studies has done at the institute like Laparoscopy Hospital aimed to evaluate the effectiveness of virtual reality simulator training and box training for training the fundamental skills of endoscopic surgery. Methods For these study were, trainee surgeons who was divided into three groups: simulator and box trainer group. The trainee surgeons in the endotrainer group underwent training using a box trainer 1 h per day for 7 days. The students in the control group watched an educational video for 60 min. The endoscopic surgical skills of all the students were evaluated before and after training with a task of suturing and knot tying using a box trainer.
Endo-trainer training increased errors during the task, but simulator training did not. The findings showed that box training and VR training have different outcomes. After this study we expect that the best curriculum for a good training centre would involve a combination that uses the merits of both methods.
In the past youngest open surgeons in the past learned procedures and techniques by watching experts perform open surgery and even laparoscopic surgery. Many training institute all over world is using this ‘‘old fashioned training’’ for their students. In the institute where this type of training is used where the trainee watching only an educational video, there was no improvement of the skill task.
When the time taken for completion of each action was measured, no significant difference was found in the time taken to pick up the needle, but there was a marked improvement in the time taken to place the stitch through the dots and to tie the knots in the endotrainer groups after training. Because the tasks of adjusting the needle to the proper angle and tying the knot require fine movement of both the right and left hand, this indicates that the training was effective in improving coordinated movements of both hands.
Interesting results were obtained regarding the incidence of errors. The surgeon who has just taken observer ship showed almost no change in the incidence of errors after training. Errors tended to increase in the proper training group and to decrease in the group who has done endo-trainer exercises and animal dissection. Several reports have shown that a VR simulator was useful for endoscopic surgery training. We studied the simulator objectively to clarify its effectiveness for training to perform endoscopic surgery. In whole world, beginners of laparoscopic surgery often have learned the techniques of laparoscopic surgery by observing and watching endoscopic surgery performed by an expert. Even the education of the observer ship group received by watching a video had an effect in the final examination, but the training using a proper quality training program had a more significant effect.
It is expected that training using a simulator will become more important because it seems that the use of animals for surgical training will decrease worldwide in the future. A simulator offers the following training advantages:
We have recorded that the movements of both forceps using the endotrainer box system. This was helpful in evaluating the fundamental skills of the trainee doctor. The decrease in total distance traced and the increase in forceps speed after training indicated that the trainee doctor could move both forceps smoothly. The results of the current study indicate that the simulator training contributed primarily to the decrease in the total distance, and that the box training the decrease in the total distance, and that the box training the details of this fundamental skill, we need to analyze the data with respect not only to the total distance and speed, but also to the acceleration (change in the rate and accuracy of task performance) of the forceps. Further analysis is progressing, and we hope to present the data in the near future.
Because each training method has its characteristic effectiveness, a better curriculum for the training might be constructed by appropriate combination of the box and the simulator training. The current study showed that good training institute with effective training and virtual reality training has different outcomes. In is proved by this study that the best curriculum for our training centre will involve a combination that uses the merits of both methods.

25 July

Laparoscopic Training Present Scenario

An astronomer in training doesn’t fly a space station at his first lesson. Skylab was the first space station the United States launched into orbit, and the second space station ever visited by a human crew. Skylab’s demise was an international media event, with merchandising, wagering on time and place of re-entry and nightly news reports. And so it goes for surgeons who wants to learn laparoscopy on their patients. To learn such complex surgical skills, it’s safer and more effective to practice first on a simulator, tissue model and animal.

Prof. Mishra performing Laparoscopic Surgery

Prof. Mishra performing Laparoscopic Surgery

In a new study, researchers at many centres has found that a complete laparoscopic skills training curriculum based entirely in the laboratory enables residents surgeon and gynaecologists to master their skills outside of the operating room.
“With the mandated reduction of work hours last year, the use of laparoscopic skills training in the highly specialized laboratory has become a greater necessity in ensuring the quality minimal access surgical education of residents,” said Prof. R.K. Mishra professor of Minimal Access Surgery at TGO University School of Modern Medicine and a Laparoscopic surgeon at World Laparoscopy Hospital, Gurgaon.
In Last few year, many organization of world mandates capped the resident’s work week at 80 hours, reducing the amount of time spent learning in the operating room and in the hospital treating patients. To ensure that residents still gain the necessary skills in laboratory invironment. Laparoscopic educators have had to adapt teaching methods and are increasingly turning to virtual and laboratory training techniques. World Laparoscopy Hospital at Gurgaon, India is only institute which is fully dedicated for laparoscopic training and considered as world’s most popular institute for laparoscopic training where more than 3000 surgeons and gynecologists from 108 contries has been trained. The detail about this institute training program can be learned at http://www.laparoscopyhospital.com/SERV01.HTM
Laparoscopy has become a valuable alternative to open surgery, laparoscopic surgery requires a great deal of practice to develop the requisite skills. During traditional open surgery, the surgeon works directly on an organ or part of the body. But with laparoscopic surgery, everything on a television monitor. It takes getting used to, especially to develop the necessary hand/eye coordination.
The objective of training program of Laparoscopy Hospital is to conduct a regular basic and advanced laparoscopic training curriculum to be used in the training of surgical residents in the laboratory invironment followed by exposure in operation theatre.
In one of the study conducted at Laparoscopy Hospital, New Delhi, fifty surgical residents participated in a progressive laparoscopic training curriculum, learning everything from basic skills like grasping to more advanced skills like tying sutures and removing organs. Following completion, residents evaluated the curriculum and when they were compared with the consultant surgeons there was a trmendous difference in the skill. The exposure in the lab eliminates much of the initial learning curve that was once overcome in the operating room on patients.
Laparoscopy Hospital is expanding its current minimal access surgical skills laboratory and putting the finishing touches on a new clinical simulation lab. The facility will allow medical students, residents and practicing physicians to hone both their clinical judgment and their technical skills by practicing on sophisticated clinical simulators as well as real clinical environment.

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