Operative Laparoscopy
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Transcript of Operative Laparoscopy
8/15/2019 Operative Laparoscopy
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OperativeLaparoscopy
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Defnition Suatu teknik pembedahan minimal invasive yang dapatdigunakan untuk keperluan diagnostic maupun terapeutikpada organ abdominal melalui insisi yang kecil denganbantuan pneumoperitonium
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2. Electronic laparoflator:
◦Untuk memasukkan udara melalui Verres Needle
◦Menjaga tekanan udara intra abdomen dalam batasannormal
◦Beberapa tipe memiliki penghangat udara untukmencegah penurunan suhu tubuh pasien
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3. Trocars:
◦Jalur akses ke intra peritoneumyang dapat dilalui alat lainnya
◦Penggunaan trocar harus sesuaidengan ukuran alat yang akandigunakan
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4. Telescope:
◦Ada beberapa ukuran dengan fungsimasing masing
◦Digunakan untuk melihat ke ronggaperitonium
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Ada 2 tipe
! "isposable! #eusable
!he can be either atraumaticor grasping foreceps.
7. Forceps and scissors:
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8. ipolar elecrtosurgey.
!. "nipolar electrosurgery.
#$. Laser.
##. "ltrasound system.
#%. Suction and irrigation system.
#&. Suture.
#'. Laparoscopic bag.
#(. )issue morcellator: untuk mengangkatspecimen besar seperti mioma atau keseluruhanuterus dalam beberapa potongan.
#*. "terine manipulator: "ntuk mobilisasi maupunstabilisasi uterus dan adne+a
Instrument
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a. (etelah tekanan &ntra
abdomen stabil+ masukkan
trokar
b. Posisi trocar harusdikon%irmasi denganmemasukkan ,aparoscopedan melikat area pel'is
&. )rocar introduction
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A. -mentum+ usus dan organ lainnya harus di e'aluasi terlebih dahuluuntuk mencegah trauma akibat dimasukkannya Verres needleataupun trokar
B. empat memasukkan trocar harus dipastikan dengan menggunakan jari atau cahaya dari laparoskope
/. &denti%ikasi jika ada perdarahan
'. -ieing the peritoneal cavity:
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(etelah tindakan+ gas didalam ca'im abdomen
harus dikeluarkan untukmencgah nyeri postoperati'e
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Ovarian Cyst
AdhesionsAntaraomentum dan
uterus
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! atalaksana 0ista -'arium
! "rainage.
! -'arian cystectomy.
! atalaksana orsio -'arium
! atalaksana endometriosis
! Mengankat kista 1ndometriosis+
kauterisasi dan adheiolisis
/lat terapiutik
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atalaksana in%ertility
! Adhesiolisis
! Mengatasi penyebabendometriosis+ P/-(3
Myomectomy digunakan untuk tipe subserosal dan
intramural.
ata laksana P&" Melalui drainase abses dan adhesiolisis
/s a therapeutic tool
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/dhesiolysis
Myomectomy
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(alpingotomy
◦ Used to preser'e the tubes %or desiredreproducti'ity.
◦ "one i% the patient is hemodynamicaly stable
◦ &% si4e 5 ) cm
◦ ,ocation must be ampullary+ in%undibular oristhmic.
◦ /ontralateral tube either normal or absent.
)atalaksana 0ehamilan 1ktopik
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Salpingotom
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! (alpingectomy
! #uptur uba
! 01 Berulang! Ukuran 6 ) cm
Indications
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! (terilisasi
! Bipolar coagulation.
! /lips %ilshie clips3 and rings
! ,aparoscopic hysterectomy.
Indikasi
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"ing sterili#ation
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2ontraindications
$. Peritonitis
2. *ypo'olemic shock
7. 0elainan Jantung
8. *emoglobin less than 9 g:d,
). Ukuran uterus6 $2 ;ks.
<. Multiple pre'ious abdominal procedures9. -besitas
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! Pneumoperitoneum
! &njury to abdominal organs3 =astointestinal
3 raktus urinarius.
2omplications
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Pembuluh darah
3 Pel'ic+ omental and mesentric3 "apat dicegah dengan memasukkan Vessel
Needle dengan posisi miring
2omplications