Operative Surgery
Question.1. Describe briefly tracheostomy.
Or
Write short note on tracheostomy.
Or
Write briefly on tracheostomy.
Or
Write in briefly about tracheostomy.
Or
Discuss indication, operative procedure, and complication of tracheostomy.
Or
Describe indication, procedure, and complication of tracheostomy.
Answer. Tracheostomy refers to a surgical entry into trachea through anterior wall to secure airway for oxygenation.
Tracheostomy Classification/Types
- Depending on the method of initial insertion:
- Surgical
- Percutaneous (needle).
- Depending on the intended duration:
- Temporary tracheostomy
- Permanent tracheostomy.
Read And Learn More: General Surgery Question And Answers
- Depending on the situation demanding the procedure:
- Emergent tracheostomy
- Urgent tracheostomy
- Elective tracheostomy.
Tracheostomy Indications
- To secure and clear the airway in upper respiratory tract obstruction (actual or potential).
- To secure and maintain a safe airway in patients with injuries to the face, head, or neck and following certain types of surgery to the head and neck in unstable cervical spine fracture.
- To facilitate the removal of bronchial secretions where there is poor cough effort with sputum retention.
- To protect the airway of patients who are at high risk of aspiration, that is patients with incompetent laryngeal and tongue movement on swallowing, e.g. neuromuscular disorders, unconsciousness, head injuries, stroke, etc.
- To enable long-term mechanical ventilation of patients, either in an acute ICU setting or sometimes chronically in hospitals.
- To facilitate weaning from artificial ventilation in acute respiratory failure and prolonged ventilation.
Tracheostomy Contraindications
- Children under 5 years of age.
- Preexisting pathology of larynx, e.g. carcinoma
- Lack of experience and knowledge of cricothyroidotomy.
- Cervical trauma.
Tracheostomy Procedure
- Step I: Skin from the chin to below the clavicles is sterilely prepared.
- Step II: Local anesthesia with vasoconstrictor is infiltrated in skin and deeper tissues.
- Step III: Skin of the neck over second tracheal ring is identified and an incision is placed horizontally along natural cervical skin crease.
- Step IV: Sharp dissection following the skin incision is done to cut across platysma muscle.
- Step V: Blunt dissection is given parallel to long axis of trachea for separating submuscular tissues until isthmus is identified.
- Step VI: A cricoids hook engages the space between cricoids and fist tracheal ring pull trachea upward. Blunt dissection is continued longitudinally through pretracheal fascia.
- Step VII: Entrance in trachea
- A linear incision is made through inter-space between second and third tracheal rings.
- Mid-portion of third or fourth tracheal ring is removed for creating tracheal window.
- An inferiorly placed U-shaped flap also known as Bjork flap incorporates the ring below the tracheal incision is raised and sutured to the skin at inferior margin.
- Step VIII: Tube is placed and is secured to neck.
Tube is inserted vertically downward into the trachea avoiding damage to the tracheal mucosa of posterior wall.
The tube is secured by suturing the flanges to the neck skin.
This is followed by tying the flanges of tube with thread encircling the neck taking care to avoid strangulation.
Tracheostomy Complications
Complications are as follows:
- Immediate complications (Perioperative period)
- Hemorrhage
- Misplacement of tube
- Pneumothorax
- Tube occlusion.
- Surgical emphysema.
- Loss of the upper airway.
- Delayed complications (Postoperative period; less than 7 days)
- Tube blockage with secretions or blood.
- Partial or complete tube displacement.
- Infection of the stoma site.
- Infection of the bronchial tree (pneumonia).
- Ulceration and/or necrosis of trachea.
- Mucosal ulceration by tube migration
- Risk of occlusion of the tracheostomy tube in obese or fatigued patients
- who have difficulty extending their neck.
- Tracheoesophageal fistula formation.
- Hemorrhage.
- Late complications (Late postoperative period; more than 7 days)
- Granulomata of the trachea may cause respiratory diffilty when the tracheostomy tube is removed.
- Tracheal dilation, stenosis, persistent sinus or collapse (tracheomalacia)
- Scar formation requiring revision.
- Blocked tubes may occur at any time, especially if secretions become thick, the secretions are notmanaged appropriately (suction) and humidification is not used.
- Hemorrhage.
Question.2. Discuss emergency tracheostomy.
Answer. Emergency tracheostomy is performed within 2 to 3 minutes in an emergency situation when patient is anoxic and requires immediate oxygenation and verifiation to avoid cerebral hypoxia.
Emergency tracheostomy Procedure
- Step I and II: Preparation of skin and local anesthesia is not performed in emergency tracheostomy.
- Step III: Skin of the neck over second tracheal ring is identified and an incision is placed horizontally along natural cervical skin crease.
- Step IV: Sharp dissection following the skin incision is done to cut across platysma muscle.
- Step V: Blunt dissection is given parallel to long axis of trachea for separating submuscular tissues until isthmus is identified.
- Step VI: A cricoids hook engages the space between cricoids and fist tracheal ring pull trachea upward.
Blunt dissection is continued longitudinally through pretracheal fascia. - Step VII: Entrance in trachea
- A linear incision is made through inter-space between second and third tracheal rings.
- Mid-portion ofthird or fourth tracheal ring is removed for creating tracheal window.
- An inferiorly placed U-shaped flap also known as Bjork flap incorporates the ring below the tracheal incision is raised and sutured to the skin at inferior margin.
- Step VIII: Tube is placed and is secured to neck.
Tube is inserted vertically downward into the trachea avoiding damage to the tracheal mucosa of posterior wall.
The tube is secured by suturing the flnges to the neck skin.
This is followed by tying the flnges oftube with thread encircling the neck taking care to avoid strangulation.
Question.3. Write short note on diathermy.
Answer. It is also known as electrocautery
It is the method to control bleeding or to cut the tissues during surgery
Diathermy Types
- Based on type of current used:
- Unipolar cautery
- Bipolar cautery.
- Based on type of action:
- Coagulation cautery
- Cutting cautery
- Blended current: Combination both coagulation and cutting cautery.
Diathermy Uses
- For coagulation of bleeding during surgery to achieve hemostasis.
- For cutting muscles, fascia, etc.
- For laparoscopic surgical procedures.
- To remove small cutaneous lesions.
Diathermy Disadvantages
- It leads to infection.
- For the cauterization of normal tissues.
- It has problem of explosion.
- It can cause diathermy burn to the patient at the site where diathermy plate is used.
- It can cause burn injury or electrical shock to surgeon and assisting personnel.
Question.4. Classify suture material. Add a small note on catgut.
Answer.
Classifiation of Suture Material
Classification I
- Absorbable suture material:
- Plain catgut
- Chromic catgut
- Vicryl
- Dexon
- Maxon
- Poly dioxanone suture material
- Monocryl
- Biosyn.
- Non-absorbable suture material
- Silk
- Polypropylene
- Polyethylene
- Cotton
- Linen
- Steel, polyester, polyamide, nylon.
- Classification II
- Natural:
- Catgut
- Silk
- Cottn
- Linen.
- Synthetic:
- Vicryl, dexon, PDS, maxon
- Polypropylene, polyethylene, polyester, polyamide.
- Natural:
- Classifiation III
- Braided: Polyester, polyamide, vicryl, dexon, silk
- Twisted: Cottn, linen.
- Classifiation IV
- Monofiament: Polypropylene, polyethylene, PDS, catgut,steel
- Multifilament: Polyester, polyamide, vicryl, dexon, silk,cotton.
- Classification V
- Coated
- Uncoated.
Catgut
- Catgut was the fist absorbable suture material available.
- Original word was kitgut, i.e. Kit means fidle and present form arise thorough confusion with kit. = cat.
- Another explanation of origin of cat in catgut is it is an abbreviation of catte which originally denoted not only the cows but all types of livestock.
- Catgut is derived from natural source which is purifid collagen tissue derived from serous layer of cow’s intestine or submucous firous layer of sheep intestine.
- Catgut is pseudo filamentous in nature, i.e. microscopically it is made up of multiple filaments which are processed in such a way that they are twisted in ground together and polished to produce the appearance of monofilament suture material.
- As it is composed of collagen fiers, chances of degradation are present, i.e. the material should be kept moist.
- Commercial supply of this material is as the package soaked in isopropyl alcohol which act as a preservative.
Resorption of catgut is via enzymatic digestion through proteolytic enzymes and phagocytosis. - When catgut is placed inside the tissues, it looses its tensile strength under 10 to 15 days, this is resorbed under 2 to 3 months.
Types Of Catgut
It is of three types, i.e.
- Plane gut
- Chromic gut
- Fast-absorbing surgical gut
Plane Gut
- At the time of suturing, it should be dry or else it become stif and diffilt to handle.
- It breaks easily as it consists of weak areas along its length due to manufacturing process.
- It is easily degraded by enzymatic action and inflmmatory reaction is present during this procedure.
- Bacterial adhesion is more as compared to nylon and polypropylene.
Tensile strength of this material is poor. Tensile strength lost in 7 to 10 days - This is used to suture subcutaneous tissue, muscle and suturing circumcision in children.
Chromic Gut
- It is the plain surgical gut which is tanned with the chromic salts.
- This is done to decrease reactivity of tissue and increase in tensile strength.
- Chromic gut has bettr knot security as compared to plane gut.
- Coating by chromic salts increases its resistance to resorption. As plain gut looses its strength by 10 to 15 days,chromic gut takes the double of this time, i.e. 3 to 4 weeks.
- Resorption gets completed after 90 days.
- Chromic gut produces tissue reaction which is less as compared to plain gut.
It is used for suturing muscle. Fascia, ligating pedicles, etc.
Fast Absorbing Gut
- When plain surgical gut is treated by heat to allow rapid resorption it is known as fast absorbing gut.
- This is designed for use on skin.
- Its tensile strength lost from 5 to 7 days and get resorbed by 2 to 4 weeks.
Question.5. Describe brief suture materials.
Answer. Suture materials are used to hold the several tissues in close approximation.
Properties of an ideal Suturing Material
- It should produce less tissue reaction.
- There should be adequate strength of suture material to withstand stress.
- It should be easily sterilized.
- It is easy to handle within the tissues.
- It should have good knot tying properties.
- It should have less capillary action.
Classification of Suture Materials
- Based on the degradation of material within the tissues:
- Absorbable
- Non-absorbable
- Based on the source of materials:
- Natural, e.g. silk
- Synthetic, e.g. polyglycolic acid
- Metallic, e.g. stainless steel
- Based on the number of filaments in the suture material:
- Monofiament
- Multifiament
- Pseudomonofiament
- Based on the diameter of the thread in cross-section:
- 1 – 0 to 10 – 0. With an increase in number of zeros,diameter of material reduces
- Based on the coating applied on the material:
- Teflon coated
- Chromic coated, etc.
Description Of Suturing Materials
Absorbable Materials
- They loose their strength into the tissues and degrades under 60 days, e.g. catgut, polyglycolic acid, polyglactin 910 (Vicryl), polydioxanone, polyglecaprone, poly trimethylene carbonate, Polyglytone 6211, etc.
- These sutures undergo enzymatic degradation by natural enzymes present in the body.
- They are used in deep layer suturing and suturing of wounds in patient who do not come for removal of sutures.
Non-Absorbable Suture Materials
- They are not degraded by the body.
- Suture removal has to be done after end of healing phase.
- Examples are silk, nylon and polyester.
Monofiament Suture Material
- It is known as monofilament as they are made up of single strand.
- They produce the advantage of least capillary effct.
- They decrease the chances of infection.
- Examples: In monofiament absorbable is monocryl and non – absorbable is polyamide, polyester, etc.
- They have major disadvantage of memory effect due to which material come to its original position and this leads to loosening of knot.
Multifiament Suture Material
- It is known as multifiament as it is made up of multiple thin strands of suture material which are either rolled,twisted or braided together to form uniform strand of thread.
- They are easy to handle and have good knot tying properties.
- Knot placed cannot get slipped.
- They are used at places where good strength is needed to hold the wound edges together.
- It has more capillary action and can act as source of infection.
- Example is black braided silk.
Pseudomonofiament
- This suture material is made up of numerous strands of fier which are processed by twisting, grinding and polishing to produce a monofiamentous appearance.
- Example is catgut.
Based on diameter of thread in Cross-section
- Suture materials are labeled from 1 – 0 to 10 – 0.
- With an increase in number of zeros, diameter of material reduces.
- 10 – 0: is used for microsurgery repair
- 5 – 0, 6 – 0: suturing for skin on face
- 4 – 0, 5 – 0: used for suturing in extremities
- 3 – 0: For scalp sutures
- 3 – 0, 4 – 0: commonly used in most of the oral surgical procedures.
Question.6. Write a brief answer on types of sutures.
Answer. Following are the types of sutures:
Interrupted Sutures
Interrupted sutures are most common type of suture and are universally used.
Used to close oral mucosal incisions and skin wounds.
Sutures Technique
- Needle should be held two-thirds the distance from tip of needle with needle holder.
- Needle is passed via one side of the flap perpendicular to the tissues and brought out along the curvature of needle.
- Needle is now passed via other flp at same distance from edge of the flp and also at the same depth.
It is brought out of the flp along with suture material till 3 to 4 cm of free end of suture material is left. - Now needle should be held in the left hand and wound around the needle holder once or twice depending on the type of knot.
- Free end of suture material is grasped with beaks of needle holder.
- Material which is wound around the needle holder is made to slip over the beaks by slow pulling on needle end of suture material.
Free end of suture material should be pulled minimally. - Knot is stabilized in the manner that it comes to one side of the flp. It should not rest along edges of wound.
- For completion of knot, hold needle in left hand and roll suture material around the beaks of needle holder in opposite direction.
Now again grasp free end of suture material and slide suture material over free end to stabilize the knot. - Hold both the free ends and needle end of suture material taut for assistant to trim them with scissors leaving 3 to 4 mm.
Mattress Sutures
Horizontal Mattress Sutures
They are used in areas where there is underlying bony defect.
Horizontal Mattress Sutures Technique
- Needle is fist passed via one flp and at same vertical level through other flp similar to placing ofan interrupted suture but the knot is not placed.
- Needle is now passed at the distance 3 to 4 mm parallel horizontally where the needle was passed through the second flp.
- Now it is passed via the fist flp at same vertical level as last bite.
- In this way, the needle comes back via the same flp where it is started at a distance of 3 to 4 mm from entry point.
- Now the knot is placed and is stabilized over that side.
Vertical Mattress Suture
They are used to close skin wounds mainly in areas where edges of skin tend to invert.
Technique
- In this needle is fist passed far away from wound edges and then nearer or at a more superficial level.
- Needle is passed via one wound edge taking a deep bite of tissue almost 4 to 8 mm from wound edge.
- It is now passed through other edge at same depth and brought out. Knot is still not placed.
- Needle is now turned around and passes backward through second flp at a level closer to wound edges.
- Needle is now passed via one flip at same superficial level and is brought out. In this way, both edges suture material are on the same side.
- Knot is now placed and stabilized on side where the suture fist began.
Continuous Sutures without locking
They are used to suture large wounds. Intra-orally, they are used when full quadrant alveoloplasty is done.
Continuous Sutures without locking Technique
- At fist time place the interrupted suture.
- While cuttng the suture ends, cut the free ends leaving the suture material with needle behind.
- Needle is now passed via flaps of wound alternately to get continuous oblique sutures all along the length of wound.
- At the end of wound, knot is placed by loop of the suture and the needle end of suture material.
Continuous Sutures with locking
Continuous Sutures with locking Technique
- First of all an interrupted suture is placed.
- Now the needle is passed through the loop made by suture material.
- Assistant should be made to follow the suture by holding suture material close to the tissues where needle was last passed via the loop.
- Each time needle pass through the flp and under the suture loop, assistant should hold suture material tightly close to the tissue to prevent suture material slipping and becoming loose.
- At end of suture line the knot is made with suture loop and the needle end of suture material.
Subcuticular Sutures
They are used for closing the cosmetic wounds.
Subcuticular Sutures Technique
- For this type of suturing technique non-absorbable monofiament suture is used.
- First the suture is passed via skin at one end of the wound such that the needle is brought in the wound.
- Needle is now passed alternately through opposite wound edges completely in subcuticular layer without piercing the skin and without placing the knot anywhere in the wound.
- At the end, needle should be brought again through edge of the wound through skin.
- Pull the suture material tightly to get good approximation of wound edges without any bunching.
- Trim the suture materials to leave long ends and taped on both ends to secure from slipping.
Question.7. Write a brief answer on endotracheal intubation.
Answer. Endotracheal intubation is the most basic skill which is acquired by an anesthesiologist.
Endotracheal intubation consists of introduction of a tube inside trachea for maintaining the patency and protecting the airway as well as to ensure proper oxygenation and ventilation.
Endotrachealintubationisthedefiitivewayofmaintaining the airway in patients who need muscle paralysis as well as intermittent positive pressure ventilation.
Whenever general anesthesia is given and needs to be maintained for long periods, endotracheal intubation is done.
Endotracheal intubation Indications
- For inducing general anesthesia for long time, i.e more than l to 2 hours.
- To maintain patency of the airway in unconscious patients.
- For protecting lungs from aspiration of regurgitated gastric contents.
- For ensuring proper delivery of adequate tidal volumes to the lungs.
- For clearing excessive as well as retained secretions from the lungs.
Endotracheal intubation Contraindications
- In cases where upper airway integrity is lost, i.e.
- In extensive maxillofacial injury with bilateral fractures of mandible and maxillae.
- Injuries to the neck along with laryngeal rupture
- Large tumors of upper airway.
In above conditions, endotracheal intubation may be extremely diffilt and even dangerous. In above situations,tracheostomy may be a bettr choice.
Endotracheal intubation Technique
- A pillow of 7 to 10 cm should be positioned under patient’s head which enables mild flxion at the cervical spine.
- Head is then extended at the atlanto-occipital joint. This is known as intubating position or “sniffi position”.
Endotracheal intubation Procedure
- Endotracheal intubation can be done in multiple ways,i.e. can be done either orally or nasally; can be done either under direct vision or indirectly by fieroptic scope.
It can be done blindly when visualization of the glotts by direct means is not possible and fireoptic scope is not available.
In such cases, if the regular antegrade technique, i.e. mouth or nose to larynx or a retrograde intubation, i.e. larynx to mouth can be tried. - In the retrograde technique, pass a guide wire from the cricothyroid membrane upward inside the mouth or nose and an endotracheal tube is guided over it into the larynx.
- Procedure of endotracheal intubation is done with the patient anesthetized but can also be carried out with the patient awake after administering local anesthesia to upper airway when a diffilt intubation is anticipated.
- Many of the airway adjuncts are available for use when a diffilt airway is encountered, especially when it is unanticipated.
These include oropharyngeal airway, nasopharyngeal airway, laryngeal mask airway and Combitube®.
Endotracheal intubation Complications
Following are the complications of endotracheal intubation:
Endotracheal intubation Immediate
- Trauma to the teeth, lips, tongue, pharynx or larynx.
- Hemodynamic changes such as tachycardia, hypertension,myocardial ischemia.
- Misplaced tube, i.e. accidental extubation and esophageal intubation
Endotracheal intubation Delayed
Laryngeal granuloma, laryngeal or subglottic stenosis
Question.8. Write brief notes on incision and drainage.
Answer. Incision and drainage is the surgical procedure carried out to relieve the pus.
- Mainly incision and drainage is done in pyogenic abscess.
- Incision and drainage is contraindicated in cold abscess.
- During incision and drainage position ofthe patient should be supine, prone or lateral depending upon site of abscess.
Incision and drainage procedure
- For this procedure, preferred anesthesia is general anesthesia because abscess is multiloculated and infiltration of lignocaine into the abscess cavity does not act because of the acidic pH of the pus.
However, a superfiial abscess which is pointing can be managed without general anesthesia. - Provide a stab incision over the most prominent part of the swelling, i.e. part which is red, skin is thinned out over it and is pointed.
- As incision is given and pus comes out of the swelling, it should be sent for culture and sensitivity.
- A sinus forceps or figer is introduced now inside the abscess cavity and all the loculi present inside the cavity should be broken.
As fresh blood oozes out, this indicates the completion of procedure. - Cavity should be irrigated with hydrogen peroxide solution or iodine solution.
- If size of the cavity is large, it should be packed by roller gauze which is soaked in iodine and it is removed after 24 to 48 hours.
Packing helps in controlling the bleeding and due to the pack the opening of abscess cavity does not close.
By 7 to 10 days, the cavity collapses spontaneously and granulation tissue fils up the cavity and healing takes place. - An abscess should not be closed, as it contains bacteria,etc. It should be drained out.
Incision and drainage Postoperative Management
- Proper antibiotics should be given to the patient.
- Control of diabetes should be done, if patient is diabetic.
- Regular dressing of wound is done by anti-septic solution.
Question.9. Write short note on laparoscopic surgery or minimal access surgery.
Answer.
Advantages of Laparoscopic Surgery
- Relatively less painful compared to open surgery. Trauma of access is very less.
- Shorter hospital stay and early return to work.
- Faster postoperative recovery.
- Better visualization of the anatomy, i.e. better approach for dissection and visualization of other parts of abdomen for any other pathology.
- Instrumental access to different abdominal locations is many times better compared to open method.
- Minimal scars on the abdomen.
Laparoscopic Surgery Instruments Used
- Zero degree laparoscope is commonly used. Side viewing scopes are also used to have bettr visualization 30°.
- Cold light source either halogen lamp or xenon lamp is used. Halogen lamp is used commonly and is cheaper.
Xenon lamp gives high visualization. - Camera: 3 chip camera is commonly used with high resolution
- Video—monitor to display images.
- CO2 insufflor.
- Long fie dissectors like in open surgical techniques.
- Hooks and spatulas are used along with cautery for dissection.
- Clip applicators
- Needle holders
- Endostaplers
- Veress needle
- Suction—irrigation apparatus.
- Trocars of diffrent sizes—10 mm, 5 mm.
- Reducers to negotiate smaller instruments through larger ports.
Laparoscopic Surgery Preparation
Always general anesthesia. Other preparations are same as for open method.
Laparoscopic Surgery Technique
- Pressure bandages are applied to both legs to improve the venous return and to decrease the stasis.
- Head end of the table is lowered to have easier insertion of veress needle and scope.
- Ryle’s tube and Foley’s catheter are essential before insertion of the trocars.
- Pneumoperitoneum is created using veress needle through umbilical incision.
Access can be achieved by open method through an umbilical incision. Carbon dioxide is commonly used to create pneumoperitoneum.
Pneumoperitoneum is created up to a pressure of 15 mm Hg which distends the abdominal cavity adequately to have proper visualization of the abdominal contents. - Laparoscope is inserted through the umbilical port(10 mm).
- Abdomen is evaluated for any pathology. Liver, gallbladder, pelvic organs are visualized.
- Additional ports (3–4) through trocars are placed depending on the procedure to be done.
It may be either 5 mm port or 10 mm port.
These ports are placed in such a way to have a proper triangulation of instruments for dissection. - To use clip applicator 10 mm port is required.
Physiologic Changes due to Pneumoperitoneum
- Carbon dioxide causes hypercapnia, acidosis and hypoxia.
- Pneumoperitoneum exerts pressure on the IVC, decreases the venous return and so the cardiac output.
- It increases arterial pressure also.
- It compromises respiratory function by compressing over the diaphragm impairing pulmonary compliance.
Laparoscopic Surgery Complications
- Carbon dioxide narcosis and hypoxia.
- Sepsis—subphrenic abscess, pelvic abscess, septicemia.
- IVC compression
- Bleeding
- Leak from the site, e.g. bile leak.
- Organ injury during insertion of ports, e.g. major vessels,bowel, mesentery, liver.
- Subcutaneous emphysema and pneumomediastinum.
- Gas emboli, though is rare but fatal.
- Postoperative shoulder pain due to irritation ofdiaphragm.
- Cardiac dysfunction due to decreased venous return.
- Injury to the abdominal wall vessels and nerves.
- Cautery burn to abdominal structures.
- Abdominal wall hernias.
- Wound infection.
- Mortality—0.5%.
Relative Contraindications
- Patients with compromised cardiac status
- Peritonitis
- Previous abdominal surgeries
- Bleeding disorders
- Morbid obesity
- Third trimester of pregnancy
- Portal hypertension.
Basic laparoscopic Surgeries
- Laparoscopic cholecystectomy: This is indicated in gallstones, cholecystitis, biliary colic
- Laparoscopic appendicectomy: This is indicated in acute appendicitis.
Question.10. Write short note on robotic surgery.
Answer. Robotic surgery is a type of minimally invasive surgery.
“Minimally invasive” means that instead of operating on patients through large incisions, we use miniaturized surgical instruments that fi through a series of quarter-inch incisions.
- When performing surgery with the da Vinci Si—the world’s most advanced surgical robot—these miniaturized instruments are mounted on three separate robotic arms, allowing the surgeon maximum range of motion and precision.
The da Vinci’s fourth arm contains a magnified high-definition 3-D camera that guides the surgeon during the procedure. - The surgeon controls these instruments and the camera from a console located in the operating room.
Placing his figures into the master controls, he is able to operate all four arms of the da Vinci simultaneously while looking through a stereoscopic high-definition monitor that literally places him inside the patient, giving him a better, more detailed 3-D view of the operating site than the human eye can provide. - Every movement he makes with the master controls is replicated precisely by the robot.
- When necessary, the surgeon can even change the scale of the robot’s movements: If he selects a three-to-one scale,the tip of the robot’s arm will move just one inch for every three inches the surgeon’s hand moves.
And because of the console’s design, the surgeon’s eyes and hands are always perfectly aligned with his view of the surgical site, minimizing surgeon fatigue. - The ultimate effect is to give the surgeon unprecedented control in a minimally invasive environment.
Utilizing this advanced technology, surgeons are able to perform a growing number of complex urological, gynecological, cardiothoracic, and general surgical procedures.
Since these procedures can now be performed through very small incisions, patients experience a number of benefits compared to open surgery, including: -
- Less trauma on the body
- Minimal scarring, and
- Faster recovery time.
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