Perkembangan Bedah Minimal Invasif di Indonesia.ppt

7/24/2019 Perkembangan Bedah Minimal Invasif di Indonesia.ppt

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Dr. Errawan R. Wiradisuria, SpB-KBD, M.Kes.Dr. Errawan R. Wiradisuria, SpB-KBD, M.Kes.

PERHIMPUNAN BEDAH ENDO-LAPAROSKOPIK INDONESIA (PBEIPERHIMPUNAN BEDAH ENDO-LAPAROSKOPIK INDONESIA (PBEI


2/83

LaparoskopiLaparAbdomen

Oskopi Melihat melalui scope

Laparoskopi: Melihat ke dalam rongga abdomenmelalui scope


3/83

Sejarah Laparoskopi

1901 George Kelling melihat kedalam ronggaabdomen menggunakan cstoscope !"it#e$

19%& 1stLap 'holangiograph ( Miri##i

19)% 1stLap App ( Kurt Semm !Gn$

19)9 1stLap 'hole ( *hilippe Mouret

1991 1stL'+,- ( +erci. *hillips


4/83

Sejarah Laparoskopi / ndonesia

1990 : im 2S 'edar Sinai ( 'al. 3SA : Li4e ,emo di 5akarta

1991 : ,r6 brahim Ahmadsah. dkk ( Laparoscopic

Cholecystectomy yang pertama

%1 5an 1997. +andung :

Perhimpunan Bedah Endo/laparoskopik Indonesia !Indonesian

Societ o8 Endo/laparoscopic Surgeons$ didirikan

Sejak 199 Lap 'hole menjadi prosedur bakuuntukpenakit/penakit kandung empedu !smptomatic gall blader$di 5akarta dan diikuti kota besar lainna di ndonesia


5/83


199) : ,r6 +arlian Sutedja. dkk6 ( Laparoscopic '+,-ploration (LCBDE) ang pertama !2S *luit ( 5kt$

&000 : ,r6 +arlian Sutedja ( Laparoscopic ;ernioraph

(TPP) ang pertama !2S *luit ( 5kt$

&00& : ,r6 +arlian Sutedja ( Laparoscopic !astric

Banding ang pertama !2S *luit ( 5akarta$

Oktober &00% : ,r6 -rra


6/83


Agustus &007 : ,r6 5ohn Sugandi ( Laparoscopic ;ernioraph(TEP) ang pertama !2S Kasih bu ( Solo$

Maret &00) : ,r6 2eno 2udiman > ,r6 -rra


7/83

Keuntungan +edah LaparoskopiMengurangi kerusakan pada jaringan

Mengurangi neri pasca bedah

*enembuhan luka bekas operasi ang lebih

cepat

Mengurangi ?ileus paralitik@ pasca bedah

!*emulihan pergerakanperistaltik usus anglebih cepat$

;asil -stetik


8/83

Keuntungan +edah LaparoskopiMencegah perlengketan !adhesi$ pasca bedah

Bisualisasi lebih jelas pada penderita obesitas

Masa pulih lebih cepat2a


9/83

Kekurangan Laparoskopi Gambar & dimensi pada monitor

*erlu adana CLearning Curve Time

;arus menesuaikan dengan kondisi sbb :16 Adana sensasi baru !New Tactile Sensation)

&6 nteraksi diantara 4isual dan operati8 !Hand andEyes Coordination$

%6 Kurangna persepsi kedalaman !Lack of Dept!erception$

76 *ergerakan ang berla


10/83

E!e"#i$E!e"#i$(%eren&ana(%eren&ana

Lapar's&'pi& &'!e&)s#e'*)Lapar's&'pi& &'!e&)s#e'*)End's&'pi& e+#raperi#'nea! inuina! ernia repairEnd's&'pi& e+#raperi#'nea! inuina! ernia repairLapar's&'pi& appendi&e'*)Lapar's&'pi& appendi&e'*)Lapar's&'pi& adesi'!)sisLapar's&'pi& adesi'!)sis

E*erensiE*erensi(awa#(awa#

Darura#Darura#

Dian's#i& !apar's&'p) $'r #rau*aDian's#i& !apar's&'p) $'r #rau*aLapar's&'pi& su#ure '$ per$'ra#ed du'dena! u!&erLapar's&'pi& su#ure '$ per$'ra#ed du'dena! u!&erLapar's&'pi& appendi+ per$'ra#i'nLapar's&'pi& appendi+ per$'ra#i'n

Adan&edAdan&edLapar's&'pi&Lapar's&'pi&

Need!es&'pi& surer) (&'!e&)s#e'*), ernia repairNeed!es&'pi& surer) (&'!e&)s#e'*), ernia repairLapar's&'pi& en#ra! ernia repairLapar's&'pi& en#ra! ernia repairNeed!es&'pi& #'ra&i& s)*pa#e'*)Need!es&'pi& #'ra&i& s)*pa#e'*)

Lapar's&'pi& surer) $'r ERD (Nissen, /'upe#, e#&Lapar's&'pi& surer) $'r ERD (Nissen, /'upe#, e#&Lapar's&'pi& &ardi'*)'#'*) $'r a&a!asiaLapar's&'pi& &ardi'*)'#'*) $'r a&a!asiaLapar's&'pi& *'r%id '%esi#) surer)Lapar's&'pi& *'r%id '%esi#) surer)Lapar's&'pi& sp!ene'*)Lapar's&'pi& sp!ene'*)Lapar's&'pi& adrena!e'*)Lapar's&'pi& adrena!e'*)Lapar's&'pi& Dis#a! Pan&rea#e'*)Lapar's&'pi& Dis#a! Pan&rea#e'*)Lapar's&'pi& &'!e'*)Lapar's&'pi& &'!e'*)Lapar's&'pi& &'!'s#'*)Lapar's&'pi& &'!'s#'*)Lapar's&'pi& assis#ed as#r's#'*)Lapar's&'pi& assis#ed as#r's#'*)

Lapar's&'pi& s!eee as#re'*)Lapar's&'pi& s!eee as#re'*)Lapar's&'pi& 0BD e+p!'ra#i'nLapar's&'pi& 0BD e+p!'ra#i'nLapar's&'pi& as#ri& surer)Lapar's&'pi& as#ri& surer)

Lapar's&'pi& surer) $'r &an&er pa!!ia#i'n (%)pass, s#ainLapar's&'pi& surer) $'r &an&er pa!!ia#i'n (%)pass, s#ainEnd's&'pi& su%$as&ia! per$'ra#'r ein surer) (SEPSEnd's&'pi& su%$as&ia! per$'ra#'r ein surer) (SEPS

1ide'-#'ra&'s&'pi& surer) (wede, %u!!e'*), e#&1ide'-#'ra&'s&'pi& surer) (wede, %u!!e'*), e#&R'%'#i& surer)R'%'#i& surer)

/e!epresen&e *ini*a! inasie surer) (ia sa#e!i#/e!epresen&e *ini*a! inasie surer) (ia sa#e!i#


11/83

Laparoscopic

nstruments

Trocar + Veres NeedleTrocar + Veres Needle

ScissorScissor


12/83

Laparoscopic

nstruments

Grasper + DissectorGrasper + Dissector

Cautery + Coagulation InstrumentCautery + Coagulation Instrument


13/83

Laparoscopic

nstruments

Suction + Irrigation InstrumentsSuction + Irrigation Instruments


14/83

Laparoscopic

nstruments

Clips ApplierClips Applier

Endo StaplerEndo Stapler


15/83

*erkembangan +edah Laparoskopi

"eedlescopGastric +anding

Laparoscopic 'ommon +ile ,uct -ploration;ands Assisted Laparoscopic Surger !;ALS$Laparoscopic 'olonic 2esectionLaparoscopic ,istal *ancreatectom

Laparoscopic Gastrectom !LA,G$Laparoscopic Slee4e Gastrectomelesurger !2obotic$


16/83

&eedlescopic Cholecystectomy


17/83

"eedlescopic nstrument

& mm

rocar


18/83

Gastric

+anding


19/83

he +io-nterics ntragastric +aloon Sstem ! "AM-, ;-AL; $

Dr. Errawan Wiradisuria Sp!"#!D $.#es.


20/83

+ile ,uct -ploration!-ksplorasi Saluran -mpedu$

Menggunakan 'holedochoscopeD -kstraktor batu !calculi$

Stone etraction using a 8ogart

embolectom catheter

$oises %aco&s et all.$oises %aco&s et all.

'aparoscopic Surgery $cGraw"(ill )**'aparoscopic Surgery $cGraw"(ill )**


21/83

;ALS

;and Assisted Laparoscopic Surger

nsisi lebih kecil E daripada ukuran sarung tangan

operator

,ilakukan untuk kasus& keganasan !malignanc$

Sensasi D palpasi lebih

baik

Kombinasi dengan trokar


22/83

Laparoscopic Assisted ,istal Gastrectom

!LA,G$

K. Kojima, et.all. : Surg.Oncology EsophagogastricSurgery, Tokyo Medical andDental Uniersity


23/83

Laparoscopic Assisted ,istal Gastrectom

!LA,G$

K. Kojima, et.all. :Surg. Oncology Esophagogastric Surgery, Tokyo

Medical and Dental Uniersity

i i l' i Di l


24/83

'aparoscopic Distal'aparoscopic Distal

,ancreatectomy,ancreatectomy

-626 =iradisuria : ,ept6 o8 Surger.

*ersahabatan General ;ospital.

5akarta. ndonesia.6March. &009


25/83

-ADI/-E01ENC2

3$eng4ancur5an sel tumor dengan

4antaran listri5 melalui 6arum 789 gauge:

C-2A!'ATIN

3,em&e5uan sel pada su4u "8;* e5stra selular

6aringan 7ice&all:

LAPAROS0OPI0-ASSIS/ED 2 pada #erapiLAPAROS0OPI0-ASSIS/ED 2 pada #erapi

"an"er"an"er


26/83

elesurger!operasi jarak jauh dengan bantuan komputer. robot D satelit$

*asien dioperasi menggunakan tangan robotik

ang dikendalikan oleh ahli bedah dari tempat

ang berbeda

Aplikasi robotik pada kasus digesti8 :

*rototipe CMO"AF dikembangkan oleh

,r6 56 ;impens D *ro8 'adiereMaret 199 : Lap 'hole

Mei 199) : -sophageal 2e8lu


27/83

-L-S32G-2


28/83

2O+O' S32G-2

'astery o Endoscopic and Laparoscopic Surgery *nded$ *++, -.*$


29/83

2O+O' S32G-2

"/B/TIC S%"!ICL E0%IP'E&TES/Putomated Endoscopic System or /ptimal Positioning

!ould 1$C and 'el#in 2$S$

'astery o Endoscopic and Laparoscopic Surgery *nded$*++, - .3 .4.$


30/83

Operating heatre

'on8iguration

Theodore &$ Pappas TLS o Laparoscopic Surgery *nded$ .555 .4 - 3$

Dr. Errawan Wiradisuria,S B(K)BD


31/83

Operating heatre

'on8iguration


32/83

Operating heatre

'on8iguration


33/83

Operating heatre

'on8iguration


34/83

Laparoscopic

'holecstectom

Theodore &$ Pappas TLS o Laparoscopic Surgery *nded$ .555 .4 - 3$


35/83

Laparoscopic

'holecstectom

,osition o= Trocar,osition o= Trocar


36/83

8. ,osisi Trocar

3. Ana#'*i per!apar's&'pe

. E5spose #andung Empedu

?. E5spose #andung Empedu


37/83

@. ,emotongan du5tus sisti5us

. 'igasi du5tus sisti5us

9. Dise5si identiB5asi du5tussisti5us


38/83

8*. #andung Empedu

;. #. Empedu di5eluar5anmelalui trocar site su&ip4oid

. D. sisti5us yg tela4 terpotong5andung empedu siap ut5

di&e&as5an


39/83

8). Anatomi setela45olesiste5tomi

88. 'iFer setela45olesiste5tomi


40/83

,arut ,asca #olesiste5tomi'aparos5opi5

,arut ,asca #olesiste5tomi#onFensional


41/83

8. ,osisi Trocar

). E5spose appendi

. ,emotongan messo"appendi


42/83

?. ,emasangan endoloop pada appendi

distal

. ,emotongan appendi

9. ,emasangan endoloop padaappendi pro5simal


43/83

. ,engeluaran appendi darirongga a&domen

@. Appendi yg tela4 dipotong


44/83

3** a#au 4**

5** a#au 4**

67**


45/83

!osisi Trocar

' Ad4 i l i' Ad4 i l i


46/83

Perlekatan erat 3 loop ususdengan dinding abdomen

1

2

3'ap Ad4esiolysis'ap Ad4esiolysis


47/83


48/83

,ada pasien pasca &eda4 laparotomi ,ada pasien pasca &eda4 laparotomi


49/83

C6/LED/C6/T/'7

LP"/SC/PIC '+, -H*LO2AO"

7E5splorasi Ductus7E5splorasi Ductus

C4oledoc4us:C4oledoc4us:


50/83

'+, -H*LO2AO"

C6/LED/C6/SC/PE I&SE"TI/&

-626 =iradisuria. 5akarta. 5ul &00I

LP"/SC/PIC




51/83

ST/&ES E8T"CTI/&

Gallstone

Small incision in '+,

Stone entrapped inbasket and remo4ed

ANTE-I- C('EDC(T$2ANTE-I- C('EDC(T$2

Swanstrom '.'.Swanstrom '.'. $inimally InFasiFe Surgery $cGraw"(ill 8;;.$inimally InFasiFe Surgery $cGraw"(ill 8;;.



52/83

ST/&ES E8T"CTI/&

-626 =iradisuria. 5akarta. 5ul &00I





53/83

T9T%BE I&SE"TI/&

ANTE-I- C('EDC(T$2ANTE-I- C('EDC(T$2

Swanstrom '.'.Swanstrom '.'. $inimally InFasiFe Surgery $cGraw"(ill 8;;.$inimally InFasiFe Surgery $cGraw"(ill 8;;.

/tube placement

'+, sutured


54/83

T9T%BE I&SE"TI/&

-62 6=iradisuria. 5akarta. 5ul &00I

LP"/SC/PIC '+, -H*LO2AO"7E5splorasi Ductus7E5splorasi Ductus



55/83

LP"/SC/PIC 'OLO"' 2-S-'O"


56/83


6and ssisted Laparoscopic Surgery (6LS)


57/83



58/83


Colon nastomosis


59/83


Complete nastomosis by Stapler


60/83


Tumor Colon Sigmoid


61/83


Post /perati#e 2ound

Pankreatektomi Distal


62/83

Massa pada permukaan anterior corpus pankreas !nsulinoma$

PerLaparoskopik

$assa pada cauda pan5reas

E.-. Wiradisuria $arc4 )**;


63/83

*ankreas distal ang telah bebas

Pankreatektomi DistalPerLaparoskopik


P k k i Di l


64/83

Pankreatektomi DistalPerLaparoskopik ,emotongan pada se&agian corpus + cauda

pan5reas dengan Endostapler



65/83

*erdarahan pada tempat reseksi pankreas. diatasi dengan beberapa

jahitan !perlaparoskopik$



Pankreatektomi Distal


66/83

Sisa corpus pankreas g sudah direseksi


Gaster

Pankr

eas

V.Li

enali

s

Live

r



67/83

*ankreas distal dimasukkan ke dalam endobag



Pankreatektomi Distal Per-k ik


68/83

Laparoskopik


-4akuasi *ankreas


69/83

Spesimen pankreas !sebagian corpus > cauda$

3

1

2

8 )

H

INS1'IN$A

7$ulti /ocal:


HARI KE 67 PAS0A BEDAH


70/83

HARI KE 67 PAS0A BEDAH


6 (SA/U BULAN PAS0A BEDAH


71/83

(


Saat 8 &ulan


72/83

pasca &eda4

'aparoscopic


73/83

apa oscop c1ltra 'owAnterior-esection71'A-:

n8erior Mesenteric Arter 'lipping D

'utting

E.-. Wiradisuria Sept )*8*


'aparoscopic


74/83

p p1ltra 'owAnterior-esection71'A-:

2ecto/Sigmoid 2esection 3sing

-ndo/Stapler



'aparoscopic


75/83

p p1ltra 'owAnterior-esection71'A-: no9"ectal Pull Through



'aparoscopic


76/83


"ectal Stump : *, cm

rom no9Cutan Line

"esected "ecto 9 Sigmoid



'aparoscopic


77/83


Post Lap$ %L" (the 3thday)

Post Lap$ %L" (the .+thday)



'aparoscopic


78/83


Post Lap$ %L" 9 the .,thday

Post Ileal "eanastomosis ; the .*thday

I C& S'ILE &/2

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Perkembangan Bedah Minimal Invasif di Indonesia.ppt