微创外科

微创外科 Minimally invasive surgery Minimally invasive surgery 微创外科 微创外科 21世纪外科发展方向 • 移植外科 • 微创外科 • 修复外科 • 肿瘤的分子生物学治疗 腹腔镜外科新进展腹腔镜外科新进展腹腔镜外科新进展 • 1901s Keilling 腔镜外科新进展腹腹腔镜外科新进展腹腔镜外科新进展 • 1910 Jacobeus used Nitze endoscope for diagnostic laparoscopy 腹腔镜外科新进展腹腔镜外科新进展腹腔镜外科新进展 • 1930 Kalk dual puncture liver biopsy Laparoscopic cholecystectomy Emblematic operation First landmarks of the laparoscopic revolution Precursor : E Mühe 1985 Pioneers : Ph. Mouret 1987 F. Dubois - J. Perissat 1988 B. Mc Herman 1988 E.J. Reddick 1988 腹腔镜外科新进展腹腔镜外科新进展腹腔镜外科新进展 • 1987 Mouret 世界首例腹腔镜 胆囊切除术 已经成为金的腹腔镜手术 已经成为金标准的腹腔镜手术 腹腔镜NISSEN手术 目前已经渐趋成熟 即将成为金标准手术 目前已经渐趋成熟 即将成为金标准手术 腹腔镜结直肠手术 腹腔镜结直肠手术 腹腔镜结直肠手术 直肠前切除术 左半结肠切除术 右半结肠切除术 横结肠切除术 全结肠切除术 乙结肠切除术 mile’s术 结肠固定术 腹腔镜结直肠手术 腹腔镜结直肠手术 腹腔镜结直肠手术 腹部切口 腹部切口 腹 部切口 腔镜甲状腺切除术 正在探索的手术 正在探索的手术 胃切除术 Global perspective of future development in Endolaparoscopic Surgery Surgery in its historical perspective Open Surgery : A long lasting journey: from 400 to 1990 The Odyssey of the Surgeon’s hands Inside human body Homeric poem 20th Century Two World Wars Birth and improvement of Vascular surgery Thoracic surgery Neurosurgery Plastic surgery Resuscitation (Intensive care units) Global perspective of future development in Endolaparoscopic Surgery Surgery in its historical perspective The Dilemma : How to make harmless the access of the surgeon’s hands inside the patient’s body Global perspective of future development in Endolaparoscopic Surgery Surgery in its historical perspective The spectacular Achievement : From 1950 to nowadays End of the Dilemma : Harmless access of the surgeon’s hands inside every corners of the patient’s body The price to pay the drawbacks of large openings Global perspective of future development in Endolaparoscopic Surgery Surgery in its historical perspective 20th Century 1990 The Turning Point Unnecessary presence of Surgeons' hands inside Human Body Laparoscopic Surgery the turning point in the History of Surgery Endoscopy in its historical perspective: Endoscopy ( to look inside ancient Greek) From antiquity to 1900 endoluminal exploration Since 1901 Laparoscopy (exploration) Interventional Endolaparoscopy Since 1970 Global perspective of future development in Endolaparoscopic Global perspective of future development in Endolaparoscopic Surgery Surgery Laparoscopic Surgery the turning point in the History of Surgery LAPAROSCOPIC SURGERY For DIGESTIVE DISEASES Logical learning progression • STEP 1 : - Exploratory laparoscopy + biopsies - Appendectomy; peritonitis - (gynaecologic emergencies) - Cholecystectomy + IOC Complete mastery of Suturing- knotting • STEP 2 : - Gastroesophageal reflux - Inguinal Hernia repair - Laparoscopic approach of the CBD - Splenectomy; (Adrenalectomy) Most advanced procedures • STEP 3 : - Colorectal surgery - Oesophagus & Stomach surgery - Major Pancreatic resections - Major hepatic resections Laparoscopic Surgery New Spaces Pleural cavity Thoracic Surgery Retroperitoneal Spaces Orthopaedic Surgery Urology Endocrine Surgery Vascular Surgery Interfascias Spaces Head and Neck Surgery Plastic Surgery Laparoscopic Surgery New Techniques-New Instruments Two Main Trends Human craftsmanship High technologies Adaptation from - Computers Open procedures to - Imaging Laparoscopic ones - Teleteaching - Robots….. Laparoscopic Surgery the turning point in the History of Surgery Surgery in its historical perspective Laparoscopic Surgery the turning point in the History of Surgery Surgery in its historical perspective The credible Future How to deal with ? : Changing our minds, educational programs: Changing our health institutions: Institutes of High Technology for MIS Updating our hospital organisation Future of surgery Open surgery M.I.S. Institutes of High Technologies Oncology Transplantation Trauma All surgical units Daily practice Future Organisation Up-dated Evolution Up-dated Evolution Odyssey of Surgeons' hands 21st Century 2000 to 2………. The Reign of Minimaly invasive Surgery And other interventional techniques Surgeons' hands and Patients' Body more and more remote Laparoscopic Surgery the turning point in the History of Surgery Endolaparoscopic Surgery in its ethical perspective You will treat your King better than your patients I can’t my Lord I can’t Why can’t you I treat them all Like Kings and Queens my Lord Ambroise Paré Laparoscopic Surgery the turning point in the History of Surgery Hand’s on Training for future Trainers 谢 谢