BM8701

DIAGNOSTIC AND THERAPEUTIC EQUIPMENT

– II

UNIT – V
EXTRA CORPOREAL DEVICES AND
SPECIAL DIAGNOSTIC TECHNIQUES
 Topics to be covered
• Need for heart lung machine
• functioning of bubble, disc type and membrane type
oxygenators
• finger pump, roller pump, electronic monitoring of
functional parameters
• Hemo Dialyser unit
• Lithotripsy
• Principles of Cryogenic technique and application
• Endoscopy, Laproscopy,Otoscopes.
• Thermography – Recording and clinical application.
 Introduction
 The Heart-lung machine is a device which is used to
provide blood circulation and oxygenation while
the heart is stopped during the open heart surgery.
 Heart-lung machine consists of three main functional
units, the pump, the oxygenator and heat exchanger.
 To function, the heart-lung machine must be to
connected the patient in a way that allows blood to be
removed, processed, and returned to the body.
 HISTORY
 The researchers searched mainly for a means to provide
oxygenated blood to organ preparations. They filtered the
blood through various screens and membranes and even
pumped it through the lungs of dogs or monkeys, but
problem was not to be their solved, though this may be
considered the beginning of research into a heart-lung
device.
 The first successful open heart procedure on a human
utilizing the heart lung machine was performed by John
Gibbon in 1953. He repaired an atrial septal defect in an
18-year-old woman.
Modified – Mayo Clinic (1955)
Present Day Machine
(Advanced)
Purpose of Heart-lung machine:-
 The heart-lung machine provides the benefit of a
motionless heart during open heart surgery.
 The heart-lung machine is valuable during this
time since the patient is unable to maintain blood
flow to the lungs or the body.
Surgical procedures in which
Heart-lung machine is used:-
 Coronary artery bypasses surgery.
 Cardiac valve repair and/or replacement (aortic
valve, mitral valve, tricuspid valve, pulmonic valve)
 Repair of large septum defects (atrial septum defect,
ventricular septum defect, atrioventricular septum
defect)
 Transplantation (heart transplantation, lung
transplantation, heart–lung transplantation)
 Implantation of heart.
Block diagram:-
Components of Heart-lung
Machine:-
 Cardioplegia
 Cannula
 Blood reservoir
 Heparin Pump
 Roller pumps/Centrifugal pump
 Oxygenators
 Heat Exchanger
Cardioplegia
 Heart-lung machine circuit consists of a separate circuit
for infusing a solution into the heart itself to
produce cardioplegia to stop the heart from beating, and
to provide myocardial protection (to prevent death of
heart tissue).
Cannula
 A venous cannula removes oxygen deprived blood from a
patient's body. An arterial cannula is sewn into a patient's
body and is used to infuse oxygen-rich blood.
 A cardioplegia cannula is sewn into the heart to
deliver a cardioplegia solution to cause the heart to
stop beating
Blood reservoir
 The blood reservoir serves as a receiving chamber for
venous return, facilitates a venous bubble trap, provides a
convenient place to add drugs, fluids, or blood, and adds
storage capacity for the perfusion system.
 Reservoirs may be rigid (hard) plastic or soft, collapsible
plastic bags.
Heparin Pump

 Once using a heart-lung machine during open-heart surgery,

A powerful anticoagulant, Heparin should be given to the
patient in order to reduce the blood's ability to clot, reducing
the risk of clots forming in the heart-lung machine.
Pumping system
1. Roller pumps
 Roller pumps compress a segment of the
blood filled tubing. Blood is then pushed
ahead of the moving roller.
Roller pumps consist tubing, which is
compressed by two rollers 180° apart. Forward
fl ow is generated by roller compression and
fl ow rate depends upon the diameter of the
tubing, rate of rotation.
Excessive compression of the tubing in a roller
pump increases the risk of hemolysis.
Conti

Fig: Diagrams of blood pumps. (A) Roller

pumps with two rollers, 180 degrees apart. The
compression of the rollers against the raceway
is adjustable. Blood is propelled in the
direction of rotation. (B) The impeller pump
uses vanes mounted on a rotating central
shaft. (C) The centrifugal pump uses three
rapidly rotated, concentric cones to propel
blood forward by centrifugal force
2 Centrifugal pump
Centrifugal pump have replaced roller pumps at many
institutions; mainly because they cannot over pressurize
the heart-lung machine system.
 It consists of smooth plastic cones, which when rotated
rapidly, propel blood by centrifugal force. An arterial
flow meter is required to determine forward blood flow,
which varies with the speed of rotation and the after load
of the arterial line.
Oxygenators
 Oxygenators not only supply vital oxygen for the
blood,
but also transport carbon dioxide, anaesthetics and other
gases into and out of the circulation.
 There are three types of oxygenator
1. Membrane oxygenators
2. Bubble oxygenator
3. Film oxygenator
Oxygenaotrs
enM
am
reb

M e m b r a n e o x y g e n a t o r s i n t i m a t e t h e natural
lung by a thin membrane of either micro porous
polypropylene or silicone rubber between the gas and blood
phases.

Diagram of a hollow fiber membrane oxygenator and heat exchanger

unit. Oxygen enters one end of the bundles of hollow fibers and exits
at
the opposite end. The hollow fiber bundles are potted at each end to
separate the blood and gas compartments. Oxygen and carbon dioxide
diffuse in opposite directions across the aggregate large surface of the
Bubble Oxygenators

In bubble oxygenators venous blood drains directly into a

chamber into which oxygen is infused through a diffusion
plate. The diffusion plate produces thousands of small
oxygen bubbles within blood. Gas exchange occurs across a
thin film at the blood-gas interface around each bubble.
Carbon dioxide diffuses into the bubble and oxygen diffuses
outward into blood.
Heat Exchanger
 Control body temperature by heating or cooling blood
passing through the perfusion circuit.

 In heat exchanger, blood flows through spiralling coils

made of stainless steel. The inner walls of the coils are
coated with polymers to limit blood-surface interactions.
The circulating water is chilled to nearly
0 0C in an ice bath and heated by an electric resistance
coil to an absolute maximum of 42 0C.
Stopping of Heart-lung machine
 Once operation is completed, The surgeon gradually
occludes the arterial pressure and pulse, and central
venous pressure are monitored and adjusted. When
cardiac performance is satisfactory and stable,
protamine is given to reverse cardioplegia and blood
return from the surgical field is discontinued.
Complications
Haemolysis
Capillary leak syndrome
Clotting of blood in the circuit – can block the
circuit or send a clot into the patient.
Air embolism
Leakage – lose blood perfusion of tissue if a line
becomes disconnected.
1.5% of patients that undergo Heart-lung machine
are at risk of developing Acute Respiratory
Distress Syndrome.
Why Automation in the Heart-lung
Machine needed?
 During open heart surgery, Per fusionists take care of the
connection procedures and maintain the performance of
machine as per requirement at the time of surgeries; sometimes
there occur faults due to carelessness. To overcome that
Automation of Heart-Lung machine is a need.
 During surgery, Pressure in the arterial line is monitored
continuously to instantly detect any increased resistance to
arterial inflow into the patient.
Computerized CPB System
 The computerized CPB system consists of an 80286
microcomputer. a reservoir blood level sensor,
a collapse sensor, and temperature sensor.
Safety mechanisms
 The computer regularly verifies all samples with their
prior values and detects not only artifacts but also hardware
failures.
 On detecting the improper sensor output, the computer
maintains both the flow rates constant and displays a
warning message with estimated locations of the trouble.
 The pump rotation speeds are also monitored and matched
with the computer's command.
 In case the computer breaks down, a perfusionist can take
over the pump control by turning an automatic/manual
switch to the manual mode.
 IDEAL OF AN OXYGENATOR
• Safe and efficient
• Overcome barrier of diffusion distance
• Minimum trauma to blood cells
• Small priming volume
• Easily assmebled
• Minimize air embolism
• Gas transfer is proportional to partial pressure
difference and surface area and inversely
proportional to diffusion distance.
 Mechanism
• oxygenator – blood and gas flow direction
will be perpendicular
 Bubble oxygenator

• 3 components :

– Oxygenation chamber

– Defoamer

– Arterial reservoir
 1.Oxygenation chamber

• Bubble size - determined by disperser by

Orifice diameter, Gas flow rate, Blood
viscosity, Surface tension.
• sparging plate – polycarbonate plate
perforated with holes of precise dimension or
porous silicate
• Purpose : break the bulk gas into small
bubbles to allow gas exchange
• More the no.of bubbles- greater efficiency of
oxygenation
• Co2 diffusion is 25times > o2.Larger bubbles will
efficiently remove of co2
• Smaller bubbles will efficiently oxygenate but
poor in removal of co2

• Size : 3 — 7 mm to optimise both CO2 & O2 gas

transfer
 2.Debubbling/defoaming area
• Made up of Polyurethane or polyester (125-
175microm)
• Beads, sponges(polyurethane),shreds, meshes,
fabrics
• Coated with Silicon(antifoam ) reduces surface
tension of bubbles & prevents bubble formation .
Hence air embolism prevented
 Configuration

Scrolled envelope Hollow fibre Parellel Plate

Microporous membrane
• Polypropylene is a heterogenous,
microporous,hydrophobic membrane
• Size- 0.03 to 0.07 Um in diameter
• Surface is hydrophobic & the pores are so
small, the blood water is not ultrafiltered;
inhibit serum leakage across the membrane
 TRUE MEMBRANE OXYGENATOR

• COIL [Scrolled] TYPE: consists of silicone

rubber sheets coiled in a cylindrical fashion
• Silicone rubber is nonporous ; there is a
complete barrier between blood and gas.

• Eg: Sci-Med oxygenator

• Advantages-- Able to maintain stable CO2 &
O2 for long periods of time (weeks), Used
primarily in ECMO
• Disadvantages--Costly to manufacture, High
priming volume.
 HEMODIALYSIS MACHINE
MODEL: Fresenius/4008S
INTRODUCTION
• Hemodialysis removes wastes and water by circulating blood outside
the body through an external filter, called a dialyzer, that contains a
semipermeable membrane.
• The blood flows in one direction and the dialysate flows in the
opposite. The counter-current flow of the blood and dialysate
maximizes the concentration gradient of solutes between the blood
and dialysate, which helps to remove more urea and creatinine from
the blood.
•
The concentrations of solutes (for example potassium, phosphorus,
and urea) are undesirably high in the blood, but low or absent in the
dialysis solution, Dialysis is an increasingly common type of
treatment.
•
The dialysis solution has levels of minerals like potassium and
calcium that are similar to their natural concentration in healthy
blood.
 PURPOSE
• When the nephrons in the kidneys are failure or not working properly,
the
ions like potassium, creatinine etc
we go through dialysis.
• Diseases of renal failure are
1. Nephrotoxins
2. Diabetic
3. Nephropathy
4. Hypertension
5. Glomerulonephritis
6. Cystic kidney
Disease
 DEFINITION
The Hemodialysis name it self contains hemo means blood and dialysis
means the diffusion of solute molecules through a semi permeable
membrane, normally passing from the side of higher concentration to
that
of
• lower.
Semi membrane is one that allows the passage of certain smaller molecules
of such crystalloids as GLUCOSE and UREA, but prevents passage of larger
molecules such as the colloidal plasma PROTEINS and PROTOPLASM.
Hemodialysis, also spelled haemodialysis, commonly called kidney
• dialysis or simply dialysis, is a process of purifying the blood of a person
whose kidneys are not working normally. It is a method that is used to
achieve the extracorporeal removal of waste products such as creatinine
and urea and free water from the blood when the kidneys are in a state
of renal failure. Hemodialysis is one of three renal replacement therapies
(the other two being renal transplant and peritoneal dialysis). An
alternative method for extracorporeal separation of blood components
such as plasma
 PRINCIPLE
• The principle of Hemodialysis is the same as other methods of dialysis; it
involves diffusion of solutes across a semi permeable membrane.
• Hemodialysis utilizes counter current flow, where the dialysate is flowing
in the opposite direction to blood flow in the extracorporeal circuit.
• Counter-current flow maintains the concentration gradient across the
membrane at a maximum and increases the efficiency of the dialysis.
• It involves diffusion,osmomis and ultra filtration.
DESCRIPTION
• Hemodialysis is diffusion across a semi permeable membrane (one that
allows only certain molecules to pass through it). The semi permeable
membrane is used to remove the wastes from the blood and at the same
time correct the level of electrolytes in the blood. Before Hemodialysis
can be performed, a surgeon must make a way for the blood to be pumped
out of the body and then be returned after it has been cleansed.
• To do this, the surgeon uses an artery and a vein in the forearm.
• Arteries (which have muscles in their walls) bring oxygenated blood to the
body from the heart, and veins return blood to the heart, which needs to
have oxygen.
• The surgeon connects the radial artery in the forearm to a large vein called
the cephalic vein. This connection is called an arterio venous shunt.
• A shunt carries something from one place to another. In this case it carries
blood from an artery to a vein. After this shunt is made, the veins in the
forearm get big and eventually form muscles in their walls like arteries.
They are now strong and can be punctured many times for dialysis.
 Description cond’t
• DIALYSIS:
There are two different kinds of dialysis used in medicine:
Hemodialysis and peritoneal dialysis. The methods for performing
dialysis may be different, but the goal of the treatment is the same, that is,
to remove waste products. These wastes are composed mainly of nitrogen
in the form of urea, uric acid, and creatinine.
• TYPES OF DIALYSIS:
There are five types of dialysis.
1. Hemodialysis.
2. Peritoneal Dialysis.
3. Hemofiltration.
4. Hemodiafiltration.
5. Intestinal dialysis.
FRONT VIEW
1. Monitor
2. Blood Pressure Cuff
3. Extracorporeal blood circuit
module
4. Concentrate connectors
5. Brake
6. Shunt interlock for the
dialyzer connecting lines
7. IV pole
8. Status indicator
BACK VIEW
1. Monitor
2. Sampling value
3.Bracket for the dialyzer connection
lines
4. Dialysate outlet tube
5. Dialysate inlet tube
6. Disinfection connector
7. Filter
8. CDS (red) option
9. Drain
10. Water connector (permeate)
11. DIASAFE plus
12. Vent tubing
13. Power supply unit
PARTS AND FUNCTIONS
S.NO PARTS FUNCTION
1 Dialysis Machine Blood A blood pump simply pumps the blood from the body
Pump and Tubing into the machine through specially made tubes.

2 Syringe The syringe contains a drug called Heparin

which prevents the blood from clotting in the tubes.

3 Dialyzer The dialyzer is a large

canister containing thousands of small fibers through
which patient blood is passed. The dialyzer is the key
part of a dialysis
machine where the cleaning of the blood takes
place.
4 Alarms in order to protect
the patient from any errors in functioning. The
things that are monitored with alarms include:
•Blood pressure within the machine
•Blood pressure of the patient
•Blood flow
•Temperature
•Dialysate mixture
 S.NO PARTS FUNCTION
1

5 Pressure monitor •Arterial pressure monitor: Detects the

pressure between the blood access and the blood pump.
•Venous pressure monitor: It normally detects positive pressures. If the
venous pressure goes low, it probably due to disconnection/low blood
flows in the circuit.
6 Air Leakage Detector The detector is settled in the venous blood
line and detects as well as in the purpose of avoiding air embolus

7 Data Interfaces Dialysis machines can include USB, Ethernet,

and a variety of serial interfaces to legacy hospital information systems.
Wireless interfaces (such as Wi-Fi) may also be included for direct
connection to the hospital wireless networks. Data card slots are also
available on some designs.
8 Valves Several valves with electronic actuation are
needed in the machine to allow variable mixing ratios. Various
implementations are possible from simple opened/closed valves driven
by solenoids to precision variable- position valves driven by stepper
motors.
9 Sensors Dialysis machines require many different types of sensors
to monitor various parameters. Blood pressure at various points
in the extracorporeal circuit, dialysate pressure, temperature,
O2 saturation, motor speed, dialyzer membrane pressure
gradient, and air are all monitored for proper values during
dialysis.
PROCEDURE
Step by step procedure:
1. After the dialysis procedure has been done to a patient, the machine
should get ready for another new patient, we should clean the disposable
tubing's and filter with sterilizing fluid and should checked with a type of
litmus test.
2. When the patient arrives, the parameters like weight, blood pressure and
temperature are measured.
3. For fistula procedure we have to connect to veins of arms or legs. For
catheter procedure we have to connect to large veins at chest.
4. Then the patient is connected to the machine with complete loop, then the
timer and pump are started.
5. Hemodialysis is under process.
6. Periodically for every half hour, the blood pressure is taken. If, low blood
pressure can cause cramping, nausea, shakes, dizziness, lightheadedness,
and unconsciousness .
7. The amount of fluid to be removed is set by the dialysis nurse according
to the patient's "estimated dry weight."
Procedure cond’t
8. At the end of the procedure time, the patient is disconnected from the
plumbing. Needle wounds are bandaged with gauze, held for up to 1 hour
with direct pressure to stop bleeding, and then taped in place.
9. Temperature, standing and sitting blood pressure, and weight are all
measured again. Temperature changes may indicate infection. BP discussed
above. Weighing is to confirm the removal of the desired amount of fluid.
10.Care staff verifies that the patient is in condition suitable for leaving. The
patient must be able to stand, to maintain a reasonable blood pressure, and
be coherent.
RISKS
1. Anemia: due to the procedure associated blood losses and mild effect on
oxygen transporting function.
2. Hematocrit (Hct): It levels, a measure of red blood cells, are typically
low in ESRD patients. This deficiency is caused by a lack of the
hormone
3. erythropoietin.
Cramps, nausea, vomiting, and headaches: Some patients experience
cramps and flu-like symptoms during treatment. These can be caused by
a number of factors, including the type of dialysate used, composition of
the dialyzer membrane, water quality in the dialysis unit, and the ultra
4. filtration rate of the treatment.
Hypotension: Because of the stress placed on the cardiovascular system
with regular Hemodialysis treatments, patients are at risk for
hypotension, a sudden drop in blood pressure. This can often be
5. controlled by medication and adjustment of the patient's dialysis
prescription.
6. Infection: Patients can also get infections through surroundings. The
room and area used for patients must be kept clean.
Infectious diseases: There is a great deal of blood exposure involved in
dialysis treatment, a slight risk of contracting hepatitis B and hepatitis C
ADVANTAGES

• Low mortality rate

• Better control of blood pressure and abdominal cramps
• Less diet restriction
Better solute clearance effect for the daily hemo dialysis: better
tolerance and fewer complications with more frequent dialysis
DISADVANTAGES
• Restricts independence, as people undergoing this procedure cannot travel
around because of supplies' availability
• Requires more supplies such as high water quality and electricity
• Requires reliable technology like dialysis machines
• The procedure is complicated and requires that care givers have more
knowledge
Requires time to set up and clean dialysis machines, and expense with
machines and associated staff
 CRYOGENIC TECHNOLOGY
 The word ‘cryogenics’ originates from Greek word
‘Cryo’ which means cold.
 Cryogenics is the study of very low temperature.
The
temperature as low as-180 C are attained in cryogenic
system.
 Cryogenics is the study of low temperature and
behaviour of material under these low temperature.
 The cryogenic process also has a unique capability
for
recycling difficult to separate composite material.
 The extremely low temperature are produced by using
substances called ‘cryogens’. Such as Liquid
Nitrogen(LN2) and Liquid Helium(LH2).
 Liquid Nitrogen are the most commonly used in
cryogenics.
 They have the boiling point of below -150 c.
 Cryogens are stored in vessels called as Dewar flask
which provides good insulation.
DEWAR FLASK
 Liquid Nitrogen
 Nitrogen gas makes up the major portion of the
atmosphere (78.03%) by volume.
 Inert, colourless, odourless, non-corrosion, non-flammable
liquid.
 Extremely cold.
 Volume of expansion liquid to gas at 15 c 1atm. i.e 1 litre
of liquid nitrogen evaporated to form 682 litres of nitrogen
gas.
 Application of cryogenics
 Aerospace – Cryogenic Rocket Engine

 Manufacturing field

 Medical field

 Electronics field

 Fuels research
 CRYOSURGERY
• Cryosurgery (also called cryo therapy) is the use of extreme cold produced by liquid
nitrogen (or argon gas) to destroy abnormal tissue.
• Cryosurgery is used to treat external tumors, such as those on the skin.
• For internal tumors, liquid nitrogen is circulated through a hollow instrument called a
cryoprobe.
• Cryosurgery has been used for many years in the treatment of skin cancer

BENEFITS OF CRYOSURGERY
• Cryosurgery is very effective and is less expensive than other treatment. It can
be done in your health care provider’s office and an anesthesia is not necessary.
• The treatment can be safely repeated and may be used along with standard
treatments such as surgery, chemotherapy, Harmon therapy and radiation.
• It can be used for patients who are not good candidates for conventional surgery
because of their age or other medical condition.
• It is used to treat skin lesions such as freckles (for cosmetic reasons),
hemorrhoids and some skin cancers
 Cryotherapy
Cryotherapy, also called cryosurgery, cryoablation, percutaneous
cryotherapy or targeted cryoablation therapy, is a minimally
invasive treatment that uses extreme cold to freeze and destroy
diseased tissue, including cancer cells. Although cryotherapy and
cryoablation can be used interchangeably, the term "cryosurgery" is
best reserved for cryotherapy performed using an open, surgical
approach.
During cryotherapy, liquid nitrogen or high pressure argon gas flows
into a needle-like applicator (a cryoprobe) creating intense cold that
is placed in contact with diseased tissue. Physicians use image-
guidance techniques such as ultrasound, computed
tomography (CT) or magnetic resonance (MR) to help guide the
cryoprobes to treatment sites located inside the body.
Cryotherapy can be applied topically (on the skin surface), percutaneously, or
surgically. Topical cryotherapy is used typically in the case of skin and eye lesions.
When the lesion is situated below the skin surface, a needle-like therapy probe
or applicator needs to be placed through the skin. Occasionally, a surgical
incision is required.
Cryotherapy is used to treat:
• skin tumors.
• pre-cancerous skin moles.
• nodules.
• skin tags.
• unsightly freckles.
• retinoblastomas, a childhood cancer of the retina.
prostate, liver, and cervical cancers, especially if surgical resection is not
possible.
Cryotherapy is also being used to treat tumors in other parts of the body, such as
the kidneys, bones (including the spine), lungs, and breasts (including benign
breast lumps called fibroadenomas). Although further research is needed to
determine its long term effectiveness, cryotherapy has been shown to be
effective in selected patients.
ENDOSCOPY
Endoscopy is a nonsurgical procedure used to examine a
person's digestive tract.
Using an endoscope, a flexible tube with a light and
camera attached to it, your doctor can view pictures
of your digestive tract on a color TV monitor.
Unlike many other medical imaging technique,
endoscopes are inserted directly into the organ.
 TYPES OF ENDOSCOPY

• GASTROSCOPY
• COLONOSCOPY
• LAPAROSCOPY
• PROCTOSCOPY
• CYSTOSCOPY
• BRONCHOSCOPY
• LARYNGOSCOPY
• NASOPHARYNGOSCOPY
 PRINCIPLE

Fibre-optic endoscopes use bundles of thin glass fibres to

transmit light to and from the organ being viewed. These
fibres use the principle of total internal reflection to transmit
almost 100 % of the light entering one end to the other end.
 CONSTRUCTION

An endoscope can consist of:

a rigid or flexible tube.
a light delivery system to illuminate the organ or object
under inspection. The light source is normally outside the
body and the light is typically directed via an optical fiber
system.
a lens system transmitting the image from the objective lens
to the viewer, typically a relay lens system in the case of
rigid endoscopes or a bundle of fiber optics in the case of a
fiberscope.
an eyepiece. Modern instruments may be video scopes, with
no eyepiece. A camera transmits image to a screen for image
capture.
an additional channel to allow entry of medical instruments
or manipulators.
ENDOSCOPIC PROCESS

• The endoscope also has a channel through which

surgeons can manipulate tiny instruments, such as
forceps, surgical scissors, and suction devices.

• A variety of instruments can be fitted to the endoscope

for different purposes.

• A surgeon introduces the endoscope into the body

either through a body opening, such as the mouth or
the anus, or through a small incision in the skin.
CROSS SECTION VIEW
SCHEMATIC DIAGRAM
FUNCTIONS

View internal body parts using lighting system, camera/video

and use of medical instruments to remove unwanted

cancers.

Enters through opening in body

Lasts 15 to 60 minutes.
LIMITATIONS
Compared with other parts of the digestive tract, the
small intestine is difficult for doctors to access. While a
camera-tipped tube slipped down the throat can get
images of the stomach and a tube inserted at the other
end of the tract reveals the large intestine, no such
device reaches into most of the small intestine. So,
doctors rely on externally generated images
RISKS
The main risks are infection, over-sedation, perforation,
or a tear of the stomach or esophagus lining and
bleeding. Although perforation generally requires
surgery, certain cases may be treated with antibiotics
and intravenous fluids.
Occasionally, the site of the sedative injection may
become inflamed and tender for a short time. This is
usually not serious and warm compresses for a few
days are usually helpful.
MEDICAL
USES
Investigation of symptoms
-nausea, vomiting, abdominal pain, difficulty
swallowing and gastrointestinal bleeding
Conformation of diagnosis
-anemia, bleeding, inflammation and cancer of
the digestive system
Giving treatment
RECENT TRENDS
Endoscopy VR simulators
Disposable endoscopy
Capsule endoscopy
Augmented reality
 LAPAROSCOPY
Laparoscopy is also known as: -

“KEYHOLE SURGERY”

MINIMALLY INVASIVE SURGERY

MINIMAL ACCESS SURGERY

 LAPAROSCOPY
• Word origin: Greek

• Lapara - "the soft parts of the body between the rib

margins and hips

• Skopein, which means "to see or view or examine."

• Laparoscope - endoscope inserted through an

incision in the abdominal wall in order to examine the
abdominal organs or to perform minor surgery
 WHAT IS LAPAROSCOPY?
• Laparoscopic surgery (minimally invasive surgery) is the
performance of surgical procedures with the assistance of
a video camera and several thin instruments.
 HOW IT IS DONE?
• Small incisions of up to half an inch are made and
plastic tubes called ports are placed through these
incisions. A camera and instruments are put into the
ports and this allows access to the inside of a patient.
The video camera serves as the eyes of the surgeon.
 WHO & WHAT?
DIAGNOSIS SURGERY

Diverticulitis Bowel resection

Gastric Obstruction Bypass

Splenic disorders
Splenectomy

Gallstone
Cholecystectomy

Appendicitis
Appendectomy

Hernia Hernia
 BENEFITS OF LAPAROSCOPY

• Shortens hospital stay - Quick recovery times

• Less post operative discomfort - smaller incisions = less
pain.
• Smaller scars
• Less internal scarring - Less Handling of intestines
results in little or no disturbance of normal function.
• Quicker return to activities of daily living - Avoidance
of the trauma of abdominal wall injury by the incision.
 Perioperative Nursing Care
Postoperative Phase

• Maintain a patent airway

• Stabilize vital signs - Presence of artificial airway, O2

saturation, BP , pulse, temperature.

• Provide pain relief

• Recognize & manage complications

 Perioperative Nursing Care
Postoperative Phase

• Check LOC - ability to follow command, pupillary response

• Urinary output

• Skin integrity

• Condition of surgical wound

• Presence of IV lines

• Position of patient to ensure safety

Appendectomy
Cholecystectomy
Inguinal Hernia Repair
 SUMMARY
• Laparoscopy is the performance of surgical procedures using a
video camera and several thin instruments.
• To perform laparoscopy, small incisions are made and ports are
placed through these incisions through which camera and
instruments allow access to the inside of a patient.
• Laparoscopy is used for surgeries of the abdominopelvic
cavity. (appendectomy, cholecystectomy etc.)
• Laparoscopy causes less pain, less discomfort, decreases
recovery time and less scarring on the inside and out than an
open surgery.
• Perioperative nursing care for laparoscopy includes history,
assessment, relieving anxiety, preparation for surgery, pain
relief, aseptic techniques etc.
Otoscopes