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ADVANCES IN SURGERY

ADVANCES IN SURGERY. Samuel Vincent G. Yrastorza, MD, FPUA. Has grown leaps and bounds for the past years. DIAGNOSTICS. Symptomatic disease - history and PE still accounts for 80-90% in clinching the diagnosis. Asymptomatic diseases - screening procedures detect early diseases

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ADVANCES IN SURGERY

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  1. ADVANCES IN SURGERY Samuel Vincent G. Yrastorza, MD, FPUA

  2. Has grown leaps and bounds for the past years DIAGNOSTICS Symptomatic disease - history and PE still accounts for 80-90% in clinching the diagnosis Asymptomatic diseases - screening procedures detect early diseases - e.g. colonoscopy for colon cancer

  3. Before • Signs and Symptoms + PE • Abdominal pain, Diarrhea • PE = abdominal mass DIAGNOSTIC ADVANCES • Diagnostic Exam/Imaging • Stool exam • Colonoscopy, Abdominal CT scan • Diagnosis • Colonic Cancer

  4. Presently • Reaching 40 y/o DIAGNOSTIC ADVANCES • Without any signs or symptoms of disease • Screening Colonoscopy • Small colonic mass noted and biopsy done • Colonic Cancer

  5. CT Scan • - Has become more sensitive and specific • Diagnostic modality of choice for a majority of surgical cases with the advent of • 3D reconstruction • CT angiography DIAGNOSTIC ADVANCES

  6. CT Scan DIAGNOSTIC ADVANCES • prototype • EMI CT scan • 256 slice CT scan

  7. CT before • 256 slice with 3D reconstruction IMAGING • COLON

  8. Colonoscopy • 256 slice with 3D reconstruction IMAGING

  9. CT before • 128 slice with 3D reconstruction IMAGING • KIDNEYS

  10. Conventional angiogram • CT angiogram IMAGING

  11. Brachytherapy - Greek brachy meaning “short” - radioactive source placed inside or next to the area of treatment - not just for adjunctive therapy or pallation - as first line treatment for various forms of cancer - commonly used for prostate cancer, cervical cancer , head and neck cancer - radioactive sources - strontium plaque - iridium wires - iodine 125 seeds Radiotherapy

  12. PROSTATE BRACHYTHERAPY

  13. PROSTATE BRACHYTHERAPY

  14. - for early and localized cancer - not for locally advanced or metastatic prostate cancer - comparable result to radical prostatectomy - out patient procedure - lesser complications than radical prostatectomy - uses iodine 125 seeds PROSTATE BRACHYTHERAPY

  15. LOCALIZED PROSTATE CA TREATMENT brachytherapy Radical prostatectomy

  16. Probes/needles directed at organ or tissue CRYOTHERAPY Freezing ---- thawing---- freezing cellular disruption cell death

  17. Used for - benign and malignant skin conditions - early and localized cancers - liver - prostate - hemorrhoids CRYOTHERAPY

  18. Used for - benign and malignant skin conditions - early and localized cancers - liver - prostate (widespread use) - hemorrhoids CRYOTHERAPY

  19. CRYOTHERAPY ice balls

  20. RFA probe (needle) placed inside the tumor (guided by CT scan or ultrasound or through open procedures) RADIOFREQUENCY ABLATION Radiofrequency waves passed through probe into tumor increased in temperature within tumor tumor necrosis

  21. Indications - tumors of the lung, liver, bone - used for primary and metastatic tumors - recurrent atrial fibrillation and supraventricular tachycardia - varicose veins RADIOFREQUENCY ABLATION

  22. RADIOFREQUENCY ABLATION RFA probe (needle) RFA generator

  23. RADIOFREQUENCY ABLATION

  24. Percutaneous approach RADIOFREQUENCY ABLATION Laparoscopic approach Open approach

  25. HIGH INTENSITY FOCUS ULTRASOUND (HIFU) HIFU directed at tissue/tumor (by ultrasound or MRI) increase temperature at target tissue/tumor tissue/tumor destruction

  26. HIGH INTENSITY FOCUS ULTRASOUND (HIFU) used for: - uterine fibroids - solid tumor of the brain, bone, breast, liver, pancreas, rectum, kidney, testes, prostate - earliest and widest use = for prostate cancer - atrial fibrillation, arrhythmia

  27. HIGH INTENSITY FOCUS ULTRASOUND (HIFU)

  28. - Trend toward less invasive procedures SURGICAL PROCEDURES • The “old way” • NOW

  29. Minimally invasive surgery • Minimal access surgery • Key hole surgery • Pinhole surgery • Band-aid surgery • *** part of a broader field of ENDOSCOPY LAPAROSCOPIC SURGERY

  30. LAPAROSCOPIC SURGERY • Access

  31. Used for: • - diagnostic • - cancer surgery • - donor organ harvest ( donor nephrectomy) • - vascular surgeries • - practically any abdominal surgery LAPAROSCOPIC SURGERY

  32. Advantages • - smaller incisions (smaller scars) • - fast recovery (short hospital stay) • - better visualization of abdminal structures LAPAROSCOPIC SURGERY

  33. Disadvantages • - more expensive • - requires expertise • - steep learning curve • - longer operating time (gap is slowly closing with that of open surgery) LAPAROSCOPIC SURGERY

  34. Cystoscopic surgery of the joints • Similar advantages and disadvantages as laparoscopy ARTHROSCOPIC SURGERY • arthroscopic • Open Knee • surgery

  35. Cystoscopic surgery of the THORAX • Similar advantages and disadvantages as laparoscopy • Instruments basically the same THORACOSCOPIC SURGERY • Open thoracic surgery • thoracoscopic

  36. Cranioscopy??? • Not enough space Others

  37. 3mm port instead of the usual 5 and 10 mm ports • Smaller instruments • Lesser pain and scar Microlaparoscopy

  38. ROBOTIC SURGERY

  39. ROBOTIC SURGERY

  40. ROBOTIC SURGERY

  41. ROBOTIC SURGERY

  42. ROBOTIC SURGERY

  43. Teaching/mentoring through the internet • “out of school students” • Open universities Telementoring

  44. Telementoring

  45. Surgical training though internet or other forms of telecommunications Telementoring

  46. Telesurgery

  47. Use of stem cells to treat certain diseases • To create new tissues/organs to replace/augment the existing ones Stem Cell Therapy

  48. Use of stem cells to treat certain diseases • To create new tissues/organs to replace/augment the existing ones Stem Cell Therapy • New pancreatic cells transplanted into patient • DM type 1

  49. Stem cells • - unspecialized cells capable of renewing themselves through cell division • - can be induced to become tissue or organ specific cells • - in gut and bone marrow • = stem cells regularly divide to repair and replace worn out or damages tissues • - pancreas and heart • = stem cells divide only under special • conditions Stem Cell Therapy

  50. Categories • 1) Non embryonic • - somatic or adult stem cell • 2) Embryonic • - use of human embryo Stem Cell Therapy

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