Minimal Access and Breast Surgery




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Chapter 8 : Minimal Access and Breast Surgery



Minimal Access Surgery: Laparoscopy arrow_upward


  • Minimal Access Surgery is the method by which surgery is done with the help of a small endoscopic camera and some thin, rigid instruments that are passed into the body through natural openings or small artificial incisions.
  • Minimal access surgery is completed with one or more small incisions instead of a large incision.
  • Laparoscopy is a form of minimally invasive surgery.

  • Laparoscopy arrow_upward


  • Laparoscopic surgery is a new surgical specialty which involves operating through small incisions.
  • During the surgical procedure, small incisions of up to half an inch are made and plastic tubes (called ports) are placed through these incisions.
    • The camera and the instruments are then introduced through the port which allows an access to the inside of the patient.
  • The camera transmits an image of the organs inside the abdomen onto a television monitor. The surgeon is not able to see directly into the patient without the traditional large incision.
  • The video camera becomes a surgeon’s eyes in laparoscopy surgery, since the surgeon uses the image from the video camera positioned inside the patient’s body to perform the procedure.
  • Laparoscopy can be done for the following:
    • Abdomen
    • Urinary System
    • Pelvis
    • Bone and Joints
    • Arthroscopy
    • Thoracoscopy

    How is Laparoscopy Performed? arrow_upward


  • The laparoscope is a sterile surgical instrument that has special optics which allows a small amount of light to be transmitted effectively.
  • Carbon dioxide gas is pumped through a channel in the laparoscope into the abdomen.
    • The gas allows the pelvic organs to be seen more clearly.
  • A laparoscopy is performed under a general anesthesia.
    • A small cut measuring 1 to 2cm is made in or just below the belly-button.
    • Through this cut, the laparoscope is gently introduced into the abdomen.
  • Additional incisions are made just at the pubic hairline and in the left and right lower abdomen.
  • Using special surgical instruments the procedure is completed through these small incisions.

  • Advantages of Laparoscopy arrow_upward


  • Advantages of Laparoscopy are:
    • Minor traumas which stand for the abatement of postsurgical pains, a quick (1-2 days) recovery of physiological functions, decrease in the risk of generating postsurgical spikes.
    • Short hospital period: The postoperative period is often confined in staying in the hospital during the daytime.
    • Reduction of the period of disablement from 2 till 5 times
    • Cosmetic effect: The traces of 5-10mm pinholes are incomparable with the scars left after the traditional “open” operations, which is especially important in the cosmetic sense.
    • The risk of postoperative hernia developing is reduced at the expense of the absence of big incisions.
    • Economic effectiveness: Although the price for an endoscopic operation is high, treatment comes to be more payable at the expense of the medicament economy of confinement of the hospital period duration and the time of a patient’s rehabilitation.

    Complications of Laparoscopy arrow_upward


  • A complication is an unforeseen problem that occurs during or after surgery.
  • Possible Complications of Laparoscopy includes:
    • Risks for any type of surgery may be greater for people who are obese, smoke cigarettes, or have additional health problems.
  • Laparoscopy usually requires general anesthesia, which carries certain risks.
  • Injury to blood vessels or organs, which causes bleeding.
  • The risks of laparoscopy include accidental damage to the bowel or blood vessels within the abdomen or pelvis.

  • Preparing for a Laparoscopy arrow_upward


  • The patient should be prepared by the doctor for the procedure both psychologically and physically.
  • It is very important that the patient receive realistic counseling before the surgery and prior to giving informed consent.
  • Tests may be ordered which include blood and urine tests, an electrocardiogram, and possibly an ultrasound scan or x-ray.
  • On the day of the operation patient must not eat or drink for at least 6 hours before the operation/admission.
  • An anesthesiologist or nurse anesthetist may ask questions about the patient's health.
  • Before the surgery, an intravenous line which consists of a small flexible plastic tube inserted into a vein in the patient's arm or hand.
    • It is used to give medications and fluids during the operation.

    Breast Surgery arrow_upward


  • Breast surgery is a form of surgery performed on the breast.
  • Various surgeries are performed which includes:
    • Breast Biopsy.
    • Removal of breast (Mastectomy).
    • Breast lump removal (Lumpectomy).

    Breast Biopsy arrow_upward


  • A breast biopsy is a procedure in which part or all of a suspicious breast growth is removed and examined, usually in the presence of cancer.
  • A breast biopsy is usually done to check a lump found during a breast examination.
  • There are several ways to do a breast biopsy:
    • Fine Needle Aspiration Biopsy.
    • Core Needle Biopsy.
    • Open Biopsy.

    Fine Needle Aspiration Biopsy arrow_upward


  • Fine Needle Aspiration is a diagnostic procedure used to investigate superficial lumps or masses.
  • Fine Needle Aspiration (FNA) is a percutaneous procedure that uses a fine gauge needle and a syringe to sample fluid from a breast cyst or remove clusters of cells from a solid mass.

  • Core Needle Biopsy arrow_upward


  • A core needle biopsy is a percutaneous procedure that involves removing small samples of breast tissue using a hollow "core" needle.
  • The needle goes through the skin to the lump or area to take out a sample of tissue about the size of a pencil lead.
  • The needle used during core needle biopsy is larger than the needle used with FNA.

  • Open Biopsy arrow_upward


  • Open surgical biopsy means that a large mass or lump is removed during a surgical procedure.
  • Surgical biopsy requires an approximately 3 to 5 centimeters incision and is normally performed in an operating room in sterile conditions.

  • Removal of Breast (Mastectomy) arrow_upward


  • Mastectomy is an operation in which the entire breast, usually including the nipple and the areola, is removed.
    • Total Mastectomy.
    • Modified Radical Mastectomy.

    Total Mastectomy

  • Simple or Total Mastectomy concentrates on the breast tissue itself:
    • The surgeon removes the entire breast.
    • Axillary lymph nodes are occasionally removed because they happen to be located within the breast tissue taken during surgery.


    Modified Radical Mastectomy

  • Modified radical mastectomy involves the removal of both breast tissue and lymph nodes:
    • The surgeon removes the entire breast.
    • Axillary lymph nodes are removed, but the chest-wall muscles are left intact.

    Surgery

  • The technique used will depend on the type of mastectomy.
  • Mastectomy is done under general anesthesia.
  • A diagonal or horizontal cut is made across the breast, and the breast tissue is removed.
  • When the operation is complete, the cuts are closed with stitches.

  • Side-Effects

  • Side-effects of a Mastectomy include:
    • Soreness, swelling, bruising and tightness.
    • Scarring.
    • Numbness and tingling.

    Breast Lump Removal (Lumpectomy) arrow_upward


  • Breast lumps are very common and most are benign and not cancerous.
  • Lumpectomy is the removal of the breast tumor (the "lump") and some of the normal tissue that surrounds it.
  • Lumpectomy is a form of “breast-conserving” or "breast preservation" surgery.
  • Lumpectomy is also referred as “Partial Mastectomy” because part of the breast tissue is removed.

  • Surgery

  • Surgeon makes a small cut in your skin over or near the lump.
  • Cut the lump away along with a section of healthy tissue around it.
  • Close the cut with the fine stitches.

  • Side-Effects

  • Side-effects of breast lump removal include:
    • Bruising and some swelling.
    • Numbness or pins and needles.
    • Scarring.


    Thank You from Kimavi arrow_upward


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