Prevention

Minimally invasive surgical approaches have reduced risks of POI for many operations. The enhanced recovery programme (see Chapter 74 ) seeks to further reduce risk of POI by avoidance of opioid-containing drugs and suppression of the inﬂammatory response.

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AVO I DA B L E FAC TO R S T H AT COMPOUND THE RESP

AVO I DA B L E FAC TO R S T H AT COMPOUND THE RESPONSE TO

Agonists and antagonists an uncertain balance

Alterations in hepatic protein metabolism the acu

Alterations in hepatic protein metabolism the acute-phase protein response

Alterations in skeletal muscle protein metabolism

C A a n

CHANGES IN BODY COMPOSITION FOLLOWING INJURY

ENHANCED RECOVERY AFTER SURGERY

FURTHER READING

Homeostasis

Hypothermia

INJURY

Immobilisation

Immobility

Introduction

Learning objectives

MANAGING THE CATABOLIC STRESS RESPONSE

MEDIATORS OF THE METABOLIC RESPONSE TO INJURY Tiss

MEDIATORS OF THE METABOLIC RESPONSE TO INJURY Tissue damage and inﬂammation

METABOLIC CHANGES AFTER SURGERY AND TRAUMA

Modern surgical care

Neuroendocrine response to injury

RESPONSE

Starvation

Systemic inﬂammation and tissue

Tissue oedema

Volume loss

b b o

l i i

s s m m

t a a

underperfusion

Analgesia

DEFINITION

DISCHARGE FROM HOSPITAL

Direct robotic systems and hybrid robotic surgery

Disadvantages of robotic surgery

Drains

Endoluminal endoscopy and natural oriﬁce surgery

Endoscopic surgery

FURTHER DEVELOPMENTS Augmented reality and minimal access surgical adjuncts

FURTHER DEVELOPMENTS Augmented reality and minimal

GENERAL INTRAOPERATIVE PRINCIPLES

History of minimal access surgery

History of robotic surgery

Hybrid minimal access surgery

Introduction

LIMITATIONS OF MINIMAL ACCESS SURGERY

Learning objectives

MINIMAL ACCESS APPROACHES Laparoscopy

Mobility and convalescence

Operative problems

Oral feeding

Oral ﬂuids

Orogastric or nasogastric tube

PERIOPERATIVE PLANNING FOR MINIMAL ACCESS SURGERY

POSTOPERATIVE CARE

Perivisceral endoscopy

Port site pain and numbness

Preparation of the patient

Principles of electrosurgery during laparoscopic s

Principles of electrosurgery during laparoscopic surgery

ROBOTIC SURGERY

SURGICAL TRAUMA IN OPEN, MINIMALL Y INVASIVE AND R

SURGICAL TRAUMA IN OPEN, MINIMALL Y INVASIVE AND ROBOTIC SURGERY

Shoulder tip pain

Single-incision minimal access surgery

Skin sutures

THE FUTURE

THEATRE SET-UP AND TOOLS

Thoracoscopy

Uptake of robotic surgery

Urinary catheter

surgery

ACKNOWLEDGEMENTS

ASSESSMENT Light microscopy

AUTOPSY

BRAF V600E mutation

Basic methods in diagnostic molecular pathology