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Tissue oedema During systemic inflammation, fluid, plasma proteins, leukocytes, macrophages and electrolytes leave the vascular space and accumulate in the tissues as oedema. The oedema - can diminish the alveolar di ff usion of oxygen and may also impair renal ...

Volume loss During simple haemorrhage, baroreceptors in the carotid artery and aortic arch and volume receptors in the wall of the left atrium initiate a ff erent nerve input to the central nervous system, resulting in the release of both aldosterone and anti...

b b o o l Insulin resistance Futile substrate cycling b b o o l Insulin resistance Futile substrate cycling b b o o l Insulin resistance Futile substrate cycling

l i i Muscle protein degradation l i i Muscle protein degradation l i i Muscle protein degradation

s s m m /H11001 /H11002 s s m m /H11001 /H11002 s s m m /H11001 /H11002

t a a Acute phase response t a a Acute phase response t a a Acute phase response

underperfusion xac - The vascular endothelium controls vasomotor tone and ter microvascular flow and regulates tra ffi cking of nutrients and biologically active molecules. When endothelial activation is excessive, compromised microcirculation and subsequent cel...

Analgesia The type and extent of analgesic requirement will depend on both the patient and procedural factors. Prior experience of opiate analgesia may increase patient tolerance to similar agents, necessitating larger doses. There is also evidence to sugges...

DEFINITION Minimal access surgery is a product of modern technology and surgical innovation that aims to accomplish surgical ther apeutic goals with minimal somatic and psychological trauma. This type of surgery has reduced wound access trauma and is less di...

DISCHARGE FROM HOSPITAL The discharge of patients is based on clinical indicators and the patient’s fitness for recuperating in a non-hospital environ - ment. One of the core drivers for the application of minimally invasive surgery is an earlier recovery and...

Direct robotic systems and hybrid robotic surgery In addition to the remote master–slave platform design, direct robot systems also exist. Each of these systems o ff ers di ff erent advantages to the operating surgeon, ranging from reducing the need for assistan...

Disadvantages of robotic surgery Cost Robotic surgery remains more costly than minimally invasive alternatives. Through upscaling of use between surgical specialties, the direct costs of purchasing a novel robotic system can be partially o ff set; however, co...

Drains The use of postoperative drains depends on the operation performed. Drain output should initially be documented at least hourly or more regularly in the event of concern regard - ing high drain output. Given the heterogeneity of drainage - systems avai...

Endoluminal endoscopy and natural orifice surgery Flexible or rigid endoscopes are introduced into hollow organs or systems, such as the urinary tract, upper or lower gastrointestinal tract and the respiratory and vascular systems. Advances in endoluminal techn...

Endoscopic surgery Lack of three-dimensional vision To perform minimal access surgery with safety , the surgeon must operate using an imaging system that provides a two-dimensional (2D) representation of the operative site. The endoscope o ff ers a whole new a...

FURTHER DEVELOPMENTS Augmented reality and minimal access surgical adjuncts The future of minimal access surgery will almost certainly feature more advanced applications of adjuncts to facilitate anatomical recognition and the localisation of pathology . Th...

FURTHER DEVELOPMENTS Augmented reality and minimal access surgical adjuncts The future of minimal access surgery will almost certainly feature more advanced applications of adjuncts to facilitate anatomical recognition and the localisation of pathology . Th...

GENERAL INTRAOPERATIVE PRINCIPLES Many minimal access procedures have a unique set of proce - dural steps that may often be in a distinctly di ff erent sequence from those of the open alternative. Methods for creating a pneumoperitoneum are described in Chapt...