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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...

History of minimal access surgery The first experimental laparoscopic procedure was performed by Kelling in 1901. Jacobaeus performed the first thoracoscopy in 1910, again using a cystoscope; however, it took another 70 years before Steptoe in the UK developed l...

History of robotic surgery The first documented clinical robotic procedure was a computed tomography (CT)-guided brain biopsy performed in 1985 utilising the PUMA (Programmable Universal Machine for Assembly) 560 system. This was followed by the ROBODOC, a pre-...

Hybrid minimal access surgery Hybrid surgery may utilise a combination of flexible and straight stick endoscopic approaches or a combination of open and endoscopic surgery . Totally endoscopic hybrid approach The diseased organ is visualised and treated by an...

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LIMITATIONS OF MINIMAL ACCESS SURGERY Minimal access surgery has limitations. A number of these have been addressed with advances in instrumentation and endoscopic systems; however, the basic principles remain. Surgical robots further address a number of the...

Learning objectives To understand: The principles of minimal access surgery • The advantages and disadvantages of minimal access • approaches The safety issues and indications for minimal access • surgery Learning objectives To understand: The principles of mi...

MINIMAL ACCESS APPROACHES Laparoscopy A rigid endoscope is introduced through a port into the perito neal cavity . Full details of laparoscopy including the principles of pneumoperitoneum can be found in Chapter 7 . Georg Kelling , 1866–1945, surgeon, Dresde...

Mobility and convalescence Patients can get out of bed to go to the toilet as soon as they have recovered from the anaesthetic and they should be encouraged to do so. Such movements are remarkably pain free when compared with the mobility achieved after an op...

Operative problems Intraoperative perforation of a viscus or vascular injury Perforation of any viscus, such as bowel, is a potential hazard that may occur inadvertently and go unrecognised or be of a severity that may require emergency conversion. The added...

Oral feeding Provided that the patient has an appetite, a light meal can be taken 4–6 hours after the operation. Some patients remain slightly nauseated at this stage, but almost all eat a normal breakfast on the morning after surgery . Subsequently a balanced...