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1、Unit7ModernSurgeryWordFormationlapar/o(abdomen)e.g.laparoscopelaparoscopylaparoscopiccholecyst/o(gallbladder)-ectomy(excision/removal)e.g.cholecystectomygynec/o(female)-ology(study)e.g.gynecologyesophag/o(esophagus)e.g.gastro-esophagealsplen/o(spleen)e.g.spelectomyadren/o(adrenalglands)-one.g.proton
2、chylomicronthorac/o(thorax)e.g.thoracoscopicmy/o(muscle)e.g.myotomycol/o(colon)e.g.colectomynephr/o(kidney)e.g.nephrectomygastr/o(stomach)e.g.gastrectomyperitone/o(peritoneum)e.g.intraperitonealcorpus-(body)e.g.extracorporeal-oma(tumor)cyt/o(cell)e.g.phaeochromocytomacontra-(against)e.g.contraindica
3、tionlymph/o(lymph)-pathy(disease)e.g.lymphadenopathyaxilla-(armpit)e.g.axillarymelan/o(black)e.g.melanomasympath/o(sympathetic)rect/o(rectus)-pexy(tofix)固定固定,固定术固定术e.g.rectopexymetastasis/metastases/metastatic/metastasizeQuestionstoconsider:1.Whatisminimalaccesssurgery?2.Whatisminimalinvasiveprocedu
4、re?3.Areyoufamiliarwithlaparoscope/endoscope?l lWhatisMinimalAccessSurgery?WhatisMinimalAccessSurgery?MinimalaccesssurgeryiscompletedwithoneormoreMinimalaccesssurgeryiscompletedwithoneormoresmallincisionsinsteadofalargeincision.Thesurgeonsmallincisionsinsteadofalargeincision.Thesurgeonpassesatelesco
5、pewithvideocamerathroughasmallpassesatelescopewithvideocamerathroughasmallincision(usuallyonly1/4long)intoabodycavity.Theincision(usuallyonly1/4long)intoabodycavity.ThesurgeonthenviewsthesurgeryonaTVmonitor.surgeonthenviewsthesurgeryonaTVmonitor.SurgicalinstrumentsarethenpassedthroughotherSurgicalin
6、strumentsarethenpassedthroughothersimilarlittleincisions.similarlittleincisions.AnoverviewThesurgeonexaminesandoperatesontheareainThesurgeonexaminesandoperatesontheareainquestionbyviewingmagnifiedimagesonatelevision.questionbyviewingmagnifiedimagesonatelevision.Whenthetelescopeisusedtooperateontheab
7、domen,Whenthetelescopeisusedtooperateontheabdomen,theprocedureiscalledtheprocedureiscalledlaparoscopylaparoscopy.Whenusedinthe.Whenusedinthechest,theprocedureiscalledchest,theprocedureiscalledthoracoscopythoracoscopy,andwhen,andwhenusedinajoint,itiscalledusedinajoint,itiscalledarthroscopyarthroscopy
8、.l lBackgroundBackgroundTheintroductionofminimalaccesssurgery(MAS)intoTheintroductionofminimalaccesssurgery(MAS)intocommonpracticebeganin1985,whenlaparoscopiccommonpracticebeganin1985,whenlaparoscopiccholecystectomywasfirstperformedtoremoveacholecystectomywasfirstperformedtoremoveadiseasedgallbladde
9、r.Intheimmediateyearsthereafter,diseasedgallbladder.Intheimmediateyearsthereafter,asmallnumberofsurgeonsintheU.S.pioneeredtheasmallnumberofsurgeonsintheU.S.pioneeredthedevelopmentoflaparoscopictechniquesforthisanddevelopmentoflaparoscopictechniquesforthisandothersurgicalapplications.Recognizingtheot
10、hersurgicalapplications.Recognizingtheimportanceoftheirpotentialtoimprovepatientcare,importanceoftheirpotentialtoimprovepatientcare,ColumbiaUniversitywasoneoftheveryfirstU.S.ColumbiaUniversitywasoneoftheveryfirstU.S.academicinstitutionstosupportthedevelopmentofacademicinstitutionstosupportthedevelop
11、mentofminimalaccesstechnologiesandtechniques.minimalaccesstechnologiesandtechniques.l lMAS(ie,laparoscopy)hasbeenusedbygynecologistsMAS(ie,laparoscopy)hasbeenusedbygynecologistsformorethan5decades.Itsapplicationtogeneralformorethan5decades.Itsapplicationtogeneralsurgerybeganwhenthefirstlaparoscopics
12、urgerybeganwhenthefirstlaparoscopiccholecystectomywasperformedin1985.In1987,cholecystectomywasperformedin1985.In1987,thelaparoscopiccholecystectomywaspopularized,andthelaparoscopiccholecystectomywaspopularized,andlaparoscopiccholecystectomysoonbecamethestandardlaparoscopiccholecystectomysoonbecameth
13、estandardofcare.Sincethattime,MAShasbeenappliedtoofcare.Sincethattime,MAShasbeenappliedtonumerousotherprocedureswithgoodresults.numerousotherprocedureswithgoodresults.IdealminimalaccesssurgeryhasIdealminimalaccesssurgeryhas:ReducedtraumaassociatedwithaccessReducedtraumaassociatedwithaccessNocompromi
14、seofexposureofoperativefieldNocompromiseofexposureofoperativefieldSurgerycanbeperformedusingthefollowingapproachesSurgerycanbeperformedusingthefollowingapproaches:LaparoscopicLaparoscopicThoracoscopicThoracoscopicEndoluminalEndoluminalIntra-articularjointsurgeryIntra-articularjointsurgeryCombinedapp
15、roachesCombinedapproachesAdvantageofminimalaccesssurgeryAdvantageofminimalaccesssurgeryLesstissuetraumaLesstissuetraumaLesspostoperativepainLesspostoperativepainFasterrecoveryFasterrecoveryFewerpostoperativecomplicationsFewerpostoperativecomplicationsBettercosmesisBettercosmesisDisadvantagesofminima
16、laccesssurgeryDisadvantagesofminimalaccesssurgeryLackoftactilefeedbackLackoftactilefeedbackIncreasedtechnicalexpertiserequiredIncreasedtechnicalexpertiserequiredPossiblelongerdurationofsurgeryPossiblelongerdurationofsurgeryIncreasedriskofiatrogenicinjuriesIncreasedriskofiatrogenicinjuriesDifficultre
17、movalofbulkyorgansDifficultremovalofbulkyorgansMoreexpensiveMoreexpensiveEstablishedminimalaccessproceduresEstablishedminimalaccessproceduresLaparoscopiccholecystectomyLaparoscopiccholecystectomyDiagnosticlaparoscopyDiagnosticlaparoscopyLaparoscopicappendicectomyLaparoscopicappendicectomyLaparoscopi
18、cfundoplicationLaparoscopicfundoplicationLaparoscopic(orthoracoscopic)HellersmyotomyLaparoscopic(orthoracoscopic)HellersmyotomyLaparoscopicadrenalectomyLaparoscopicadrenalectomyLaparoscopicsplenectomyLaparoscopicsplenectomyLaparoscopicrectopexyLaparoscopicrectopexyl lEquipmentEquipmentSpecialmedical
19、equipmentmaybeused,suchasfiberSpecialmedicalequipmentmaybeused,suchasfiberopticcables,miniaturevideocamerasandspecialsurgicalopticcables,miniaturevideocamerasandspecialsurgicalinstrumentshandledviatubesinsertedintothebodyinstrumentshandledviatubesinsertedintothebodythroughsmallopeningsinitssurface.T
20、heimagesofthethroughsmallopeningsinitssurface.Theimagesoftheinteriorofthebodyaretransmittedtoanexternalvideointeriorofthebodyaretransmittedtoanexternalvideomonitorandthesurgeonhasthepossibilityofmakingamonitorandthesurgeonhasthepossibilityofmakingadiagnosis,visuallyidentifyinginternalfeaturesandacti
21、ngdiagnosis,visuallyidentifyinginternalfeaturesandactingsurgicallyonthem.surgicallyonthem.l lInstrumentInstrumentRefinementinfibreoptictechnologyandengineeringRefinementinfibreoptictechnologyandengineeringhaveproducedinstrumentswhichareusedforso-haveproducedinstrumentswhichareusedforso-calledkeyhole
22、surgery.calledkeyholesurgery.FineFinetoolscanbepassedintotoolscanbepassedintotheabdominalandchestcavitiessothatmanytheabdominalandchestcavitiessothatmanyoperationswhichpreviouslyrequiredmajorincisionsoperationswhichpreviouslyrequiredmajorincisionscannowbeperformedthroughquitesmallpuncturecannowbeper
23、formedthroughquitesmallpuncturewounds.Thisisparticularlywellestablishedinwounds.Thisisparticularlywellestablishedingynaecologicalsurgeryandinoperationsuponthegallgynaecologicalsurgeryandinoperationsuponthegallbladder,andtechniquesarebeingdevisedforsimilarbladder,andtechniquesarebeingdevisedforsimila
24、roperationsonotherorgans.operationsonotherorgans.ThistechnologyalsoinvolvesthedevelopmentofThistechnologyalsoinvolvesthedevelopmentofinstrumentstopassalongeverytubeinthebody,forinstrumentstopassalongeverytubeinthebody,forexampletoremoveobstructionsintheoesophagus,bileexampletoremoveobstructionsinthe
25、oesophagus,bileducts,bowel,prostate,andmajorbloodvessels.Manyducts,bowel,prostate,andmajorbloodvessels.Manyproceduresonjointsforexample,removalofatornproceduresonjointsforexample,removalofatorncartilagefromthekneecannowbeperformedsafely,cartilagefromthekneecannowbeperformedsafely,usingtheseminimalac
26、cesstechniques.usingtheseminimalaccesstechniques.l lTheThelaparoscopelaparoscope,afiber-optictelescope,isinserted,afiber-optictelescope,isinsertedthroughoneport(throughoneport(口口口口,孔孔孔孔)andattachedtoacamera.It)andattachedtoacamera.Itsendsimagesfromtheabdominalcavitytotelevisionsendsimagesfromtheabdo
27、minalcavitytotelevisionmonitorsplacedforeasyviewingbyalltheoperatingmonitorsplacedforeasyviewingbyalltheoperatingroompersonnel.Thus,thesurgeonandhisorherroompersonnel.Thus,thesurgeonandhisorherassistantscanviewtheabdominalcavityanditsassistantscanviewtheabdominalcavityanditscontents.Throughtheremain
28、ingports,long-handledcontents.Throughtheremainingports,long-handledinstrumentsareusedtoperformvariousprocedures.instrumentsareusedtoperformvariousprocedures.l lEndoscopyEndoscopyisaminimallyinvasivediagnostictool,isaminimallyinvasivediagnostictool,usedtoviewtheinsideoforgans,inspectforusedtoviewthei
29、nsideoforgans,inspectforabnormalitiesandtakeabnormalitiesandtakebiopsiesbiopsies.Asmallcameraand.Asmallcameraandlightsourcearemounted(fixed)ontoaflexibletubelightsourcearemounted(fixed)ontoaflexibletubewhichcanbeinsertedintothemouth(toinspectthewhichcanbeinsertedintothemouth(toinspecttheesophagus,st
30、omachandduodenum)ortheanus(toesophagus,stomachandduodenum)ortheanus(toinspectthelargebowel).inspectthelargebowel).l lWhatisaminimallyinvasiveprocedure?Whatisaminimallyinvasiveprocedure?AminimallyinvasiveprocedureisanyprocedureAminimallyinvasiveprocedureisanyprocedure(surgicalorotherwise)thatislessin
31、vasivethanopen(surgicalorotherwise)thatislessinvasivethanopensurgeryusedforthesamepurpose.Aminimallysurgeryusedforthesamepurpose.Aminimallyinvasiveproceduretypicallyinvolvesuseofinvasiveproceduretypicallyinvolvesuseoflaparoscopicdevicesandremote-controlmanipulationlaparoscopicdevicesandremote-contro
32、lmanipulationofinstrumentswithindirectobservationofthesurgicalofinstrumentswithindirectobservationofthesurgicalfieldthroughanendoscopeorsimilardevice,andarefieldthroughanendoscopeorsimilardevice,andarecarriedoutthroughtheskinorthroughabodycavitycarriedoutthroughtheskinorthroughabodycavityoranatomica
33、lopening.oranatomicalopening.Thismayresultinshorterhospitalstays,orallowThismayresultinshorterhospitalstays,orallowoutpatienttreatment.However,thesafetyandoutpatienttreatment.However,thesafetyandeffectivenessofeachproceduremustbedemonstratedeffectivenessofeachproceduremustbedemonstratedwithrandomize
34、dcontrolledtrials.Thetermwascoinedwithrandomizedcontrolledtrials.ThetermwascoinedbybyJohnEAWickhamJohnEAWickhamin1984,whowroteofitinin1984,whowroteofitinBritish Medical JournalBritish Medical Journalin1987.in1987.l lBenefitsBenefitsMinimallyinvasiveMinimallyinvasive surgeryshouldhavelessoperativesur
35、geryshouldhavelessoperativetraumaforthepatientthananequivalentinvasivetraumaforthepatientthananequivalentinvasiveprocedure.Itmaybemoreorlessexpensive.Operativeprocedure.Itmaybemoreorlessexpensive.Operativetimeislonger,buthospitalizationtimeisshorter.Itcausestimeislonger,buthospitalizationtimeisshort
36、er.Itcauseslesspainandscarring(lesspainandscarring(疤痕形成疤痕形成疤痕形成疤痕形成),speedsrecovery,and),speedsrecovery,andreducestheincidenceofpost-surgicalcomplications,suchreducestheincidenceofpost-surgicalcomplications,suchasadhesions(asadhesions(粘连粘连粘连粘连).However,minimallyinvasivesurgery).However,minimallyinva
37、sivesurgeryisnotnecessarilyminorsurgerythatonlyregionalisnotnecessarilyminorsurgerythatonlyregionalanesthesiaisrequired.Infact,mostoftheseproceduresanesthesiaisrequired.Infact,mostoftheseproceduresstillrequiresstillrequiresgeneralanesthesiageneralanesthesia(全麻全麻全麻全麻)tobeadministered)tobeadministered
38、 beforehand.beforehand.l lRisksRisksMinimallyinvasiveproceduresarenotcompletelysafe,Minimallyinvasiveproceduresarenotcompletelysafe,andsomehavecomplicationsrangingfrominfectiontoandsomehavecomplicationsrangingfrominfectiontodeath.Risksandcomplicationsincludethefollowing:death.Risksandcomplicationsin
39、cludethefollowing:AnesthesiaormedicationreactionsAnesthesiaormedicationreactionsBleedingBleedingInfectionInfectionInternalorganinjuryInternalorganinjuryBloodvesselinjuryBloodvesselinjuryVeinorlungbloodclottingVeinorlungbloodclottingBreathingproblemsBreathingproblemsDeath(rare)Death(rare)Understandin
40、gtheTextPara.11.facilitate-v.tomakesth.possibleoreasier;toimprove促进促进,促使促使 2.miniaturizedvideocameras-微型摄像机微型摄像机 3.imagereproduction-影像重现影像重现 4.procedure5.established-recognized被确认被确认 6.validate-vt.testify验证验证 7.enablingtechnologies7.enablingtechnologies-使能技术使能技术使能技术使能技术/支撑技术支撑技术支撑技术支撑技术/促成科技促成科技促成科
41、技促成科技 enabling-a.enabling-a.授权的授权的授权的授权的,使成为可能的使成为可能的使成为可能的使成为可能的“使能技术使能技术使能技术使能技术”：使其它工艺能够运行的技术：使其它工艺能够运行的技术：使其它工艺能够运行的技术：使其它工艺能够运行的技术基本上用于：基本上用于：基本上用于：基本上用于：1-1-实现某种功能的技术。例：电子管、晶体管、集成实现某种功能的技术。例：电子管、晶体管、集成实现某种功能的技术。例：电子管、晶体管、集成实现某种功能的技术。例：电子管、晶体管、集成 电路之于电子计算机。电子计算机之于自动限制。电路之于电子计算机。电子计算机之于自动限制。电路之于
42、电子计算机。电子计算机之于自动限制。电路之于电子计算机。电子计算机之于自动限制。软件之于硬件。软件之于硬件。软件之于硬件。软件之于硬件。2-2-使人具备某种本事、赐予人某种便利的技术。例：使人具备某种本事、赐予人某种便利的技术。例：使人具备某种本事、赐予人某种便利的技术。例：使人具备某种本事、赐予人某种便利的技术。例：互联网之于电子商务。数字技术之于电影绝技。互联网之于电子商务。数字技术之于电影绝技。互联网之于电子商务。数字技术之于电影绝技。互联网之于电子商务。数字技术之于电影绝技。基因技术之于生物开发。基因技术之于生物开发。基因技术之于生物开发。基因技术之于生物开发。l lVirtualRe
43、alityVirtualReality简介简介简介简介l l 虚拟现实，或虚拟实境虚拟现实，或虚拟实境虚拟现实，或虚拟实境虚拟现实，或虚拟实境(VirtualReality)(VirtualReality)，简称，简称，简称，简称VRVRl l 技术，也称灵境技术或人工环境，是利用电脑模拟产技术，也称灵境技术或人工环境，是利用电脑模拟产技术，也称灵境技术或人工环境，是利用电脑模拟产技术，也称灵境技术或人工环境，是利用电脑模拟产l l 生一个三度空间的虚拟世界，供应运用者关于视觉、生一个三度空间的虚拟世界，供应运用者关于视觉、生一个三度空间的虚拟世界，供应运用者关于视觉、生一个三度空间的虚拟世界
44、，供应运用者关于视觉、l l 听觉、触觉等感官的模拟，让运用者犹如身历其境一听觉、触觉等感官的模拟，让运用者犹如身历其境一听觉、触觉等感官的模拟，让运用者犹如身历其境一听觉、触觉等感官的模拟，让运用者犹如身历其境一l l 般，可以刚好、没有限制地视察三度空间内的事物。般，可以刚好、没有限制地视察三度空间内的事物。般，可以刚好、没有限制地视察三度空间内的事物。般，可以刚好、没有限制地视察三度空间内的事物。l l 运用者进行位置移动时，电脑可以立刻进行困难的运运用者进行位置移动时，电脑可以立刻进行困难的运运用者进行位置移动时，电脑可以立刻进行困难的运运用者进行位置移动时，电脑可以立刻进行困难的运l
45、 l 算，将精确的算，将精确的算，将精确的算，将精确的3D3D世界影像传回产生临场感。该技术世界影像传回产生临场感。该技术世界影像传回产生临场感。该技术世界影像传回产生临场感。该技术集集集集l l 成了计算机图形成了计算机图形成了计算机图形成了计算机图形(CG)(CG)技术、计算机仿真技术、人工智技术、计算机仿真技术、人工智技术、计算机仿真技术、人工智技术、计算机仿真技术、人工智l l 能、传感技术、显示技术、网络并行处理等技术的最能、传感技术、显示技术、网络并行处理等技术的最能、传感技术、显示技术、网络并行处理等技术的最能、传感技术、显示技术、网络并行处理等技术的最l l 新发展成果，是一种
46、由计算机技术帮助生成的高技术新发展成果，是一种由计算机技术帮助生成的高技术新发展成果，是一种由计算机技术帮助生成的高技术新发展成果，是一种由计算机技术帮助生成的高技术l l 模拟系统。模拟系统。模拟系统。模拟系统。8.virtualrealitylaparoscopicsimulator-8.virtualrealitylaparoscopicsimulator-虚拟的腹腔镜模拟装置虚拟的腹腔镜模拟装置虚拟的腹腔镜模拟装置虚拟的腹腔镜模拟装置 Para.2Para.21.seachange-1.seachange-巨变巨变巨变巨变 2.opticaltelescope-2.opticaltel
47、escope-光学望远镜光学望远镜光学望远镜光学望远镜 3.unassisted-3.unassisted-unaidedunaided没有助手没有助手没有助手没有助手 4.technicalrepertoire-4.technicalrepertoire-整个技术整个技术整个技术整个技术 l lseachange-aprofoundtransformationseachange-aprofoundtransformation巨变，突变，突发性彻底转变巨变，突变，突发性彻底转变巨变，突变，突发性彻底转变巨变，突变，突发性彻底转变l l 和其很多精彩的英语词汇一样，和其很多精彩的英语词汇一样，和
48、其很多精彩的英语词汇一样，和其很多精彩的英语词汇一样，seachangeseachange的灵的灵的灵的灵l l 感同样出自莎士比亚大师之手。莎翁的最终一部感同样出自莎士比亚大师之手。莎翁的最终一部感同样出自莎士比亚大师之手。莎翁的最终一部感同样出自莎士比亚大师之手。莎翁的最终一部l l 传奇剧作暴风雨（传奇剧作暴风雨（传奇剧作暴风雨（传奇剧作暴风雨（TheTempestTheTempest）中，莎翁用）中，莎翁用）中，莎翁用）中，莎翁用 l lseachangeseachange来表示一种根本的、彻底的变更，就来表示一种根本的、彻底的变更，就来表示一种根本的、彻底的变更，就来表示一种根本的、
49、彻底的变更，就l l 像某物长期沉没在水中所发生的变更一样。其实，像某物长期沉没在水中所发生的变更一样。其实，像某物长期沉没在水中所发生的变更一样。其实，像某物长期沉没在水中所发生的变更一样。其实，l l 从莎翁的年头到今日，英语本身也阅历了从莎翁的年头到今日，英语本身也阅历了从莎翁的年头到今日，英语本身也阅历了从莎翁的年头到今日，英语本身也阅历了seachangeseachange。Para.3Para.31.ofchoice-1.ofchoice-首选的首选的首选的首选的,精选的精选的精选的精选的2.retract-2.retract-vt vt.1)1)缩回缩回缩回缩回,缩近缩近缩近缩近
50、(pullback,drawback)(pullback,drawback)2)2)撑开撑开撑开撑开,拉开拉开拉开拉开,牵开牵开牵开牵开(useasurgicalinstrumenttohold(useasurgicalinstrumenttoholdopen(theedgesofawoundoranorgan)open(theedgesofawoundoranorgan)e.g.Fortheuncircumcisedboy,e.g.Fortheuncircumcisedboy,retractretracttheforeskinoftheforeskinofthepenisandcleanse