Recent Advances in Surgery

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Recent Advances in Surgery

• Dr. Divakar Shenoy
• Professor and HOD
• Dept of Surgery

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• Surgery has undergone a sea of change in recent
  times.
• Advances have resulted from simple, painstaking
  clinical observations on one hand and highly
  sophisticated scientific methods on the other.
• These advances have changed the way surgeries are
  done, and are shaping the future of Surgery

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The Harmonic scalpel

• The Harmonic Scalpel is an ultrasonic cutting and
  coagulation surgical device
• it uses ultrasonic energy to vibrate its blade at
  55,000 cycles per second.
• Invisible to the naked eye, the vibration
  transfers energy to the tissue, providing
  simultaneous cutting and coagulation.
• It thus cuts and coagulates by using lower
  temperatures than those used by electro surgery
  or lasers.

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• The Harmonic scalpel

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• Harmonic scalpel adapted for endoscopic
  procedures

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• It is used for surgical procedures in which
  soft-tissue incisions will be made and in which
  bleeding control and minimal lateral thermal
  damage to tissue are desired.
• When compared with electro surgery, - fewer
  instrument exchanges
• less tissue charring and dessication
• - visibility in the surgical field is improved.

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The Margin-probe

• This is an intraoperative probe used in breast
  lumpectomy procedures to aid in intraoperative
  margin assessment.
• The instrument has two components a disposable
  probe unit and an external console unit.

The probe unit
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• The measured site is a 7mm wide by 1mm deep,
  coin-shaped slice of tissue against which the
  sensor, at the tip of the probe, is pressed.
• It provides surgeons with a simple, real-time,
  audible and visual indication of the tissue's
  malignancy status, that is, cancerous vs. normal.

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• The Margin Probe

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Robotics

• Robotics is rapidly developing in surgery
• The machine acts as a remote extension of the
  surgeon as a master-slave manipulator
• The goal is to restore the tactile cues and
  intuitive dexterity of the surgeon, with a force
  feedback(haptic) system, which replaces the
  tactile sensibilities and restores dexterity

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• Effector arms of da Vinci surgical
  system. The attached instruments are controlled
  by the surgeon, who sits at an adjacent console.

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• Effector tips of the da Vinci
  surgical system incorporate miniature wrists
  that allow them to mimic any movement made by the
  surgeon at the control console

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• Motion scaling software is used to translate
  large natural movements to extremely precise
  micro movements.
• Surgeons can immediately observe the instruments
  in the patient's body respond to the movements of
  their hands on the handles

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The surgeon
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The Surgery
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• This technology is also being used in open
  procedures that require extreme precision, for
  example, microvascular anastomosis and nerve
  repair.
• In such settings, the robot can enhance the
  surgeons skills by eliminating physiological
  tremors.

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Stereotaxy

• Stereotactic surgery or
• stereotaxy is a minimally-
• invasive form of surgical intervention which
  makes use of a three-dimensional coordinates
  system to locate small targets inside the body
  and to perform some action on them (Biopsy,etc).
• "Stereotactic" in Greek means movement in space.

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• Its applications have been used mainly in brain
  surgery though any organ system inside the body
  can be subjected to stereotactic surgery.

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Stereotactic brain biopsy being taken. Probe can
be visualised.(arrows)
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• Brain lesion biopsy being taken with
  stereotactic frame in-situ

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Keratinocyte Culture

• In extensive burns, there is a dire need for
  normal healthy skin for transplantation onto the
  damaged areas.
• This need was being met by harvesting healthy
  skin from undamaged areas of the body.
• In extensive burns, the area that has escaped
  damage is little and is not sufficient.

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• This need is being met by culturing
  keratinocytes( cells present in normal skin) and
  transplanting them onto the damaged areas.
• The keratinocytes are first transferred onto
  suitable media where they proliferate

Keratinocyte culture with a magnified view of
proliferating keratinocytes
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• The keratinocyte rich matrics are then
  transplanted onto the wounds where they are
  incorporated into the healing process

A magnified view of cultured keratinocytes
proliferating across the culture matrix
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• A Sheet of cultured keratinocytes ready for
  transfer and clinical use

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Cardio-pulmonary bypass

• Cardiopulmonary bypass (CPB) is a technique that
  temporarily takes over the function of the heart
  and lungs during surgery, maintaining the
  circulation of blood and the oxygen content of
  the body.
• The development of the cardiopulmonary bypass
  machine has revolutionized cardiothoracic surgery
  and open heart surgery

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• The Heart- Lung Machine

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• The Heart-Lung machine in use during heart
  surgery

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The Ventricular Assist Device

• A Ventricular assist device, or VAD, is a
  mechanical device that is used to partially or
  completely replace the function of a failing
  heart.
• Blood from the ventricle passes through a pump
  and thence through a
• tube to the aorta.

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• Using these Ventricle Assist Devices, the amount
  of blood pumped out by the heart is increased and
  the work load on an already failing heart is
  decreased.

A VAD and its position in the heart
illustrated
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A VAD in-situ.
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Thank You