8/15/2019 Operative Laparoscopy

http://slidepdf.com/reader/full/operative-laparoscopy 1/32

OperativeLaparoscopy

8/15/2019 Operative Laparoscopy

http://slidepdf.com/reader/full/operative-laparoscopy 2/32

Defnition Suatu teknik pembedahan minimal invasive yang dapatdigunakan untuk keperluan diagnostic maupun terapeutikpada organ abdominal melalui insisi yang kecil denganbantuan pneumoperitonium

8/15/2019 Operative Laparoscopy

http://slidepdf.com/reader/full/operative-laparoscopy 3/32

8/15/2019 Operative Laparoscopy

http://slidepdf.com/reader/full/operative-laparoscopy 4/32

2. Electronic laparoflator:

◦Untuk memasukkan udara melalui Verres Needle

◦Menjaga tekanan udara intra abdomen dalam batasannormal

◦Beberapa tipe memiliki penghangat udara untukmencegah penurunan suhu tubuh pasien

8/15/2019 Operative Laparoscopy

http://slidepdf.com/reader/full/operative-laparoscopy 5/32

3. Trocars:

◦Jalur akses ke intra peritoneumyang dapat dilalui alat lainnya

◦Penggunaan trocar harus sesuaidengan ukuran alat yang akandigunakan

8/15/2019 Operative Laparoscopy

http://slidepdf.com/reader/full/operative-laparoscopy 6/32

4. Telescope:

◦Ada beberapa ukuran dengan fungsimasing masing

◦Digunakan untuk melihat ke ronggaperitonium

8/15/2019 Operative Laparoscopy

http://slidepdf.com/reader/full/operative-laparoscopy 7/32

8/15/2019 Operative Laparoscopy

http://slidepdf.com/reader/full/operative-laparoscopy 8/32

 Ada 2 tipe

! "isposable! #eusable

!he can be either atraumaticor grasping foreceps.

7. Forceps and scissors:

8/15/2019 Operative Laparoscopy

http://slidepdf.com/reader/full/operative-laparoscopy 9/32

8/15/2019 Operative Laparoscopy

http://slidepdf.com/reader/full/operative-laparoscopy 10/32

8. ipolar elecrtosurgey.

!. "nipolar electrosurgery.

#$. Laser.

##. "ltrasound system.

#%. Suction and irrigation system.

#&. Suture.

#'. Laparoscopic bag.

#(. )issue morcellator: untuk mengangkatspecimen besar seperti mioma atau keseluruhanuterus dalam beberapa potongan.

#*. "terine manipulator: "ntuk mobilisasi maupunstabilisasi uterus dan adne+a

Instrument

8/15/2019 Operative Laparoscopy

http://slidepdf.com/reader/full/operative-laparoscopy 11/32

8/15/2019 Operative Laparoscopy

http://slidepdf.com/reader/full/operative-laparoscopy 12/32

8/15/2019 Operative Laparoscopy

http://slidepdf.com/reader/full/operative-laparoscopy 13/32

a. (etelah tekanan &ntra

abdomen stabil+ masukkan

trokar 

b. Posisi trocar harusdikon%irmasi denganmemasukkan ,aparoscopedan melikat area pel'is

&. )rocar introduction

8/15/2019 Operative Laparoscopy

http://slidepdf.com/reader/full/operative-laparoscopy 14/32

 A. -mentum+ usus dan organ lainnya harus di e'aluasi terlebih dahuluuntuk mencegah trauma akibat dimasukkannya Verres needleataupun trokar 

B. empat memasukkan trocar harus dipastikan dengan menggunakan jari atau cahaya dari laparoskope

/. &denti%ikasi jika ada perdarahan

'. -ieing the peritoneal cavity:

8/15/2019 Operative Laparoscopy

http://slidepdf.com/reader/full/operative-laparoscopy 15/32

(etelah tindakan+ gas didalam ca'im abdomen

harus dikeluarkan untukmencgah nyeri postoperati'e

8/15/2019 Operative Laparoscopy

http://slidepdf.com/reader/full/operative-laparoscopy 16/32

8/15/2019 Operative Laparoscopy

http://slidepdf.com/reader/full/operative-laparoscopy 17/32

Ovarian Cyst

AdhesionsAntaraomentum dan

uterus

8/15/2019 Operative Laparoscopy

http://slidepdf.com/reader/full/operative-laparoscopy 18/32

8/15/2019 Operative Laparoscopy

http://slidepdf.com/reader/full/operative-laparoscopy 19/32

! atalaksana 0ista -'arium

! "rainage.

! -'arian cystectomy.

! atalaksana orsio -'arium

! atalaksana endometriosis

! Mengankat kista 1ndometriosis+

kauterisasi dan adheiolisis

/lat terapiutik

8/15/2019 Operative Laparoscopy

http://slidepdf.com/reader/full/operative-laparoscopy 20/32

  atalaksana in%ertility

! Adhesiolisis

! Mengatasi penyebabendometriosis+ P/-(3

  Myomectomy digunakan untuk tipe subserosal dan

intramural.

ata laksana P&" Melalui drainase abses dan adhesiolisis

/s a therapeutic tool

8/15/2019 Operative Laparoscopy

http://slidepdf.com/reader/full/operative-laparoscopy 21/32

/dhesiolysis

Myomectomy

8/15/2019 Operative Laparoscopy

http://slidepdf.com/reader/full/operative-laparoscopy 22/32

(alpingotomy

◦ Used to preser'e the tubes %or desiredreproducti'ity.

◦ "one i% the patient is hemodynamicaly stable

◦ &% si4e 5 ) cm

◦ ,ocation must be ampullary+ in%undibular oristhmic.

◦ /ontralateral tube either normal or absent.

 )atalaksana 0ehamilan 1ktopik

8/15/2019 Operative Laparoscopy

http://slidepdf.com/reader/full/operative-laparoscopy 23/32

Salpingotom

8/15/2019 Operative Laparoscopy

http://slidepdf.com/reader/full/operative-laparoscopy 24/32

! (alpingectomy

! #uptur uba

! 01 Berulang! Ukuran 6 ) cm

Indications

8/15/2019 Operative Laparoscopy

http://slidepdf.com/reader/full/operative-laparoscopy 25/32

8/15/2019 Operative Laparoscopy

http://slidepdf.com/reader/full/operative-laparoscopy 26/32

! (terilisasi

! Bipolar coagulation.

! /lips %ilshie clips3 and rings

 ! ,aparoscopic hysterectomy.

Indikasi

8/15/2019 Operative Laparoscopy

http://slidepdf.com/reader/full/operative-laparoscopy 27/32

8/15/2019 Operative Laparoscopy

http://slidepdf.com/reader/full/operative-laparoscopy 28/32

"ing sterili#ation

8/15/2019 Operative Laparoscopy

http://slidepdf.com/reader/full/operative-laparoscopy 29/32

8/15/2019 Operative Laparoscopy

http://slidepdf.com/reader/full/operative-laparoscopy 30/32

2ontraindications

$. Peritonitis

2. *ypo'olemic shock

7. 0elainan Jantung

8. *emoglobin less than 9 g:d,

). Ukuran uterus6 $2 ;ks.

<. Multiple pre'ious abdominal procedures9. -besitas

8/15/2019 Operative Laparoscopy

http://slidepdf.com/reader/full/operative-laparoscopy 31/32

! Pneumoperitoneum

! &njury to abdominal organs3 =astointestinal

3 raktus urinarius. 

2omplications

8/15/2019 Operative Laparoscopy

http://slidepdf.com/reader/full/operative-laparoscopy 32/32

Pembuluh darah

3 Pel'ic+ omental and mesentric3 "apat dicegah dengan memasukkan Vessel

Needle dengan posisi miring

2omplications