RAJIV GANDHI UNIVERSITY OF HEALTH SCIENCES

BANGALORE, KARNATAKA

SYNOPSIS PROFORMA FOR THE REGISTRATION OF

SUBJECTS FOR DISSERTATION

SUBMITTED BY:

Ms. CHINDU RAJAN,

I YEAR M.Sc. NURSING [MEDICAL SURGICAL],

[2011-2013 BATCH]

VARALAKSHMI COLLEGE OF NURSING

NO: 19, KIADB ROAD, CHOKKASANDRA,

T. DASARAHALLI, BANGALORE- 57.

RAJIV GANDHI UNIVERSITY OF HEALTH SCIENCES

BANGALORE, KARNATAKA.

SYNOPSIS PROFORMA FOR REGISTRATION OF

SUBJECTS FOR DISSERTATION.

1 NAME OF THE

CANDIDATE

AND ADDRESS

Ms. CHINDU RAJAN

I ST YEAR M.Sc. NURSING,

VARALAKSHMI COLLEGE OF

NURSING,

NO:19,KIADB ROAD,

CHOKKASANDRA,

T.DASARAHALLI, BANGALORE-57

2 NAME OF THE

INSTITUTION

VARALAKSHMI COLLEGE OF

NURSING,

NO:19,KIADB ROAD,

CHOKKASANDRA,

T.DASARAHALLI, BANGALORE-57.

3 COURSE OF THE

STUDY AND

SUBJECT

M.Sc. NURSING, MEDICAL SURGICAL

NURSING

4 DATE OF

ADMISSION OF

COURSE

17/06/2011

5 TITLE OF THE

STUDY

KNOWLEDGE AND ATTITUDE REGARDING

KEYHOLE SURGERY AMONG PATIENT’S

ATTENDING SURGICAL OPD

6. BRIEF RESUME OF THE INTENDED WORK

INTRODUCTION

“Ever since surgery began, mans destiny has been to suffer, in order that he might

be cured and no one can change, that gentleman”

-JEAN SCOTT ROGERS

Keyhole surgery is also called minimally invasive surgery, band aid surgery or

laparoscopic surgery is a modern surgical technique in which operations in the

abdomen are performed through small incisions [usually 0.5-1.5cm] as compared to

the larger incision needed in the laprotomy.Keyhole surgery uses images displayed on

T.V monitors for magnification of the surgical elements1

Laparoscopic surgeries like most surgery are not without risk. Over 1 million

cholecystectomies are performed in the U.S annually, with over 96% of those being

performed laproscopically.In India hip replacement procedure has the success rate of

99% and has proved extremely beneficial for relatively young patients suffering from

secondary arthritis and also liver transplant is having the success rate more than 90%

for the patients and 100% safety record for the donors. The success rate of clearance

of stones with this procedure range of between 90 to 95%.This actually depends on

the size, number and location of the stones. In Karnataka BGS global hospital

performed first minimal invasive [keyhole] liver surgery for metastatic cancer.2

Laparoscopic surgery includes operations within the abdominal or pelvic

cavities, whereas keyhole surgery performed on the thoracic chest cavity is called the

thoracoscopic surgery.Laproscopic and thoracoscopic surgery belong to the broader

field of endoscopy. Laparoscopic was a surgical approach with very limited

application, used mainly for the purposes of diagnosis and performance of simple

procedure in gynecologic applications. In the ensuing several decades, numerous

individuals refined and popularized the approach further for laparoscopy.1

In laparoscopic surgeries there are different formats. Multiple incision are

required for technology such as “Davince system” which uses a console located away

from the patient within the surgeon controlling a camera, vaccumpump, saline

cleansing tools etc each located within its incision site, but oriented towards the

surgical objective. In contrast only requiring only a single small incision, the “Bonati

system” uses a single functional control; so that the saline solution and the vacuum

pump operate together within the laser cutter is achieved. The “Bonati system” was

designed for spinal surgery and has been promoted only for that purpose.1

Laparoscopy can be used for the diagnosis of gastrointestinal diseases. Special

fibro optic allows direct visualization of the organs and structures within the

abdomen, permitting visualization and identification of any growth anomalies and

inflammatory process. In certain advanced laparoscopic procedures where the size of

the specimen being removed would be too large to pull out through a trocar site an

incision larger than 10mm must be made. The most common procedures are removal

of all or part of the colon [colectomy] or removal of the kidney

[nephrectomy].3

6.1 NEED FOR THE STUDY

The knowledge and attitude regarding the keyhole surgery varies from one

person to another. Conceptually, the laparoscopic approach is intended to minimize

postoperative pain and speed up recovery times. In the last two decades laparoscopic

surgery has been adopted by various surgical subspecialties including gastrointestinal

surgery, gynecologic surgery and urology. Based on numerous prospective

randomized controlled trials, the approach has proven to be beneficial in reducing

post-operative morbidities such as wound infections and incision hernias[especially in

morbidly obese patients] and is now deemed safe when applied to surgery for cancers

such as cancer of colon.1

Robotic surgery has been touted as a solution to underdeveloped nations;

where as a single central hospital can operate several machines at distant locations.

The potential for robotic surgery has strong military interest as well, with the intention

of providing mobile medical care while keeping trained doctors safe from battle 1

Mr. Ralph Austin had conducted a study on surgery with removal of

gallbladder via the stomach rather than through the skin. This was a pilot study aimed

at examining the outcomes of bladder recovery through a gastronomy concentrating

on safety. The gallbladder is dissected as for a standard laparoscopic cholecystectomy

but is then recovered via a hole in the stomach created and closed endoscopically

rather than through the skin as in the standard fashion. 4

Joseph C Noggle and Daniel M Scuba was conducted a study related to

superciliary keyhole craniotomy for brain abscess debridement. These methods often

require large incisions with vast exposure and may be associated with high morbidity

rates .These patients with frontal epidural abscess underwent minimally invasive

debridement procedures. Frontal epidural abscess can adequately and safely degraded

by minimally invasive supraciliary craniotomy.5

As the technology become even more sophisticated it has been adopted as the

recognized procedure for a whole range of surgery which would have previously

required to be opened with a traditional scalpel. Some of the more commonly

operations in India today by minimal access surgery and it is estimated that an

overwhelming majority of operations being performed conventionally by long

incisions will be performed by minimal access by the next decade. Most of the studies

emphasize that the need of keyhole surgery is usually quicker and fewer side effects.6

Hence the initial researcher would like to assess the knowledge and attitude

regarding keyhole surgery among patients attending surgical OPD. To create

awareness and to provide information on keyhole surgeries by using an informational

guide sheet.

6.2 REVIEW OF LITERATURE

Review of literature is defined as broad, comprehensive in depth systematic

and critical review of scholarly publication, unpublished scholarly print materials,

audiovisual materials, and personal communications. Review of literature is a key

step in research process. Review of literature refers to an extensive, exhaustive and

systemic examination of publication relevant to research project

Review of literature comprises of following headings

A. Study related to knowledge regarding keyhole surgery

B. Study related to attitude regarding keyhole surgery

A. Study related to knowledge regarding keyhole surgery

Mohammed Al Marhoon, Joseph Kunjumathew, Hawraa Al Lawati.

conducted a study related to knowledge of keyhole surgery of the kidney at Sultan

Qaboos university hospital at Oman in March 1998.Percutaneous access surgery was

introduced at the hospital and a retrospective review of 25 patients who underwent

percutaneous nephrolithotomy for the treatment of large renal stone and 6 patients

who underwent endopyelotomy for the treatment of pelviureteric junction [PUJ]

obstruction were studied. In the PCNL group complete stone clearance was achieved

in 68% patients and the complication rate was 28%.In endopyelotomy group the

success rate of relief of obstruction of pelviureteric junction measured by renogram

and relief of symptoms. One of the limitations of the study, in addition to being

retrospectives, is the short follow up period that makes comparison to other data

difficult and the result of stone free-rate after and the improvement of PUJ obstruction

after endopyelotomy are comparable to international results.8

Vistch A,Gian carto MD,conducted a study to assess the knowledge and

association between surgical resection of intramedullary spinal cord cavernous

malformations[IMSC] and to examine the outcomes and delayed complications after

the surgical resection of the imtramedullary spinal cord cavernous malformations. The

record of 17 patients who underwent resection of their histolligically vitrified IMSC

malformations were analysed.There were 9 female and 8 male patients and presented

with radiculopathy,myelopathy and conus medullaris syndrome..Intraoperatively

16[94.1%] IMSC cavernous malformations were associated with cryptic venous

malformations. Most patients who underwent resection had improved neurologically

at long-term follow up.9

Yuan-Hatching And Shinn-Zing Lin. conducted a study related to suborbital

keyhole surgery for knowledge regarding optic nerve decompression and durameter in

July 2004.Eleven cases of basal skull fracture complicated with the either optic nerve

decompression and or CSF leakage were surgically treated .Six cases had primary

optic nerve decompression, four had CSF leakage and one case involved both

injuries.CSF leakage was successfully stopped in all cases. This approach allows the

treatment of both CSF leakage and optic nerve decompression. Result indicates that

keyhole operation is a safe and effective method for preserving and improving vision

and attenuating CSF leakage following surgery.10

Sanabria A, Villegas Mislabel on October 19, 2005. conducted a study

regarding the laparoscopic repair of perforated peptic ulcer and patients knowledge

related to the perforated peptic ulcer .Study indicates to measure the effectiveness of

knowledge related to laparoscopic surgical treatment versus open surgical treatment in

patient with diagnosis of peptic ulcer in relation to abdominal septic complications. It

included 3 randomized clinical trials of acceptable quality. The study found that there

was founds no statistical significant difference between laparoscopic and open surgery

in proportion of abdominal septic complications and pulmonary complications. This

review suggests that decrease in septic abdominal complications may exist when

laparoscopic surgery is used to correct perforated peptic ulcer.11

Jacana Park,Dong-Hunkong .conducted a study to assess the knowledge and

practices related to the superciliary keyhole surgery for unruptured posterior

communicating artery aneurysms with occulomotor nerve palsy[ONP].Thirteen

patients presenting with complete [7 patients] or incomplete[6 patients] occulomotor

nerve palsy underwent surgery through a surgical approach. In all cases, aneurysms

were successfully clipped using a 3.5cm eyebrow incision and suborbital craniotomy.

Twelve[92.3%] of the thirteen patients showed complete resolution of ONP,where as

6[85.7%] of the 7 patients with complete ONP recovered complete within 1-6 months

after surgery.Superciliary keyhole approach can be the optimal treatment modality for

unruptured posterior communicating artery including ONP because it is safe, effective

and durable.12

B. Study related to knowledge regarding keyhole surgery

Leel.Swanstom,Erick volckmann,Eric Hungness.2009 conducted a study

related to patient attitude and expectations regarding Natural Orifice Transluminal

Endoscopic Surgery[NOTES] and the patient attitude towards NOTES will influence

its adoption, this study aimed to assess the patients opinion regarding NOTES

procedure and 192 patients were surveyed .Both NOTES and laparoscopic surgery are

described together. Complication risks, recovery time and postoperative pain were

considered more important than cosmetic, length of hospitality. The patient perceives

NOTES as having less pain, risk of complications and recovery time but requiring

more surgical skill than open surgery. The majority of patients surveyed would

choose NOTES for their cholecystectomy.13

Warren Boiling on January 4, 2010.conducted a study related to minimal

assess keyhole surgery for the temporal lobe epilepsy. Keyhole surgical approach for

the treatment of medically intractable temporal lobe epilepsy is described. Patient who

had keyhole surgery is contrasted with individuals who underwent a non-keyhole

approach. Rate of seizure freedom were comparable in 11 patients with surgery and

34 individuals who had a non-keyhole approach. The restricted keyhole exposure has

not limited the ability to perform surgery for temporal lobe epilepsy with favorable

results on reducing the surgical tendency and the patient may be benefited by a

minimal assess technique with more rapid recovery with surgery.14

Nozaki L,Kubo.Y,Kurita.A,Ohta.k conducted a study related to patients

attitude and practices remain in the laparoscopic colectomy for colorectal cancer

patients with previous abdominal surgery. The aim of the study was to evaluate the

preoperative and long-term outcome of patients, and to compare them to patients

without previous surgery. Twenty one cases [17%] of laparoscopic colectomy were

performed for colorectal cancer patients with previous surgery. Although the

operation time for the previous surgery group was significant difference in the peri-

operative complications and the overall survival between the two groups. Although

the previous abdominal surgery increases the time it takes to perform the laparoscopic

colectomy, the preoperative and long-term outcomes were comparable to those from

patients without previous surgery.15

Raman Jd,Jeffey A Caddedu,Bagrodia A ,Stern Jim .conducted a study

related to assuming the attitude regarding laboratory and clinical development of

single keyhole umbilical nephrectomy.Laproscopic nephrectomy assumed a central

role in the management of benign and malignant kidney diseases. While laparoscopy

is less morbid than open surgery, it still requires a several incisions each at least

1.2cm in length. An alternative to conventional laparoscopy it has single access to

keyhole surgery which utilizes Magnetic Anchoring and Guidance System [MAGS]

technology. Laboratory and early clinical series demonstrate feasibility as well as safe

and successful completion of keyhole surgery.16

David W McFadden, Dale R Rigs, Linda Vane-Davis was conducted a

study related to Keyhole Limpet Hemocyanin[KLH],a novel immune stimulant with

promising anticancer activity in barrettes esophageal carcinoma.Barretes esophageal

adenocarcinoma cell lines were cultured using standard techniques. Cells were plated

at keyhole limpet cyanine and was added at concenterations.After 24 and 72hrs

incubation cells were assayed for viability using the MTT technique.Stastical analysis

was performed using KLH treatment significantly reduced viability in dose and time

dependent manner.KLH directly inhibits the growth of human esophageal cancer.17

STATEMENT OF THE PROBLEM

“A Study to Assess the Knowledge and Attitude regarding Keyhole Surgery

among patients attending Surgical OPD in selected Hospitals at Bangalore with a

view to develop an Informational Guide Sheet regarding Keyhole Surgery”

6.3 OBJECTIVES

1. To assess the knowledge regarding keyhole surgery.

2. To assess the attitude regarding keyhole surgery.

3. To find the correlation between knowledge and attitude regarding keyhole

surgery.

4. To associate the knowledge and attitude regarding keyhole surgery with

selected demographic variables.

5. To develop an informational guide sheet regarding keyhole surgery.

6.4 HYPOTHESIS

H1.There will be significant correlation between knowledge and attitude regarding

keyhole surgery among patients attending surgical OPD

H2.There will be significant association between knowledge and attitude regarding

keyhole surgery with their demographic variables among patients attending surgical

OPD

6.5 OPERATIONAL DEFINITIONS

1 Assess

The response of subjects regarding keyhole surgery by means of

questionnaire

2 Knowledge

The patients verbal response regarding keyhole surgery

3 Attitude

A way of thinking or feeling of patients about keyhole surgery

4 Keyhole surgeries

Keyhole surgery is a method of carrying out an operation without having to

make a large incision

5 Surgical OPD

A place where the clients consult a surgeon before any surgical procedures

6 Informational guide sheets

It refers to the concise and comprehensive information material regarding keyhole

surgery.

6.6ASSUMPTIONS

- Patients attending surgical OPD may have inadequate knowledge

regarding the keyhole surgery

- Informational guide sheet helps to improve the knowledge and attitude

regarding keyhole surgery

6.7DELIMITATIONS

- The study is limited only to the patients attending surgical OPD and who

will be available during the time of data collection.

6.8 VARIABLES

1 Dependent variables

Level of knowledge and attitude of patients undergoing keyhole surgery

2 Extraneous variables

Age of the patients, gender, religion, occupation, type of family and sources of

information

7 MATERIALS AND METHOD

7.1 SOURCES OF DATA

Data will be collected from the patients attending surgical OPD in selected

Hospitals, Bangalore

7.2 METHOD OF DATA COLLECTION

7.2.1 RESEARCH APPROACHDescriptive survey approach

7.2.2 RESEARCH DESIGN

Non-experimental design

7.2.3. SETTING OF THE STUDY

This study will be conducted in surgical OPD in selected hospitals at

Bangalore

7.2.4. POPULATION

The population of present study comprises of all patients of surgical OPD

7.2.5. SAMPLE SIZE

The sample size of study consists of 60 patients attending the surgical OPD

7.2.6. SAMPLING CRITERIA

Inclusive criteria – The study includes patients:

a. Who are willing to participate

b.Who are available at the time data collection

c. Who can speak and understand Kannada or English

Exclusive criteria –The study excludes patients:

a. Who may have surgical procedures

b. Who may have deliberate illness

7.2.7. SAMPLING TECHNIQUE

Non probability convenience sampling

7.2.8 TOOL OF DATA COLLECTION

The tool consists of the following sections

SECTION A - Selected demographic variables such as age, gender, education,

religion, income, type of family and source of information.

SECTION B – Consists of knowledge questionnaire regarding the importance of

keyhole surgery among patients attending surgical OPD

SECTION C - Consists of attitude scale regarding the importance of keyhole surgery

among patients attending surgical OPD

7.2.9 COLLECTION OF DATA

It consists of structured interview schedule

7.2.10 DATA ANALYSIS METHOD

The collected data will be analyzed by descriptive and inferential statistics

Descriptive statistics- Frequency, mean percentage and standard deviation of

described demographic variables to assess the knowledge and attitude regarding

keyhole surgery among patients attending surgical OPD.

Inferential statistics-.Karl’s Pearson’s correlation to assess the correlation between

knowledge and attitude regarding Keyhole surgery among patients attending surgical

OPD.Chi-suare test will be used to analyses the association between knowledge and

attitude regarding keyhole surgery among patients attending surgical OPD.

7.3 DOES THE STUDY REQUIRES ANY INVESTIGATIONS TO BE

CONDUCTED ON PATIENTS OR ANY OTHER HUMANS?

- NO

7.4 HAS ETHICAL CLEARANCE HAS BEEN OBTAINED FROM YOUR

INSTITUTION?

Yes, informed consent will be obtained from,

The research committee of Varalakshmi College of nursing

The authorities of the hospital.

Consent from samples.

8. LIST OF REFERENCES

1. A brief introduction to keyhole surgery from

http://www.wikipedia.org/wiki/laproscoipicsurgery

2. Incidence of keyhole surgery from

http://www.surgery.com/laproscopy/morbidity-mortality

3. Suzanne C Smeltzer, Brenda G Bare. Medical surgical Nursing. Laparoscopy.

Philadelphia: Lippincott; 9th edition.2001.page no: 959-966.

4. Safety study of gallbladder surgery from http://www.clinicaltrials.govt.com

5. Joseph c Noggle, Daniel M Scuibba.Superciliary keyhole craniotomy for brain

abscess debridement. Journal of neurosurgery. June 2009; 24(6); 11-15.

6. Rate of keyhole surgery available from http://www.doctor.ndtv.com

7. B.T Basavanthappa. Nursing Research: Review of literature. New Delhi:

Jaypee brothers; 2003; page no.48.

8. Mohammed Sal Marhoon, Joseph KunjuMathew, Hawraa AL. Lawati.

Keyhole surgery of the kidney. Oman. Sultan Qaboos University Medical

Journal; 2007 August; 7(2); 117-122.

9. Vishtesh A, Giancarlo, Suresh M.D Surgical resection of intramedullary spinal

cord cavernous malformations: delayed complications, long-term outcomes.

Journal of neurosurgery. November 1997; 41(5); 1094-1101.

10. Yun-Haochin, Shinn-Zong Lin, Yung-Hsia chang.Suborbital keyhole

approach for optic nerve decompression. Journal of Neurotrauma.July 2004;

7(7); 976-981.

11. Sanabria A, Villegas Misabel, Marales Uribe C.H.Laproscopic repair of

perforated peptic ulcer disease. The Cochrane Database of systematic reviews.

October 2004; 2(4); 55-59.

12. Jaechan Park, Dong-Hun Kong, Bo-Young Chun.Superciliary keyhole surgery

for unruptured posterior communicating artery aneurysms with oculomotor

nerve palsy. Journal of neurosurgery. October 2011; 115(4); 700-706.

13. Leel Swanstrom, Eric volckmann, Eric Hungness.Patient attitude and

expectations regarding Natural Orifice Transluminal Endoscopic Surgery.

Journal of surgical endoscopy.2009; 23(7); 1519-1529.

14. Warren Boiling. Minimal assess keyhole surgery for mesial temporal lobe

epilepsy. Journal of clinical neuroscience.Sep 2010.17(4); 1180-1184.

15. Noza ki L, Kurita A, Ohta K.Laproscopic colectomy for colorectal cancer

patients with previous abdominal surgeries. Journal of surgery.2008

May.55(84);943-6

16. Raman J.D, Jeffey A Cadeddu.Laboratory and clinical development of single

keyhole umbilical nephrectomy.Indian Journal Urology. October 2008 24(4);

457-460.

17. David w ME Fadden, Date R Riggs, Linda vona Davis. Keyhole limpet

hemacyanin, a novel immune stimulant with promising anticancer activity in

Barrett’s esophageal adenocarcinoma.The American journal of Surgery.

November 2003; 86(5); 552-555.

18. Denise F.Polit, Cheryl Tatane Beck. Nursing Research: Data analysis and

interpretation. Williams and Williams’s publications. NewDelhi.2008. page

no: 506,642.

9. SIGNATURE OF THE STUDENT :

10. REMARKS OF THE GUIDE :

11.NAME AND DESIGNATION OF

11.1.GUIDE :

11.2. SIGNATURE :

11.3.HEAD OF THE DEPARTMENT :

11.4. SIGNATURE OF HOD :

12. REMARKS OF THE PRINCIPAL :

12.1. SIGNATURE OF PRINCIPAL :

The topic is appropriate and study is

suitable and useful in field of nursing.

Mrs. Thresa. A,

Professor,

Varalakshmi College of Nursing,

No-19, KIADB road, Chokkasandra,

T.Dasarahalli,

Bangalore-560057.

Mrs. Thresa.A,

Professor,

Varalakshmi College of Nursing,

No-19, KIADB road, Chokkasandra,

T.Dasarahalli,

Bangalore-560057.

The study selected by the researcher will

improve the knowledge and attitude

about keyhole surgery among patients.