Practical Endoscopy: Tips by Experts Sunita R Tandulwadkar, Nirzari Mangeshikar
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1PRACTICAL ENDOSCOPY: Tips by Experts2
3PRACTICAL ENDOSCOPY: Tips by Experts
Second Edition
Editor Sunita R Tandulwadkar MD FICS Dip Endo (USA and Germany) Head of Department of Obstetrics and Gynecology, Ruby Hall Clinic Chief, Ruby Hall IVF and Endoscopy Center Pune, Maharashtra, India Co-editor Nirzari Mangeshikar MBBS DNB (OBGY) III-year PG Student, Ruby Hall Clinic Pune, Maharashtra, India Forewords Togas Tulandi Bomi Bhote
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Practical Endoscopy: Tips by Experts
First Edition: 2008
Second Edition: 2015
9789351525875
Printed at
5Dedicated to
My Guru Param Pujya Swami Shree Gagangiri Maharaj
Guru Brahma Guru Vishnu Guru Devo Maheshwaraha |
Guru Saakshat Para Brahma Tasmai Sree Gurave Namaha ||
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7Contributors 9Foreword
“There is a single light of science, and to brighten it anywhere is to brighten it everywhere.”
–Isaac Asimov (1920–1992)
Many operations that previously required a laparotomy can now be performed with minimally invasive technique. This progress has been adopted everywhere in the world. The clear advantages of laparoscopy and hysteroscopy have achieved a prominent position in the field of gynecology.
The second edition of this book encompasses a variety of minimally invasive gynecology techniques ranging from vaginal surgery, laparoscopy and hysteroscopy. It starts with basic principles of endoscopic surgery, instrumentations and set-up. Among the relatively new developments are the use of laparoscopy with robotic assistance, single incision laparoscopy and transvaginal sling procedures for stress incontinence.
Dr Sunita R Tandulwadkar has dedicated her time and effort to assemble and edit the book. It has beautiful surgical photographs that facilitates understanding of the surgical technique. This edition is a good addition to the medical literature that will be useful for both the trainees and the practicing gynecologists.
Togas Tulandi md mhcm frcsc facog
Professor and Academic Vice Chairman of Obstetrics and Gynecology
Milton Leong Chair in Reproductive Medicine
McGill University, Canada
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11Foreword
Endoscopic surgery has changed the face of medical surgeries particularly in the spectrum of gynecology. By means of this technology, surgeons are now able to perform the most complex procedures with minimal invasion. With immense pride, I write the foreword of the book Practical Endoscopy: Tips by Experts penned by a true master in the realm of gynecological endoscopy. Each chapter describes in-depth the preoperative preparation, steps of surgery, tips and tricks by surgeons along with images of the surgeries.
With each chapter in this book, I am struck by the complexity of work that Dr Sunita R Tandulwadkar has amassed in the last few years since such endoscopic procedures have gained popularity. While I have witnessed Dr Tandulwadkar's natural gift as a gynecologist par excellence, I admire her knowledge and endeavor to pen down her insightful first-hand experiences in the intricate field of endoscopy with which she treats her patients. The well-iterated descriptions and step-by-step pictorial references make this book an interesting read. It has been a pleasure to be associated with such an expert in her field, and I am confident that this book will become an important reference tool guiding surgeons not only now, but also in the times to come.
Bomi Bhote
Chief Executive Officer
Ruby Hall Clinic, Pune
Maharashtra, India
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13Preface
In this ‘Information Age’, an interested reader can easily locate information on everything from movies to medical care with the click of a finger. When it comes to health and disease, the quality of information is vital.
Many standard books have been published on endoscopy during the last two to three decades to meet the needs of beginners in the field of endoscopy. Endoscopy Simplified—Practical Tips by Experts was brought out in 2008, and covered important surgeries related to laparoscopy and hysteroscopy in gynecology. All the practical tips to enhance the surgical performance have been given in an absolutely simplified way, and the book is of great help to beginners as well as practicing endoscopists.
I am extremely pleased and gratified to present the second edition of this book, which I presume will be read by tens of thousands of medical students and medical practitioners. One likes to think that the clinical practice of these practitioners will be influenced by the book and that patient care will be a little more humane, a little more gentle and perhaps a little more effective because some of the practical tips in the book will take root.
In this second edition, we have not only added a few chapters from our side, but we have nearly 12 internationally renowned endoscopy faculty, who have happily contributed. We have tried to cover all aspects of the field, from setting up an endoscopy to guiding regarding energy sources and suturing techniques, and the latest advances like robotic surgery.
A thorough reader of this book will have very little trouble in starting an endoscopy set-up with least complication rates. In order to make the book as useful as possible, other than the practical tips and footnotes at the end of the chapters, the salient feature of the book remains its self-explanatory colorful illustrations.
Although this book will be useful for the medical students as well as the practicing endoscopists, professors in training programs will also find its content germane to their students. We have worked hard to make this book clinically relevant and almost all the chapters include the application of the principles being discussed. Every case draws on the clinical experience and expertise of the authors and illustrates how the principles of the book can be applied in a clinical setting. I am sure you will get an experience as if you are performing surgery while going through the steps of the surgery and the color figures. Also, apart from the practical tips that have been given, each endoscopist can individualize the steps of surgery to enhance the performance.
I wish to thank my colleagues and students in the Department of IVF and Endoscopy, Ruby Hall Clinic, Pune, India, for providing valuable suggestions, which have been indispensible to the accomplishment of my task.
I wish to thank Dr Nirzari Mangeshikar, my third year postgraduate student in OBGY, who has shown tremendous interest in helping me out with each and every section, while compiling this second edition.
Most of all, thanks go to my family, my husband, Dr Rajesh Tandulwadkar, Surgeon Gastroenterologist and GI Endoscopist and my son, Rishi, all took notes for me that found their way into the pages of my book. And, as for my earlier writings, my husband continues to be my first reader and key critic, apart from my great assistance in difficult situations.
Sunita R Tandulwadkar
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23General Guidelines for Beginners 24DO'S AND DON'TS
DO's
Surgeon
“I think It's OK” - Syndrome
Be aware of the words “I think it's OK”.
The surgeon must determine whether the organ in question is or is not injured. If the conclusion is that it is injured, proper steps are taken to deal with it. The matter should not be put aside for period of observation.
  1. Personnel.
  2. Equipment not working.
  3. Running out of critical supplies.
  4. In fact, just about any thing that can have an effect on operating surgeon or his/her performance.
Assistant
Assisting is a very special part of any operative procedures.
The purpose of the assistance is not only to assist, but to enhance the performance of operating surgeon.
A good assistant can make a good case even better
A bad assistant can turn a good case into a disaster
Make suggestions that might help the procedure.
The surgeon and assistant should wok as a team, and each team member has his/her task to do.
DONT'S
Assistant
Do not try to do the procedure.
In operative laparoscopy, two surgeons can make great team if they work together. Remember the more you work together, the more you will actually.
“WORK TOGETHER”
A good operative laparoscopy is a four-handed procedure.
Do not let your mind wonder back to Mayo's stand or back table. If you are trying to assist someone and you let your attention drawn away from that person, you break line of communication.
“Freeze, don't move !”
During the actual procedure your best move as an assistant is sometimes.
“No move at all !”
“The flexible surgeon is familiar with all available techniques so that the best approach is selected for the individual patient”