Minimally invasive surgery 微创外科,郑民华 上海交通大学医学院附属瑞金医院外科 上海市微创外科临床医学中心,21世纪外科发展方向,移植外科 微创外科 修复外科 肿瘤的分子生物学治疗,J. PERISSAT,Operating room 1896,Professor Terrier Paris,1901s Keilling,腹腔镜外科新进展,1910 Jacobeus used Nitze endoscope for diagnostic laparoscopy,腹腔镜外科新进展,1930 Kalk dual puncture liver biopsy,腹腔镜外科新进展,J. PERISSAT,Professorof Gynaecology Kiehl,Pr. Kurt Semm,Laparoscopic cholecystectomy,Emblematic operation First landmarks of the laparoscopic revolutionPrecursor : E Mhe 1985Pioneers : Ph. Mouret 1987F. Dubois - J. Perissat 1988B. Mc Herman 1988E.J. Reddick 1988,腹腔镜外科新进展,1987 Mouret 世界首例腹腔镜胆囊切除术,J. PERISSAT,J. PERISSAT,已经成为金标准的腹腔镜手术,腹腔镜外科新进展,胆囊切除术 脾切除术 疝修补术 抗食管反流手术 肾上腺切除术,Laparoscopic cholecystectomy Laparoscopic splenectomy Laparoscopic hernia repaire Laparoscopic fundoplication Laparoscopic adrenectomy,疝修补Hernia repair,腹腔镜NISSEN手术,腹腔镜NISSEN手术,目前已经渐趋成熟 即将成为金标准手术,腹腔镜外科新进展,结直肠切除术 甲状腺切除术 胰尾部切除术,直肠前切除术左半结肠切除术 右半结肠切除术横结肠切除术 全结肠切除术 乙结肠切除术 miles术 结肠固定术,腹腔镜结直肠手术,腹壁切口开腹,腹壁切口腹腔镜,腹腔镜结直肠手术,右半结肠切除术,右半结肠切除术,直肠切除范围,标本的取出与切除,腹部切口,腹壁切口,腔镜甲状腺切除术,腹腔镜外科新进展,腔镜甲状腺切除术,正在探索的手术,腹腔镜外科新进展,胃癌根治术 胰十二指肠头部切除术 血管外科手术,胃切除术,腹腔镜胰十二指肠切除术,Global perspective of future development in Endolaparoscopic Surgery Surgery in its historical perspective,Open Surgery : A long lasting journey: from 400 to 1990 The Odyssey of the Surgeons hands Inside human body Homeric poem,20th Century Two World Wars,Birth and improvement of Vascular surgery Thoracic surgery Neurosurgery Plastic surgery Resuscitation (Intensive care units),Global perspective of future development in Endolaparoscopic Surgery Surgery in its historical perspective,The Dilemma :How to make harmless the access of the surgeons hands inside the patients body,Global perspective of future development in Endolaparoscopic Surgery Surgery in its historical perspective,The spectacular Achievement : From 1950 to nowadays End of the Dilemma : Harmless access of the surgeons hands inside every corners of the patients bodyThe price to pay the drawbacks of large openings,Global perspective of future development in Endolaparoscopic Surgery Surgery in its historical perspective,20th Century 1990 The Turning Point Unnecessary presence of Surgeons hands inside Human Body,J. PERISSAT,Laparoscopic Surgery the turning point in the History of Surgery,Endoscopy in its historical perspective:Endoscopy ( to look inside ancient Greek) From antiquity to 1900 endoluminal exploration Since 1901 Laparoscopy (exploration) Interventional Endolaparoscopy Since 1970,J. PERISSAT,Global perspective of future development in Endolaparoscopic Surgery,Laparoscopic sugery15 years laterLessons learned,Laparoscopic Surgery the turning point in the History of Surgery,LAPAROSCOPIC SURGERY For DIGESTIVE DISEASES Logical learning progression,STEP 1 : - Exploratory laparoscopy + biopsies - Appendectomy; peritonitis- (gynaecologic emergencies)- Cholecystectomy + IOCComplete mastery of Suturing- knottingSTEP 2 : - Gastroesophageal reflux- Inguinal Hernia repair- Laparoscopic approach of the CBD- Splenectomy; (Adrenalectomy)Most advanced proceduresSTEP 3 : - Colorectal surgery- Oesophagus & Stomach surgery- Major Pancreatic resections- Major hepatic resections,Laparoscopic Surgery New Spaces,Pleural cavityThoracic SurgeryRetroperitoneal SpacesOrthopaedic SurgeryUrologyEndocrine SurgeryVascular SurgeryInterfascias SpacesHead and Neck SurgeryPlastic Surgery,Laparoscopic Surgery New Techniques-New Instruments,Two Main TrendsHuman craftsmanship High technologies Adaptation from - Computers Open procedures to - Imaging Laparoscopic ones - Teleteaching - Robots,未来 ？,J. PERISSAT,Opration Lindbergh September 9th 2001,Jacques Marescaux,Laparoscopic Surgery the turning point in the History of Surgery Surgery in its historical perspective,The credible FutureIntracorporeal navigatorsPercutaneous approachLaparoscopic surgeonsInterventional radiologistsIntraluminal approachInterventional flexible endoscopists,Laparoscopic Surgery the turning point in the History of Surgery Surgery in its historical perspective,The credible Future How to deal with ? :Changing our minds, educational programs:Changing our health institutions:Institutes of High Technology for MISUpdating our hospital organisation,Future of surgery,Open surgery M.I.S.Institutes of High Technologies Oncology Transplantation Trauma All surgical units Daily practice,PermanentEducation,Benign disorders,Future Organisation,Endo Unit,M.I.T. Centre,Int. Radiology,Lap. Surg.,X. Ray. Dept.,Gastroenterological department,Surgical Dept.,Up-dated Evolution,M.I.T. Centre for Digestive diseases,