Fetal laparoscopy and thoracoscopy is evolving. Here baby’s malformed abdominal or thoracic organs are managed by a scope inserted through the mothers belly, uterine wall and then in side the baby’s abdominal cavity or thoracic cavity. This can tackle most of the life threatening conditions of the fetus. This method needs precession and accuracy. Modern technique like robotics can eliminate human errors and tremors. It has a plus point over the open fetal surgery that it can reduce the incidence of abortion after the procedure.
Open fetal surgery is very fascinating. But only few cases have advantage over the operation done after the birth. It is very costly and hence all over the world only about eight centers perform this type of operations. In this procedure fetus does not need separate anesthesia. Only mother is anaesthetized. Various electronic gadgets are connected to mother to record various parameters. Mother’s abdomen is opened as done in caesarian section. According to the disease the part of the fetus is brought out and operated upon. After completing the operation, baby is returned to the original place and all the wounds are sutured. Often a cordless device is placed in side baby’s body to monitor the vital parameters of the fetus after operation. One interesting advantage of fetal surgery is this if the operation is performed around six months of pregnancy; no scar is left in the baby. Hence it has a good prospect in the treatment of cleft lip babies.
Fetal surgery is a science which is still evolving. Stem cell transplant bears a bright future. Probably after few years a major portion of the congenital surgical diseases will be amenable before delivery and all the families will be presented with a healthy baby at birth.
Endoscopy – The Technique of Looking Inside A Man
Dr Jayanta Kr Goswami
External appearance of a man not only fascinates artist and sculptors, but also fellow human being from the days of Adam and Eve.
The view of interior of a human through natural openings or in side a hollow body cavity through an artificial opening is helping the physicians a lot to diagnose and treat many diseases and has given rise to a separate branch of medical science known as Endoscopy.
Examination of mouth and throat is probably the ancient one, as it does not require any aid. Famous Greek physician Hippocrates (460-375 BC) used a special instrument to see the rectum and female genital tract. Various persons to facilitate the view of interior of a man used various innovative techniques. Use of reflecting mirrors by Arabians around 1000AD, light from a lantern through a tube in 1806 by Bozzini and electric light discovered by Edison in 1879 are some of these examples. Various rigid tubes were used to various parts of the body. Some of these are still used by doctors. Initially these tubes had device to send light to inside from exterior, but later on distal illumination device, where a small bulb fixed at the tip of the instrument had come. Telescopes made of many lenses were used to magnify and to see the objects nearer. In 1960 Hopkins of UK discovered a telescope known as rod lens system where in contrast to other telescope air is used as lens in the glass column. It has increased the field and clarity of images.
Japanese physician used fiber optic cables in1963 and had revolutionized the endoscopic procedures. It is based on the principle of total internal reflection. Individual glass fiber carries light from one end to other even if it is bent. Similarly thousands of such fibers form a bundle. In an endoscope two bundles are arranged in such a manner that one transmits light from outside to interior and other to carry picture from in side to outside. The bundle that carries light can be arranged in haphazard manner, called incoherent. But the bundle which carries images should be coherent, that is arrangement of the fibers should be such that at both the ends the fibers should be arranged identically so that same picture is generated by the light from the tip to the observing end.
Introduction of cold light, where light from a halogen or xenon bulb is transmitted through a fiber optic cable, is another development in endoscopy.
Electrocautery is a machine where electric current is used to cut tissues and to burn the bleeding points has been used widely in endoscopic treatment. Some other machines like Harmonic scalpel, CUSA knife, Water jet dissectors are also used in endoscopic treatment, specially in laparoscopy.
Small cameras are often used in the stumps in cricket games. Similar cameras with silicon chip technology are used to project the picture of interior on a monitor screen. These cameras are very light and give good quality of pictures with magnification. New high-resolution monitor gives good quality of pictures. Various recent instruments like stapler, band, laser are effectively used through endoscopes. Now a days by endosuturing technique one can stitch tissues as we stitch cloth.
Three dimensional picture, endoscopic ultrasound scan, small camera fixed at the tip of the instruments, telephotography, where a small camera is swallowed and cordless camera gives picture are the new developments.
Various endoscopic procedures, which are commonly performed, are as follows-
Nasopharyngoscopy: Here interior of nose and pharynx can be examined and some operations like control of bleeding, removal of foreign body and polyp, drainage of pus from sinuses in sinusitis etc can be done.
Oesophagoscopy: In this procedure the food pipe is examined and treated for narrowing, ulceration, bleeding and for impacting foreign bodies. Here both rigid and flexible instruments are used.
Laryngoscopy: To diagnose and treat various diseases of larynx or voice box this procedure is done. This may be rigid or flexible. Rigid variety is often used by anaesthetist to secure the air way during operation of any part of the body.
Bronchoscopy: This procedure is to see the windpipe and its branches. Several life saving procedures and other procedures are possible through it. These are removal of peanut or other foreign body, control of bleeding, removal of thick sputum, biopsy from growth etc. Both rigid instrument with fiber optic light and flexible instruments are used.
Upper Gastro-Intestinal endoscopy: This is to see the stomach and areas beyond it. Diagnoses of various diseases like ulcer, polyp, foreign body, tumour and treatment of conditions like control of bleeding, removal of foreign body, biopsy of tumour etc. can be made in this procedure.
ERCP is a procedure where bile duct and pancreatic duct can be accessed through the endoscopes. Diagnosis and treatment of bile duct stone, some pancreatic diseases etc. can be made by this method.
Lower Gastro-Intestinal endoscopy: Here flexible endoscope is inserted through the anus and various diseases like bleeding, foreign body, tuberculosis, cancer, inflammation of rectum and adjoining areas can be diagnosed and treated.
Cystoscopy: Here inside the urinary bladder, its inlet and outlets are seen. Various operations for prevention of back flow of urine, obstruction in outflow as in enlarged prostate, crushing of bladder stone has been done widely with cystoscopes.
Laparoscopy: It is a new and widely expanded field. Here punctures are made in the abdomen and various operations are possible. Now a days many operations have been done through laparoscope. Gall bladder removal is the operation done commonly. In some cases like blunt abdominal injury, difficult sex determination, infertility, sterilization its value is undebatable. With the time smaller and smaller instruments are coming up and hence the size of the opening is also gradually decreasing. Needloscopy is the term used for such procedures where the instruments can be introduced through a needle puncture and operations are done through it.
Other endoscopic procedures are nephroscopy for the kidneys, thoracoscopy for structures of the chest cavity, neuroendoscopy for brain and spinal cord, arthroscopy for joints, hysteroscopy for inside of the uterus, retroperitoneoscopy for the organs of the abdomen that is attached to the wall but remains out side the cavity.
There are lots of advantages of endoscopes. When it is used through a natural passage no anaesthesia is required. Endoscopies can often be used for those areas where access by open operation is difficult due to vital structures around or due to curved path and needs cutting of wide areas of normal tissues. As there is minimal injury to the muscle, ligament, skin etc, hospital stay and cost is also reduced. So return to work especially by athletes becomes earlier.
Endoscopy requires costly machines and doctors need orientation in two-dimensional view.
Endoscopy is a good example of utilization of science for betterment of mankind. Development of three-dimensional viewing, tele-surgery, where surgeon of a distant place will operate through internet, robotics and laparoscopy will very soon take surgery to a separate sphere of high-tech world.
Address for correspondence:
Dr Jayanta Kr Goswami
MBBS, MS(General Surgery), MCh(Paediatric Surgery)(AIIMS)
Rajendra Mansion
Pragati Path
RGB Road
Guwahati-781003
Phone- 03612522111.
Published on the October issue of assam24x7.com :
The Darkness Beneath the Festival of Light
Dr Jayanta Kr Goswami
Dewali or Deepawali is the festival of light. Light is like knowledge. The festival of light spreads knowledge and joy. Nevertheless, often we do not notice the darkness hidden underneath the source of light. Similarly, there is a darker aspect of this festival as well.
Fireworks are not toys but explosives. Gunpowder is used in most of the fire works. The same gunpowder is used for the firearms. The law permits use of fifty grams or less of gunpowder in each firework. In the western countries, there are strict laws for using fireworks. In many countries, professionals display fireworks. Common people are allowed to watch it only from a distance of 1/3 km away. In the pack, the name of manufacturer and the instruction for its use is mandatory. In US, fireworks are not sold to those below 18 years of age. However, in India fireworks are sold without any restrictions. It is astonishing that many children are engaged in preparing crackers and fireworks ignoring the labor law. Each ear many children die because of factory accidents.
Fireworks, which explode with high sound may cause psychological trauma to the developing mind of a child. It may also cause harm to a very young child, sick and old persons. A toy gun offered to a child may lead to a casual attitude towards the real firearms in future life.
Sound pollution is the main subject of concern during these festival days. Crackers and chocolate bombs are the main sound pollutants. Decibel (db) is the unit of sound measurement. The human ear can tolerate sounds up to 80db. More than 130 db sound causes earache and headache. Persistent high intensity sound may cause irritability, aggravates high blood pressure and cause heart problem. Very high intensity sound may cause deafness by causing rupture of eardrums, damage to the inner ear cells or sudden death by cardiac arrest. Pets especially dogs are more sensitive to high intensity sound.
Smoke and fumes of fireworks are very toxic. These contain toxic gases like carbon monoxide, sulphur dioxide, carbon dioxide, and gases of metals and other materials like lead, mercury, sulphur etc. Suspended particles like soot, hydrocarbons and carbons are other constituents. These materials are injurious when ingested. However, these are more dangerous if inhaled. As inhaled substances bypass the liver and directly go to blood bypassing the liver. Liver has the capacity of detoxifying various swallowed toxic materials. The fumes of fireworks can aggravate bronchitis and asthma problems. It can also cause skin disease and conjunctivitis.
Burn injury is another hazard related to the cracker and fireworks. Though Indian figures are not available, even in US, about 13,000 firework related injury cases are found each year. Out of these 45% victims are children, 40% are hand burns and 20% are the eye injuries. One third of these eye injury cases loose their eyesight permanently. Rocket is the single most important cause of eye injuries.
In contrary to the popular belief sparkler (Phuljharies) are not safe for the children. A burning sparkler can generate a heat up to 1800 degree Fahrenheit, which is enough to melt Gold.
The financial aspect too cannot be ignored. Most of the fireworks are very expensive. Be cause of the social custom people who cannot afford two meals in a day, purchase costly fireworks. In a poor country like India, we spend 160 crores of rupees each year on fireworks.
Some precautionary measures:
☻ Buy firework from a reliable source and buy only legally licensed brands.
☻ Follow the instructions on the labels and use your common sense.
☻ Never allow children below five years of age to light fireworks. For older children also adult supervision is essential.
☻ Use outdoor and open spaces away from houses and cars. There should not be any inflammable substance, glass articles or thatched houses nearby.
☻ Do not use fireworks in a crowded area and do not throw it at anybody.
☻ Never cover a firework with a bin or container. AS far as possible avoid glass bottle to place a rocket.
☻ Do not keep the firework in the pocket. Keep it at a distant place.
☻ Do not experiment with fireworks.
☻ Do not bend over to look or to pick up a failed firework.
☻ Spinning wheels (Chakras) and fire pots should never be lighted on hands and always use level grounds.
☻ Hold sparklers away from the body. Use gloves if possible. Never make circles of a lighted sparkler. Keep a bucket of water handy to dispose the finished hot sparkler and for emergency use.
☻ Wear cotton cloths and shoes.
☻ Avoid rockets if there is strong wind.
☻ Be considerate for children, pregnant woman, ailing and elderly people and pets.
FIRST AID MEASURES FOR BURNS:
☻ Pour cold (not ice-cold) water on the burnt area till the pain and the burning sensation subsides.
☻ Do not apply ointment, grease or cream etc.
☻ If flame catches clothing, lie down and roll on the ground.
☻ In case of eye injury and burns do not touch or rub the eye. Do not apply water or any ointment. Do not cover the eye. Seek immediate medical attention.
Remember, fireworks are not toys but explosives.
