60 y/o
hypertension / thyroidism
cecal polyp, TVA(tubular villous adenoma) of 5~6 cm
(-) biopsy doesn't mean it's not cancer
CEA(carcinoembryonic antigen) needs to be looked to verify the presence of colon cancer
three parts of the procedure
1) laparoscopic
cutting off blood supplies to the R colon, freeing the colon from fascia
2) open
pull out the colon through the hole
debridement of the R colon that has cecal polyp
anastomosis of the small intestine and transverse colon
3) laparoscopic
check for bleeding
suture the lap. opening
advantages of laparoscopy
- reduced pain(1 day less narcotic), reduced hospital stay(by 1 day), fewer wound complications, better cosmetic results
disadvantages
- negative physiological effects of CO2 pneumoperitoneum, technical challenges of operation with 2-dimensional TV visualization and the ability to view only surface anatomy(partially overcome by intraoperative ultrasonography)
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Hyperthyroidism (or "overactive thyroid gland") is the clinical syndrome caused by an excess of circulating free thyroxine (T4) or free triiodothyronine (T3), or both.
Signs and symptoms
Major clinical features in humans are weight loss (often accompanied by a ravenous appetite), Intolerance to heat, fatigue, weakness, hyperactivity, irritability, apathy, depression, polyuria, and sweating. Additionally, patients may present with a variety of symptoms such as palpitations and arrhythmias (notably atrial fibrillation), dyspnea, loss of libido, nausea, vomiting, and diarrhea. In the elderly, these classical symptoms may not be present and they may present only with fatigue and weight loss leading to apathetic hyperthyroidism
Neurological manifestations are tremor, chorea, myopathy, and periodic paralysis. Stroke of cardioembolic origin due to coexisting atrial fibrillation may be mentioned as one of the most serious complications of hyperthyroidism.
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Villi (singular: villus) are tiny, finger-like structures that protrude from the wall of the intestine and have additional extensions called microvilli (singular: microvillus) which protrude from epithelial cells lining villi. In all humans, the villi and microvilli together increase intestinal absorptive surface area 30-fold and 600-fold, respectively, providing exceptionally efficient absorption of nutrients in the lumen. This increases the surface area of the intestine to around the area of a small parking lot or a tennis court. There are also enzymes on the surface for digestion. Villus capillaries collect amino acids and simple sugars taken up by the villi into the blood stream. Villus lacteals collect absorbed fatty acids.
In short, villi are small projections shaped like fingers extending into the interior of the small intestine. They increase the absorptive area of the intestinal wall. Digested nutrients (including sugars and amino acids) pass into the villi. Circulating blood then carries these nutrients away. [1]
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Using Harmonial Scarpel
Electrocauterization is the process of destroying tissue with electricity. A small probe with an electric current running through it is used to cauterize (burn or destroy) the tissue. The procedure is frequently used to stop bleeding.
Electrocauterization (or electrocautery) is a safe procedure that is routinely used in surgery to remove unwanted or harmful tissue. It can also be used to burn and seal blood vessels, which helps reduce or stop massive bleeding (hemorrhaging). A small electrode is applied to the skin near the surgery site. This electrode collects the electricity from the body and safely sends it back to the machine. A grounding pad is placed on the person's body (usually the thigh) before the surgery to protect the patient. ---------------------------------------------------------------------
Pneumoperitoneum is air or gas in the abdominal (peritoneal) cavity, usually seen on x-ray. The most common cause is a perforated abdominal viscus, generally a perforated ulcer, although any part of the bowel may perforate from a benign ulcer, tumor or trauma. A perforated appendix seldom causes a pneumoperitoneum.
A pneumoperitoneum is deliberately created by the surgical team in order to perform laparoscopic surgery. This is achieved by insufflating the abdomen with carbon dioxide.
Frontal chest X-ray. The air bubble below the right hemidiaphragm (on the left of the image) is a pneumoperitoneum.
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In medicine, an embolism occurs when an object (the embolus, plural emboli) migrates from one part of the body (through circulation) and cause(s) a blockage (occlusion) of a blood vessel in another part of the body.
This can be contrasted with a "thrombus" which is the formation of a clot within a blood vessel, rather than being carried from elsewhere.
Blood clots form the most common embolic material by far: other possible embolic materials include fat globules (a fat embolism), air bubbles (an air embolism), septic emboli (containing pus and bacteria), or amniotic fluid.
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