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In such a case with making a small incision on the abdominal wall we gain access to the peritoneal cavity and when we become sure of the safety buy discount viagra erectile dysfunction treatment pills, then we insert the trocar under the dirct vision order viagra 25 mg line erectile dysfunction treatment options articles. The incision is made tight around the port with 76 application of sutures at the edges of it cheap 100 mg viagra fast delivery erectile dysfunction otc treatment. Conditions for inspetion of the abdominal cavity cheap kamagra oral jelly 100mg, optic The laparoscope consists of a lens system and an objective generic cipro 500 mg without a prescription. In such an optic the spaces between the lenses-instead of air- are filled with the glasses. Optics The optical characteristics of the laparoscope are determined by: visual angle, visual field, focal length, and the light loss. The bigness of the visual angle is marked by the closed angle that is made by the axes of the objective and other lenses of the laparoscope which depends on the direction of optics. The 0 77 laparoscope provides a straight forward view, and the 30 laparoscope a forward oblique view. Light source Illumination of the abdominal cavity is of a basic importance for orientation and suitable carrying out of the surgical steps. Currently, a 150300 W fan-cooled xenon light source is used to provide color-corrected light for extended periods of time without overheating. The illumination is transmitted to the laparoscope via a flexible fiber-optic light guide (180250 cm long). Laparoscopic camera (A), Optic and long connected light cable and camera (B), Light cable (C), Monitor (D) Laparoscopic irrigation/suction device: It is a necessary device in laparoscopic surgeries. Its central unit is continuously producing a 180 mmHg positive- and a 500 mmHg negative pressure. These effects can be applied into the abdominal cavity with the help of tubes and a valve. Irrigation/suction device 78 Electrocautery devices They are similar to those used in open conventional surgeries and can be either mono- or bipolar. In a monopolar system the circuit of the electric current is made by the active electrode (i. A bipolar system, in contrast, places the tissue between two electrodes, so the current passes from one electrode to the other through the interposed tissue. Laparoscopic needle holders (parrot and flamingo) (A), Correct holding of the needle holders (B), Intracorporeal sutures (C) 79 Difficulties of the laparoscopic technique: Tow- dimentional approach and three- dimentional activity Eye-hand coordination Feeling the depth Coordinated use of the dominant and non-dominant hands Lack of the tactile sensation Magnified surgical territory and finer manipulations Fulcrum effect Limited movement New and unusual instruments Continuous care of the techniqual equipment Increased physical and mental demands The laparoscopic technique due to its known benefits- became extraordinarily famous. In spite of this, the application of this method is not easy and needs too many practices. Immediately following entry into abdominal cavity you do feel the unusual orientation. The instruments (which are completely different from the usual and accustomed ones) with respect to the characteristic of the optics actually move in a direction opposite to the surgeons aims. It is obvious that to become expert in laparoscopic surgery is not possible with performing it on patients. You can get experinces with practising it on a pelvitrainer and -after getting enough experiences - animals.

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First find the artery In monopolar diathermy generic viagra 25mg with amex erectile dysfunction 9 code, there is a high current density by feeling for pulsation discount viagra on line erectile dysfunction shake. Push the points of a fine ensured at the point of contact with the active electrode at haemostat into the connective tissue around it and separate the diathermy probe tip but the current is then dissipated in them to open up a plane (3-4B) purchase viagra line erectile dysfunction tulsa. Gradually develop this a large volume of tissue through a large surface area plane until you can see the artery you are looking for buy cheap toradol on-line. Usually you will pick up a blood vessel with coagulation in the testicular vessels purchase cheap super viagra line, especially if you lift dissecting forceps, and touch the forceps with the the scrotum up in your hand. As metal is a good conductor of current, little heat is generated in its passage through the forceps. Do not use diathermy in an amputation for an ischaemic Make sure though that your gloves have no holes, leg (35. In bipolar diathermy, the current passes between two If the patient has a cardiac pacemaker, the diathermy point electrodes placed across the vessel to be coagulated. Do not use diathermy in the presence of inflammable Bipolar diathermy only works with low currents, and is anaesthetic agents, e. Do not use of diathermy on obstructed bowel: it may detonate if methane gas has accumulated inside! You can use any of these: A special pneumatic tourniquet which resembles the cuff of a sphygmomanometer. The pressure at which a tourniquet is applied is important; this is more easily Fig. A, monopolar diathermy produces high current density at the active controlled pneumatically, so a pneumatic tourniquet is electrode dissipated through the body tissues through the much the best. Also you can, if necessary, let it down indifferent electrode with resulting low current density. B, bipolar rapidly during an operation to perfuse the tissues, or to diathermy produces high current density across insulated diathermy find arteries that need tying. If you touch the skin or vessels very close to the skin (2) You do not put it on too tight, especially on a thin limb. If small, it is best to excise this, especially if it tyre (3-7): the tube from an ordinary car tyre is too thick) is on the edge of a wound. You may not have a special pneumatic tourniquet, so this is probably what you Do not use diathermy on the penis: you may cause will have to use. A tourniquet will prevent blood entering a thrombosis in the corpora unless you use bipolar limb, but it will not remove blood which was already there diathermy. At this point the femoral artery lies close to Then apply a pneumatic tourniquet (or a sphygmo- the femur and is easily compressed. This will provide an almost totally bloodless field, but is only safe if there is no sepsis, which would then be spread proximally.

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