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Clip Applier
Laparoscopic Surgery Procedures By Dr. M.G. Bhat and Dr.JayaBhat
Laparoscopic cholecystectomy is the most common laparoscopic procedure performed. In this procedure, 5-10mm diameter instruments (graspers, scissors, clip applier) can be introduced by the surgeon into the abdomen through trocars (hollow tubes with a seal to keep the CO2 from leaking). Rather than a minimum 20cm incision as in traditional cholecystectomy, four incisions of 0.5-1.0cm will be sufficient to perform a laparoscopic removal of a gallbladder. Since the gall bladder is similar to a small balloon that stores and releases bile, it can usually be removed from the abdomen by suctioning out the bile and then removing the deflated gallbladder through the 1cm incision at the patient's navel. The length of postoperative stay in the hospital is usually 2-3 days.
In certain advanced laparoscopic procedures where the size of the specimen being removed would be too large to pull out through a trocar site, as would be done with a gallbladder, an incision larger than 10mm must be made. The most common of these procedures are removal of all or part of the colon (colectomy), or removal of the kidney (nephrectomy). Some surgeons perform these procedures completely laparoscopically, making the larger incision toward the end of the procedure for specimen removal, or, in the case of a colectomy, to also prepare the remaining healthy bowel to be reconnected (create an anastomosis). Many other surgeons feel that since they will have to make a larger incision for specimen removal anyway, they might as well use this incision to have their hand in the operative field during the procedure to aid as a retractor, dissector, and to be able to feel differing tissue densities (palpate), as they would in open surgery. This technique is called hand-assist laparoscopy. Since they will still be working with scopes and other laparoscopic instruments, CO2 will have to be maintained in the patient's abdomen, so a device known as a hand access port (a sleeve with a seal that allows passage of the hand) must be used. Surgeons that choose this hand-assist technique feel it reduces operative time significantly vs. the straight laparoscopic approach, as well as providing them more options in dealing with unexpected adverse events (i.e. uncontrolled bleeding) that may otherwise require creating a much larger incision and converting to a fully open surgical procedure.
About the Author
Dr. M.G. Bhat and Dr.JayaBhat are the Laparoscopy Surgeon Bangalore, Laparoscopy Surgeons Bangalore, and Laparoscopy Surgery India , with very well experienced by performing more than 10000 Laparoscopy Surgeries by them.
What do i need for school in year nine?
i will be starting my Gcse's early a new school rule meant to be starting this year coming but our school does not listen to anything.. anyway it means all p.e stuff and basically everything
school bag.. i already have
school bag
planner
water bottle
lunch bag/lunch money
reading book
make up bag..eyeliner mascara foundation chapstick lipgloss and appliers
hair clips
deodorant
soothers
handjel
antibacterial..
i just need a list too go and bye the rest.. thanks
The kind of stuff I took in Year 9 was:
- Pens: as you're starting GCSEs, I'd say to use a black pen all the time. Reason why is that some exam boards insist on black ink. Also, if you use a fountain pen, maybe consider getting erasable ink for it.
- Pencils: Mechanical pencils or wooden HBs, your choice. If you're taking Art, maybe get a set of graded pencils for doing drawings. I use Royal Langnickel most of the time for art pencils.
- Highlighters: Absolute /must/ in Year 9. Useful for pretty much every subject - particularly English (for analysing pieces of writing, peer marking, et cetera), Maths (highlighting answers to make them stand out - helps with revision), Geography (colour-coding maps, highlighting facts), Science (highlighting keywords in your book - helps with revision) - I could go on and on, but they're mostly similar uses. Also, they help with "prettification", as my Geography teacher puts it!
- Notebooks: Seeing as these are (usually) provided in UK schools, you probably won't need to buy many. However, if you know that one of your teachers can be a bit snarky about giving you a new exercise book (particularly for subjects that you go through a lot of notebooks - for me, it's French), it might be worth getting a few. Not spiral bound, though - I'm always managing to lose the pages of those. Also, if you tend to do your homework during lunch, it might be an idea to get an A4 notebook with perforated pages - makes tearing them out and handing them in easier.
-Maths kit: Standard maths kit should do - supermarket own-brands are fine, but I like the Helix Oxford range. A tip, though: make sure that the compass is one of the ones with metal legs - the plastic ones break easily. Typically, you'll use these in maths, but I've found them useful in Graphics, Geography and Science, too.
-Calculator: For Year 9 (and 10/11), you'll need a scientific calculator. It's likely you'll have one of these already, but, if not, it's probably best to go for a Casio - they're pretty easy to get hold of, and reliable. Not sure what the latest one is, but I've got an fx-83ES, which I bought when I was in Year 7. If you're wanting to take A-level Maths at Sixth Form, your teacher might recommend buying a graphic calculator in advance (in Year 10/11), so you get used to it, but every teacher has a preference as to what you use.
-USB drive ("flash drive", "USB key", "pen drive" - they come by many names). Very useful, as there's a lot of ICT-based work to do. I'd suggest getting one with at least 2GB of memory, which should last most people the whole way through Year 9 without any major clean-outs. I use a 4GB TEXET drive, which is better for me, as I tend to store a lot of stuff on it. Good to have, regardless of subjects you're taking, as most (if not all) subjects have ICT based elements at some point.
-Coloured pencils: Most people can get by with a cheap set of colours, but if you're taking subjects that involve a lot of colouring (Geography, Art, and pretty much any Design Technology), it might be worth investing in some more substantial ones. Crayola works fine - very durable and easy to find in shops.
-Coloured biros: Useful for peer marking, or generally adding contrast to different bits of your work. As standard, I'd suggest getting red, green and blue (or one of those pens that has all three in it!), but there are loads of colours you could get. You could use fineliners, if you prefer.
-Sharpeners: Helix, Staedtler - both are very durable.
-Erasers: Again, Helix and Staedtler are good, but really, any brand will do, as long as it's not too plastic-y. Wilkinson sell some nice ones for about 30p for 2, and Poundland (and similar) sometimes have packets of 10-15 good erasers for a £1. If you're taking Art as a GCSE and you're serious about it, you might want to get a putty eraser for highlights. Not essential, but if you draw a lot, they're handy.
-Scissors: As long as they're pretty sturdy, they should be OK.
-Glue: Pritt Stick is a good choice, failing that UHU works fairly well. I don't know what your teachers are like, but a lot of mine require scissors and glue.
-Plastic folder: For loose sheets of paper - I have a waterproof one that's very strong. Not the prettiest, but very practical.
Other stuff:
-If you're taking art, your school might ask you to buy your own sketchbook. They would have told you before the summer if you needed to buy one outside of school, but some schools sell them to art students during school time.
-Box file: I bought one of these to file marked homework in - haven't put it to use yet, but it'll (probably) be an improvement on my previous method of chucking it all in my wardrobe, then searching frantically if I needed something.
That's about all I can think of... best of luck in your GCSEs!
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