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Dissection is understood to be the separation of tissues with haemostasis. It includes a combined sensory (visual and tactile elements) component and an access component involving tissue manipulation and instrument maneuverability. They are combined to attain exposure i.e. creating a suitable space for seeing and handling target structures. Laparoscopic dissection way is completely reverse compared to open surgery since it need a lot of precision and perfect ergonomics.
Precision, proper hand eye coordination and meticulous haemostasis is essential requirements in minimal access surgery. Endoscopic dissection, as opposed to dissection in conventional surgery, possesses several limitations. In open surgery we quite often think for haemostasis after dissection but in general surgery we wants to be sure about haemostasis before dissection before we don't want a single drop of blood which could reduce our vision dramatically. In Laparoscopy three- dimensional direct vision is replaced by two dimensional indirect visions in laparoscopic surgery. We operate over image rather than reality. Illumination and also the video image quality continue to be limited despite recent advances in video systems such as digitization and 3-chip endocamera. Movement of the functional tip of laparoscopic instruments is bound combined with the kinematics response. The loss of tactile sensation in endoscopic surgery is yet another limiting factor
A number of mechanisms have been used to divide tissue and enable haemostasis. All of them incorporate some form of physical energy being put on the appropriate tissue. The amount of energy necessary for dissection depends upon the kind and constituency from the tissue. The properties of tissues can vary in various directions and for different disease states. This in totality influences the option of the modality for dissection.
The ideal dissection technique takes a modality that may accomplish meticulous haemostasis and you will be tissue selective without causing inadvertent tissue damage. It should be safe for both patient and surgical team when in regular use so when inactive in storage. In this way built-in safety precautions are mandatory. An ideal dissecting modality ought to be efficient both in power delivery and in space requirement. The modality must be cost- effective. The initial expenditure needed to acquire and set- in the necessary equipment must be taken into consideration together with subsequent operational and maintenance costs.
The truth is there isn't any single “ideal “dissecting modality to have an entire procedure. In actual practice a mix of energy forms is applied with selection of the best one at each particular phase from the operation. This brief review examines the advantages, disadvantages and limitations of the several available modalities. Additionally , it addresses the issue of preference of the very suitable (ideal) modality that satisfies as near as possible the above mentioned outline criteria.
