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Shoulder Impingement
Created by: Anestis IossifidisDirectory:
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Information about shoulder impingement.
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Anestis Iossifidis
Consultant Orthopaedic Surgeon , Shoulder & Upper Limb SurgeonDirectory:
Expertise:
Dr Iossifidis was educated at the University of Montpellier in France. His postgraduate surgical training took place in Norwich and Cambridge. He then joined the Guy’s and St Thomas’ hospital higher surgical training rotation. As a Senior registrar he developed an interest in shoulder surgery and completed a Shoulder fellowship in London and New York.
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Christopher Anderson
Consultant Surgical UrologistDirectory:
Expertise:
Mr Christopher Anderson is a consultant urological surgeon with a specialist interest in renal and prostate cancer. He is the Clinical Lead of the Robotic Surgery Unit and the Lead Cancer Clinician at St George's Hospital, London.
Mr Anderson was one of the pioneers of Robotic Surgery in the UK and holds membership at the British Association for Urological Surgeons. He completed his undergraduate work at Stellenbosch and his postgraduate training in Cape Town, South Africa, before taking up a substantive consultant post at St George’s Healthcare, London, in 1999. He undertook fellowships to Cleveland, the University of Miami and Detroit in the United States before travelling to the University of Leipzig in Germany where he learned laparoscopic radical prostatectomy due to the increasing popularity of minimally invasive surgical approaches to prostate cancer in recent years.
Mr Anderson was one of the first to adopt laparoscopic techniques in urology surgery in the UK. In 2004 he introduced laparoscopic renal cryotherapy, also the first operation of its kind in the UK. He continued to develop this technique and has the largest series with long term follow-up in the country.
He was an integral member of the team that pioneered robotic surgery in the UK, introducing the robotic surgery programme to St George’s Healthcare in July 2008, and has successfully developed the service as lead robotic surgeon.
His particular clinical interests include robotic prostatectomy, robotic partial nephrectomy, robotic pyeloplasty and laparoscopic nephrectomy. Mr Anderson is available for private consultations at The Princess Grace Hospital, London.
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Robotic surgery is an extension of laparoscopic (keyhole) surgery and offers advantages that overcome some drawbacks of laparoscopy.Most people are familiar with laparoscopy in which the surgery is performed by manipulating straight instruments while viewing the movement of the instruments inside the body on a screen. There are usually a group of small incisions (1cm or less) made on the body to allow access for the ports and instruments.
During a robotic surgical procedure, the surgeon sits in the console of the da Vinci surgical system a few feet away from the patient. While watching through the console/video monitoring system, he/she moves the handles on the console in the directions he /she wants to move the surgical instruments. The handles on the console translate the surgeon's natural hand and wrist movements into corresponding and very precise movements inside the body.
Using the da Vinci System, surgeons can operate with the look and feel of open surgery, performing complex surgical maneuvers. The surgeon has intuitive control, range of motion and fine tissue manipulation characteristic of open surgery. All of this is performed through small ports of minimally invasive surgery.
One obstacle of standard laparoscopy is the loss of three dimensional (3-D) spatial relationships since the screen has only a two dimensional view (2D), like a television. The da Vinci Surgical System uses a camera that provides the surgeon with a truly 3-D view of the surgical field. The physician looks through the vision system - like a pair of binoculars - and gets a 3-D view inside the patient's body that allows the surgeon to experience the depth of the field being operated. The system also provides magnification ten-twelve times that of the naked eye, allowing the surgeon the ability to see the operating field more clearly.
Standard Laparoscopic instruments have the feel of "chop sticks". However the DaVinci Surgical Cart uses EndoWrist® Instruments that are designed to mimic the movement of the human hands, wrists and fingers. The extensive range of motion allows precision that is not available in standard laparoscopy.
The history of Robotics
The prototype for the da Vinci® robot was designed by the United States military with the hope of allowing surgeons to operate on wounded soldiers from a safe distance. Unfortunately, this goal was abandoned because the robot was not sufficiently portable for use in this capacity. Subsequently, the technology was sold to a private company (Intuitive Surgical) who adapted it for application in an operating theatre and developed an instrument that has become the most advanced tool in a surgeon's armamentarium.
By integrating robotic technology with surgeon skill, the da Vinci® Surgical System enables surgeons to perform surgery in a manner never before experienced. It has improved and magnified the visibility and enabled considerably enhanced precision.
Why is it better for the patient?
The benefits of this minimally invasive surgery are significant to patients.
- Reduced trauma to the body
- Less blood loss and need for transfusions
- Less post-operative pain and discomfort
- Minimal need for pain killers
- Shorter hospital stay
Why is it better for the surgeon?
With its 3-D view, the da Vinci Surgical System aids the surgeon to more easily identify vital anatomy such as the delicate nerves and blood vessels surrounding specific anatomy.
The EndoWrist® Instruments provide the surgeon with the dexterity not available using conventional laparoscopic instruments to perform a delicate and precise surgical dissection, reconstruction or removal of specific tissue.
