Laparoscopic surgery

What Is Laparoscopy?
Laparoscopy, also known as diagnostic laparoscopy, is a surgical diagnostic procedure used to examine the organs inside the abdomen. It’s a low-risk, minimally invasive procedure that requires only small incisions.
Laparoscopy uses an instrument called a laparoscope to look at the abdominal organs. A laparoscope is a long, thin tube with a high-intensity light and a high-resolution camera at the front. The instrument is inserted through an incision in the abdominal wall. As it moves along, the camera sends images to a video monitor.
Laparoscopy allows your doctor to see inside your body in real time, without open surgery.

How Is Laparoscopy Performed?
Laparoscopy is usually done as an outpatient procedure. This means that you’ll be able to go home the same day as your surgery.
You’ll likely be given general anesthesia for this type of surgery. This means that you’ll sleep through the procedure and won’t feel any pain. To achieve general anesthesia, an intravenous (IV) line is inserted in one of your veins. Through the IV, your anesthesiologist can give you special medications and well as provide hydration with fluids.
In some cases, local anesthesia is used instead. A local anesthetic numbs the area, so even though you’ll be awake during the surgery, you won’t feel any pain.
During laparoscopy, the surgeon makes an incision below your belly button, and then inserts a small tube called a cannula. The cannula is used to inflate your abdomen with carbon dioxide gas. This gas allows your doctor to see your abdominal organs more clearly.
Once your abdomen is inflated, the surgeon inserts the laparoscope through the incision. The camera attached to the laparoscope displays the images on a screen, allowing your organs to be viewed in real time.
The number and size of incisions depends upon what specific diseases your surgeon is attempting to confirm or rule out. Generally, you get from one to four incisions that are each between 1 and 2 centimeters in length. These incisions allow other instruments to be inserted. For example, your surgeon may need to use another surgical tool to perform a biopsy. During a biopsy, they take a small sample of tissue from an organ to be evaluated.
After the procedure is done, the instruments are removed. Your incisions are then closed with stitches or surgical tape. Bandages may be placed over the incisions.
Laparoscopic surgery, also called ”minimally invasive surgery” (MIS)”, band-aid surgery”, ”keyhole surgery” is a modern surgical technique in which operations in the abdomen are performed through small incisions (usually 0.5-1.5 cm) as compared to larger incisions needed in traditional surgical procedures. Keyhole surgery uses images displayed on TV monitors for magnification of the surgical elements. Laparoscopic surgery includes operations within the abdominal or pelvic cavities, whereas keyhole surgery performed on the thoracic or chest cavity is called thoracoscopic surgery. Laparoscopic and thoracoscopic surgery belong to the broader field of endoscopy.There are a number of advantages to the patient with laparoscopic surgery versus an open procedure. These include reduced pain due to smaller incisions and hemorrhage, and shorter recovery time. This elevates the abdominal wall above the internal organs like a dome to create a working and viewing space. CO2 is used because it is common to the human body and can be absorbed by tissue and removed by the respiratory system. It is also non-flammable, which is important because electrosurgical devices are commonly used in laparoscopic procedures.

Laparoscopic Surgery Procedures
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). There are two different formats for laparoscopic surgery. Multiple incisions are required for technology , which uses a console located away from the patient, with the surgeon controlling a camera, vacuum pump, saline cleansing solution, cutting tools, etc. each located within its own incision site, but oriented toward the surgical objective. The surgeon uses two Play Station type controls to manipulate the devices. In contrast, requiring only a single small incision, uses a single 5-function control, so that a saline solution and the vacuum pump operate together when the laser cutter is activated. A camera and light provide feedback to the surgeon, who sees the enlarged surgical elements on a TV monitor. The Bonati system was designed for spinal surgery and has been promoted only for that purpose.Rather than a minimum 20 cm incision as in traditional (open) cholecystectomy, four incisions of 0.5-1.0 cm 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 1 cm incision at the patient’s navel. The length of postoperative stay in the hospital is minimal, and same-day discharges are possible in cases of early morning procedures. The most common of these procedures are removal of all or part of the colon (colectomy), or removal of the kidney (nephrectomy).

Conceptually, the laparoscopic approach is intended to minimise post-operative pain and speed up recovery times, while maintaining an enhanced visual field for surgeons.
Due to improved patient outcomes, in the last two decades, laparoscopic surgery has been adopted by various surgical sub-specialties including gastrointestinal surgery (including bariatric procedures for morbid obesity), gynecologic surgery and urology. Based on numerous prospective randomized controlled trials, the approach has proven to be beneficial in reducing post-operative morbidities such as wound infections and incisional hernias (especially in morbidly obese patients), and is now deemed safe when applied to surgery for cancers such as cancer of colon. The first transatlantic surgery (Lindbergh Operation) ever performed was a laparoscopic gallbladder removal. Laparoscopic techniques have also been developed in the field of veterinary medicine. Due to the relative high cost of the equipment required, however, it has not become commonplace in most traditional practices today but rather limited to specialty-type practices.Many of the same surgeries performed in humans can be applied to animal cases – everything from an egg-bound tortoise to a German Shepherd can benefit from MIS.

Laparoscopic Surgery Advantages
There are a number of advantages to the patient with laparoscopic surgery versus an open procedure.
These Include:

  • Reduced hemorrhaging, which reduces the chance of needing a blood transfusion.
  • Smaller incision, which reduces pain and shortens recovery time, as well as resulting in less post-operative scarring.
  • Less pain, leading to less pain medication needed.
  • Although procedure times are usually slightly longer, hospital stay is less, and often with a same day discharge which leads to a faster return to everyday living.
  • Reduced exposure of internal organs to possible external contaminants thereby reduced risk of acquiring infections.

Following are procedures that can be performed by laparoscopic surgery. Benefits includes less pain, shorter hospital time, shorter recovery at home and less scarring:

  • Gastric Bypass Surgery
  • Lap Band
  • Cholecystectomy or Removal of Gallbladder
  • Hernia Repair
  • GERD or Anti Reflux Surgery
  • Treatment of Liver and Biliary Diseases
  • Treatment of Hiatal Hernia
  • Splenectomy and Treatment of the Spleen
  • Intestinal and Colon Disorders
  • Ulcer Surgery
  • Small Bowel Obstruction
  • Achalasia
  • Removal of Appendix
  • Removal of Adrenal Gland

SILS (Single Incision Laparoscopic Surgery) :
Single incision laparoscopic surgery (SILS) is a new technique that has now been utilized in many centers for minimal access surgery. We have previously detailed our initial experiences with the use of SILS for appendicectomy and cholecystectomy in the adult population. Now we have started performing even advanced surgery by single incision. The major difficulty with this new technique is the sacrifice that has to be made in terms of comfort and ergonomics. All patients and their parents were very satisfied with their operative management by SILS, and particularly enthusiastic in regard to the cosmetic outcome of single incision approach.

Key Benefits Of Single Incision Laparoscopic Surgery

  • Fewer incisions – Typically, this surgery requires only one small incision.
  • Health and cosmetic benefits – Since there are fewer incisions, there is less possibility of infection, less scarring and better cosmetic results.
  • Faster recovery times – The surgery is recognized as minimally invasive to cause shorter recovery times.
  • The most recent technology – Laparoscopic surgery has generally replaced the need for traditional open surgeries in the abdominal or pelvic cavities.

Since SINGLE INCISION LAPAROSCOPIC SURGERY procedures are relatively new and in evolution, many techniques happen to be described but no widely accepted standard exists. SILS was first adapted to cholecystectomy and once the strategy was proved to be effective and safe for basic laparoscopic procedures, it was put on a few of the technically simpler bariatric procedures.

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