Surgery

Advanced & Conventional Laparoscopic Surgery

Laparoscopic or "minimally invasive" surgery is a specialized technique for performing surgery. In the past, this technique was commonly used for gynecologic surgery and for gall bladder surgery. Over the last 10 years the use of this technique has expanded into intestinal surgery. In traditional "open" surgery the surgeon uses a single incision to enter into the abdomen. Laparoscopic surgery uses several 0.5-1cm incisions. Each incision is called a "port." At each port a tubular instrument known as a trochar is inserted. Specialized instruments and a special camera known as a laparoscope are passed through the trochars during the procedure. At the beginning of the procedure, the abdomen is inflated with carbon dioxide gas to provide a working and viewing space for the surgeon. The laparoscope transmits images from the abdominal cavity to high-resolution video monitors in the operating room. During the operation the surgeon watches detailed images of the abdomen on the monitor. This system allows the surgeon to perform the same operations as traditional surgery but with smaller incisions.

Advantages of laparoscopic surgery

Compared to traditional open surgery, patients often experience less pain, a shorter recovery, and less scarring with laparoscopic surgery.

 

What kinds of operations can be performed using laparoscopic surgery

Most intestinal surgeries can be performed using the laparoscopic technique. These include surgery for Crohn's disease, ulcerative colitis, diverticulitis, cancer, rectal prolapse and severe constipation.

In the past there had been concern raised about the safety of laparoscopic surgery for cancer operations. Recently several studies involving hundreds of patients have shown that laparoscopic surgery is safe for certain colorectal cancers.

How safe is laparoscopic surgery

Laparoscopic surgery is as safe as traditional open surgery. At the beginning of a laparoscopic operation the laparoscope is inserted through asmall incision near the belly button (umbilicus). The surgeon initially inspects the abdomen to determine whether laparoscopic surgery may be safely performed. If there is a large amount of inflammation or if the surgeon encounters other factors that prevent a clear view of the structures the surgeon may need to make a larger incision in order to complete the operation safely.

Any intestinal surgery is associated with certain risks such as complications related anesthesia and bleeding or infectious complications. The risk of any operation is determined in part by the nature of the specific operation. An individual's general heath and other medical conditions are also factors that affect the risk of any operation. You should discuss with your surgeon your individual risk for any operation.

  • Laparoscopic cholecystectomy: Stones in gallbladder, In a standard procedure we make 4 small holes on the abdominal wall and remove the gallbladder with the stones. With advancement now we also perform the procedure using 2 holes or sometimes with a single hole (SILS).
  • Laparoscopic appendicectomy: Removal of appendix, We remove the appendix through 3 small holes in the abdominal wall.
  • Laparoscopic CBD exploration: CBD stones, Patients who have stone in the common bile duct are in most cases subject to an ERCP. In this an endoscopy is passed through the mouth and the CBD stones are removed through the intestines. But now a days in some cases we d o the procedure by laparoscopy. The advantage of this that the patient needs to undergo a single operation instead of two.
  • Laparoscopic Fundoplication: For GERD and hiatus hernia,This is done for patients for patients with reflux disease or symptomatic hiatus hernia. The valve at the gastroesophageal junction is tightened and the hernia is repaired.
  • Laparoscopic Cardiomyotomy: For Achalasia cardia. The obstruction at the GE junction is opened up.
  • Laparoscopic hernia repair: Inscisonal hernia, inguinal hernia. In this procedure the hernia is reduced and a special mesh is placed inside the abdomen and fixed tackers
  • Laparoscopic assisted Small bowel resection: The intestine is examined and the position of the area to be resected is ascertained and the actual resection is done through a small incision in the abdominal wall.
  • Laparoscopic assisted colon resection- for selective cases: The large intestine is mobilized laparoscopically and tumor resected intracorporeally or extracorporeally. The bowel anastomosis may again be done either intracorporeally or extracorporeally.
  • Laparoscopic surgery for hydatid cyst of the liver: The cyst is evacuated and cyst wall is removed and the cyst cavity is packed with omentum.
  • Bariatric Surgery- sleeve gastrectomy and gastric bypass: In sleeve gastrectomy a large part of the stomach is removed leaving a small portion so that the patient is able to eat small quantities of food only. In gastric bypass not only is the stomach capacity reduces but a significant length of small intestine is bypassed as a result of which the absorption of food is also decreased leading to further weight loss.
Laparoscopic left hemicolectomy for colon cancer
Laparoscopic splenectomy for ITP