introduction to laparoscopic surgery
Laparoscopy is a minimally
invasive surgical procedure. After making small incisions while the
patient is asleep and under the effects of anesthesia, the doctors
use small scopes and specially designed tools to perform the
surgery, which includes exploratory, appendix, hernia, gallbaldder,
colon and hiatal hernia procedures.
Laparoscopic Exploratory Surgery:-
Exploratory laparoscopy has often
been used for diagnostic purposes to view the abdomen after
abdominal trauma and in cases of abdominal illness.
Laparoscopy is a term given to a
group of operations that are performed with the aid of a camera
placed in the abdomen. Originally, the laparoscope was used during
surgical removal of the gallbladder (laparoscopic cholecystectomy)
and appendix (laparoscopic appendectomy).
Now the laparoscope also allows
physicians to perform minimally invasive surgery with just a small
incision in the abdomen. This technology, known as laparoscopic
assisted surgery, enables the minimally invasive removal of the
colon, and the weight reducing procedure gastric bypass.
The procedure is usually done in
the hospital, under general anesthesia, and after informed consent
has been obtained. A catheter (a small flexible tube) is inserted
through the urethra into the bladder. An additional tube may be
passed through the nostril and into the stomach to remove intestinal
contents (N-G tube). The skin of the abdomen is cleansed, and
sterile drapes are applied.
A small incision is made above or
below the navel to allow the insertion of a trocar (essentially a
tube extending from inside the abdomen to the outside), which allows
passage of a video camera. Prior to insertion of the trocar, a
needle is inserted into the incision and carbon dioxide gas is
injected to elevate the abdominal wall, and thereby create a larger
space to work in. This allows for easier viewing and manipulation of
After an adequate amount of gas
is instilled, the laparoscope is inserted, and the organs of the
pelvis and abdomen are examined. Additional small incisions are made
for instruments that allow the surgeon to move the abdominal organs,
cut tissue, suture, and staple structures to safely and effectively
perform the necessary procedure.
Following the examination, the
laparoscope is then removed, the incisions are closed with sutures,
and bandages are applied. Depending upon the operation performed, a
drain may be left through one of the incisions to allow for removal
of accumulated fluid.
Laparoscopic Appendix Surgery:-
Laparoscopic Appendectomy is a
much less invasive procedure for patients who have been diagnosed
with an acute appendicitis than is traditional surgery.
The surgery can be completed in
less than an hour in most cases.
The appendix is a small,
finger-shaped pouch that projects out from your colon on the
right-hand side. The appendix has no known purpose. Every year about
7 percent of Americans develop appendicitis — a condition in which
the appendix becomes inflamed and filled with pus.
The main symptom of appendicitis
is pain that begins around the navel and then shifts to the
lower-right abdomen. The pain usually increases over a period of 12
to 24 hours, and eventually may be very severe.
Anyone can develop appendicitis,
but it most often strikes people between the ages of 10 and 30 and
is one of the most common reasons for emergency abdominal surgery in
The standard treatment for
appendicitis is surgical removal of the appendix (appendectomy). In
many cases the surgery is straightforward and you recover quickly.
But if your appendix has ruptured, the surgery may be more
complicated and you’ll take longer to heal. A ruptured appendix
that's not promptly treated can lead to serious complications such
as an infection of the abdominal lining (peritonitis) or a
walled-off area of infection (an abscess). In rare instances a
ruptured appendix may be fatal.
Laparoscopic Gallbladder Surgery:-
Sometimes, the gallbladder is no
longer working properly, which can cause severe stomach pain. To
relieve the pain, patients need to have the gallbladder removed. The
gallbladder is a small pear-shaped organ under the liver. It stores
bile which aids in digesting fatty foods. The amount of bile and
other liquid chemicals inside the gallbladder can be out of balance.
When this happens, some of the chemicals become solid and form a
kind of sediment called gallstones (stones).
1) If the stones stay in the
gallbladder, they might irritate the gallbladder's wall or be
"silent" and cause no symptoms.
2) In the cystic duct, gallstones may block the duct and cause upper
abdominal pain, nausea, vomiting, heartburn, and back pain. The
gallbladder can become infected.
3) In the common bile duct, if a stone is stuck or has trouble
passing through, it can cause pain and conditions like jaundice
(yellowing of the skin) or pancreatitis (an inflamed pancreas).
Laparoscopic surgery usually lasts approximately 1 hour. Patient can
likely go home on the day of the surgery. The surgery is performed
through several small incisions. The laparoscope is inserted through
one incision. One end of the scope shines light inside the body. The
other is attached to a a tiny camera. The camera lets your doctor
view your gallbladder. The surgeon inserts special instruments
through other small incisions. Then the gallbladder is removed
through a small incision in your navel.
Laparoscopic Hernia Surgery:-
A hernia occurs when inner layers
of abdominal muscle become weakened. The lining of the abdomen then
bulges out into a small sac, and part of the intestine or abdominal
tissue may enter the sac. Hernias occur most commonly in the groin
(inguinal hernia), the navel (umbilical hernia), and at the incision
site of a previous surgery.
Some people with hernias remain
relatively free from symptoms. But a hernia can cause severe pain
and other potentially serious problems (e.g., infection, bowel
obstruction). Surgery is the only way to repair them, because they
do not resolve on their own.
Laparoscopic surgery can be used
for hernia repair. Instead of one long incision, four or five tiny
incisions are made in the area around the hernia. A device called a
laparoscope, which is a miniature scope attached to a video camera,
is inserted into one of the incisions. The surgeon is able to see
the hernia and the surrounding tissue and organs on a video screen.
Instruments used to repair the
hernia are inserted through the other incisions and the operation
proceeds in much the same way as open surgery. Advantages of this
technique include shorter recovery time and less postoperative pain.
Eligibility for laparoscopic
surgery depends on a number of factors. The surgeon must be able to
see the interior of the abdomen clearly, and sometimes obesity or
large amounts of scar tissue make that difficult. Also, the patient
may not be a good candidate because other health problems prohibit
the use of general anesthesia.
The colon is a part of the
digestive system. A healthy colon helps form the solid stool that is
later expelled by the body. But growths or inflammation within the
colon can cause colon problem which prevents the colon from working
Thus, the infected part of the
colon needs to be removed.
Part or all of the colon can be removed laparoscopically without
causing serious health concerns. Surgeries remove the affected piece
in a process called a resection. Then the two ends are stapled
together, which is called anastomosis.
If the affected part is
cancerous, this surgery removes the cancer and some of the
surrounding tissue and lymph glands to help reduce the chance of a
recurrence. The surgeon preserves the colon's tubelike shape,
allowing waste to pass through it easily, and retain normal bowel
Some common colon problems
Polyps, which are tissue growth in the colon linings. If caught early, they
frequently are not cancerous, but as they grow larger it becomes
more likely they will become cancerous. Thus, removing the polyp
early may decrease the risk of colon cancer.
Diverticulitis are two
other related colon conditions. Diverticulosis occurs when small
pouches form on the lining of the colon. Diverticulitis occurs when
one of these pouches becomes infected and inflamed. In some cases,
the pouch also may break.
Inflammatory bowel disease
is a condition that
causes swelling, inflammation, and sores in the digestive system.
Patients with untreated IBD may be at higher risk of colon cancer.
Laparoscopic Hiatal Hernia Surgery:-
A hiatal, or diaphragmatic,
hernia occurs when the lower part of the esophagus and a portion of
the stomach slide up through the esophageal hiatus, an opening in
the diaphragm through which the esophagus passes before it reaches
the stomach. In a small percentage of cases, the junction of the
esophagus and stomach remains in place, but a portion of the stomach
rolls up and through the esophageal hiatus alongside the esophagus.
Histal hernias are repaired using
a procedure known as Nissen fundoplication, which is surgery to
repair a bulging (herniation) of stomach tissue through the muscle
between the abdomen and chest (diaphragm) into the chest (hiatal
When the opening (hiatus) in the
muscle between the abdomen and chest (diaphragm) is too large, some
of the stomach can slip up into the chest cavity. This can cause
heartburn (gastro-esophageal reflux: GER) as gastric acid backflows
from the stomach into the esophagus. GER can, over many years,
damage the mucosa of the esophagus and in a minority of cases, is
thought to lead to cancer of the esophagus.
This may be performed
laparoscopically. In a laparoscopic fundoplication, small (1 cm)
incisions are made in the abdomen, through which instruments and a
fiberoptic camera are passed. The operation is performed using these
small instruments while the surgeon watches the image on a video
monitor. Laparoscopic fundoplication results in less pain and
shorter hospitalization times than the open operation.
While the patient is deep asleep
and pain-free (general anesthesia), the stomach and lower esophagus
are placed back into the abdominal cavity. The opening in the
diaphragm (hiatus) is tightened and the stomach is stitched in
position to prevent reflux. The upper part of the stomach (funds)
may be wrapped around the esophagus (fundoplication) to reduce
Patients may need to spend 3 to
10 days in the hospital after surgery.