Laparoscopic Introduction

introduction to laparoscopic surgery

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 the organs.

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 children.

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.

Laparoscopic Colon Surgery:-

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 properly.

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 function.

Some common colon problems include:

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.

Diverticulosis and 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 (IBD) 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 hernia).

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 reflux.

Patients may need to spend 3 to 10 days in the hospital after surgery.


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