General Surgery

What a Laparoscopic Procedure Involves

A patient undergoing a laparoscopic procedure will usually come to the hospital on the day of the procedure. Except in unusual cases, the laparoscopy will be done in an operating room with a general anesthetic. For that reason, the patient will need to be fasting after midnight the night before the procedure.

After the surgery, a patient spends 2-3 hours in the recovery room and then goes to a hospital room. Most patients undergoing diagnostic laparoscopy or hernia repair go home the same day. Some patients undergoing gallbladder surgery also go home the same day while other gallbladder patients will spend one night in the hospital after the surgery. Most patients undergoing surgery for reflux, splenectomy, or adrenalectomy will spend one night in the hospital. Other types of surgery, particularly laparoscopic surgery on the stomach or intestine will require a 2-4 day stay in the hospital. However, after discharge home, most patients find they feel better every day until they are fully recovered. Although some patients require no pain medication after going home, most patients require a few pain pills over the first 2-3 days at home.

Laparoscopic Cholecystectomy

This operation removes the gallbladder. In most cases, the gallbladder is removed to treat gallstones that are causing symptoms such as abdominal pain or indigestion. Less commonly the gallbladder is removed when there are no gallstones but there is other evidence of gallbladder disease or malfunction. Most patients spend one night in the hospital and resume normal activities within a week.

Gynecological surgery

Laparoscopy is frequently used to diagnose and manage conditions of the reproductive organs, including endometriosis, ovarian cysts, fibroids, adhesions, uterine diseases and urinary incontinence, as well as to check for ectopic pregnancy, causes of pelvic pain, and tumors. This technique is used to remove polyps and fibroids, perform selective endometrial biopsies and address scarring in the endometrial cavity. Problems of the uterus can be treated through laparoscopic-assisted vaginal hysterectomy, which enables the surgeon to view the pelvic organs while removing the uterus. Tubal sterilization also can be performed laparoscopically.

Fibroids

These are soft tissue tumors of the uterine wall, and can range in size from microscopic to basketball-size. These tumors can cause a variety of problems, such as infertility and abnormal bleeding, as well as significant pain and pressure. Recently developed minimal access surgical options have become so refined that fibroids can often now be treated on an outpatient basis with preservation of the uterus and childbearing capabilities.

Colorectal surgery

In just the past ten years, the field of minimal access, minimally-invasive, or laparoscopic (lap-rah-sca-pick) surgery has skyrocketed. Today, laparoscopic surgery is the standard of care, or operation of choice, for procedures such as cholecystectomy (gallbladder removal) or Nissen fundoplication (wrapping the stomach around the esophagus to correct GERD, or gastroesophageal reflux disease). Generally, the benefits of all the new laparoscopic procedures include less postoperative pain and therefore, less pain medication, faster healing for a quicker return home, and smaller, less noticeable scars after healing.

In 1991, surgeons first began performing laparoscopic-assisted colon resections to treat colorectal cancer and other disorders. Unlike the procedures noted above, colonic resections are technically more difficult, usually requiring dissection in more than one area in the abdomen, in addition to separating the bowel from the blood vessels that supply it in order to remove a portion of the intestine.

In the surgery, the abdomen is inflated with carbon dioxide gas to lift the abdominal wall away from the internal organs. Hollow cylinders called ports are inserted through 1/2" to 1" insertions in the abdominal wall to provide access for the surgical instruments. These ports have valves that permit insertion of instruments but prevent the carbon dioxide from escaping.

The laparoscope, a fiber-optic telescope, is inserted through one port and attached to a camera. It sends images from the abdominal cavity to television monitors placed for easy viewing by all the operating room personnel. Thus, the surgeon and his or her assistants can view the abdominal cavity and its contents. Through the remaining ports, long-handled instruments are used to perform fine dissection, cutting, and suturing, eventually joining two ends of bowel together, called an anastomosis.

Thoracic surgery

Thoracoscopy was first performed in 1910 for the diagnosis of pleural diseases. The procedure was frequently performed under local anesthesia to diagnose and treat pleural tuberculosis. There was limited therapeutic application of this technology until the introduction of video-endoscopic instrumentation in the late 1980s.

Minimally invasive thoracic surgery allows the performance of surgical procedures in the chest cavity utilizing small incisions and specially-adapted, video-endoscopic instruments. This affords a quicker and less painful convalescence for the patient. Many procedures which were previously performed with larger incisions can now be done thoracoscopically, with comparable results. Thoracoscopy is useful for the diagnosis and treatment of a variety of intra-thoracic processes.

Minimally invasive surgery in the chest, referred to as video-assisted thoracic surgery (VATS), is being used for both diagnostic and therapeutic interventions for a number of chest problems that previously required large, open surgical incisions. These procedures include lung, pleural and node biopsies; the removal of peripheral lung nodules; the treatment of pleural effusions and recurrent pneumothorax; resection of small mediastinal tumors; lung-volume reduction for pulmonary emphysema; and surgery for lung cancer, coronary artery disease and valvular disease.

Urological surgery

Laparoscopic and minimally invasive applications in urology have become increasingly valuable in the treatment of disorders, tumors and malformations of the kidney, as well as in kidney transplant. In its early days, laparoscopy was difficult to perform and apply to kidney surgery because the kidneys are hidden behind the abdomen. The technique was subsequently modified and special devices developed to perform hand-assisted laparoscopy. This allows the surgeon greater internal access (through an incision in the abdomen) to better maneuver the laparoscopic instruments used for viewing and for dissection. The surgeon can gently and safely remove the kidney through two small punctures and the three-inch incision made in the abdomen. This procedure can be performed to remove a kidney that contains a tumor (radical nephrectomy) or to remove the kidney from a living donor for transplant.

Pediatric surgery

Minimally invasive surgery, which includes laparoscopy and thoracoscopy, is a group of techniques that allow surgeons to perform operations through very small incisions. A tiny video camera is placed through one incision, and working instruments are passed through others; the surgeon can then perform an operation by watching a video screen while manipulating the instruments.

The procedures for which have used minimally invasive techniques include:

•  appendectomy 
• cholecystectomy (removal of the gall bladder) 
• diagnostic laparoscopy for chronic abdominal pain 
• pull-through procedures for Hirschsprung"s disease 
• splenectomy 
• tumor biopsy 
• pectus excavatum repair 
• pyloromyotomy 
• treatment of empyema (infection in the chest) and pneumothorax (air trapped in the chest) and others.

Advances in video technology have enabled surgeons to perform complex procedures without the traditional unsightly and painful incisions of the past. The use of Minimal Access techniques in infants and children requires surgical and anesthetic expertise, as well as instruments specifically made for conditions common in infants and children.