LAPAROSCOPIC SURGERY

What is laparoscopic surgery?

 

Is a specialized technique known as minimally invasive surgery which allows surgeons to perform many common procedures through small incisions. Laparoscopic surgery uses several 0.5-1cm incisions where a tubular instrument known as a port is inserted.  Specialized instruments and a special camera known as a laparoscope are passed through the ports during the procedure. At the beginning of the procedure, the abdomen is inflated with carbon dioxide gas to provide a viewing space for the surgeon to work in. The laparoscopic camera 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 and with instruments though the ports the surgeon is to perform the same operations as traditional surgery but with smaller incisions.

In certain situations a surgeon may choose to use a special type of port called a ‘hand port’ which is a type of port which is large enough to insert a hand. When a hand port is used the surgical technique is called “hand assisted” laparoscopy. The incision required for the hand port is larger than the other laparoscopic incisions for ports but it is usually smaller than the incision which will be required for open abdominal surgery.

 

What are the advantages of laparoscopic surgery?

 

Compared to traditional open surgery, patients often experience less pain, a shorter recovery, and less internal scarring and a better cosmetic result with a smaller scar with laparoscopic surgery.

 

What kinds of operations can be performed using laparoscopic surgery?

 

Most intestinal, gynaecological and urological procedures can be performed using the laparoscopic technique. These include surgery for gall bladder, appendix, endometriosis, prostate etc.

 

How safe is laparoscopic surgery?

 

Laparoscopic surgery is as safe as open surgery. At the beginning of a laparoscopic operation the laparoscope is inserted through a small incision near the belly button (umbilicus). The surgeon initially inspects the abdomen to determine whether laparoscopic surgery may be safely performed.  If the surgeon encounters other factors that prevent a clear view of the structures or the degree of disease makes it unsafe to proceed with a laparoscopic approach, the surgeon may need to convert by making a larger incision in order to complete the operation safely.

Unfortunately, all abdominal operations are associated with certain risks related to the type of anesthesia or surgery. 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. Your surgeon will provide you or discuss with you at length your individual risk for any operation.

 

 

LAPAROSCOPIC COLON & RECTAL SURGERY - A MORE DETAILED ACCOUNT

 

What is laparoscopic colorectal surgery?

 

Is a specialized and more technologically advanced approach which allows surgeons to perform many colorectal procedures, similar to those performed with traditional open procedures, through smaller incisions.

 

What procedures are suitable for laparoscopic colorectal surgery?

 

Virtually every open colorectal surgical procedure can be performed with the laparoscopic approach. Colorectal cancer, inflammatory bowel disease, diverticular disease, rectal prolapse and severe constipation can all be treated laparoscopically. However for a number of reasons, it may not be appropriate for some patients therefore a consultation with a surgeon qualified in laparoscopic colon resection if is essential.

 

What are the advantages of laparoscopic colorectal surgery?

Patients undergoing colon and rectal surgery often face a long and difficult recovery because the traditional ‘open’ procedures are highly invasive. In most cases, surgeons are required to make a long incision. Surgery results in an average hospital stay of a week or more and usually 6 weeks of recovery. Laparoscopic surgery offers a minimal invasive surgical approach for diseases of the colon and rectum that can enhance recovery. 
Results may vary depending upon the type of procedure and patient's overall condition.

 

Common advantages include:

 

  • Less postoperative pain

  • Shortened hospital stay

  • Faster return to solid-food diet

  • Quicker return of bowel function

  • Quicker return to normal activity     

  • Improved cosmetic results

 

How is laparoscopic colorectal surgery performed?

 

Using a port (a narrow tube-like instrument), the surgeon enters the abdomen. The abdomen cavity is inflated with carbon dioxide gas to provide a viewing space for the surgeon to work in. A laparoscope (a tiny telescope connected to a video camera) is inserted through a port, giving the surgeon a magnified view of the patient's internal organs on a television monitor. Several other ports are inserted to allow the surgeon to work inside and sometimes remove part of the colon and rectum. By using several smaller incisions, one long incision in the abdomen, is avoided. Special long instruments are inserted through these ports to remove part of the diseased colon and/or rectum. The entire procedure may be completed through the ports. In some cases one of the small incisions may be lengthened to 3-5 cm around the belly button or just above the pelvic bone to complete the procedure or extract the resected diseased colon ‘extraction site’. The figures on the left hand side illustrate the typical port sites and extraction sites.

In certain situations the surgeon may choose to use a ‘hand port’ which is a type of port which is large enough to insert a hand. The incision required for the hand port is larger than the other laparoscopic incisions for ports but it is usually smaller than the incision which will be required for open abdominal surgery. By placing a hand in the abdomen the surgeon is sometime able to obtain better exposure and retraction and allow the procedure to be completed laparoscopically rather than converted to an open procedure. When a hand port is used the surgical technique is called “hand assisted” laparoscopy.

 

Is laparoscopic colorectal surgery safe?

In the past, there have been concerns raised about the safety of laparoscopic surgery for cancer operations. However several large worldwide studies involving hundreds of patients have shown that this technique is safe. The National Institute of Clinical Excellence (NICE) has also recommended laparoscopic surgery as an alternative to open surgery for colorectal cancer however they specify that this procedure should only be performed by surgeons who have completed appropriate training in the technique, and who perform this procedure often enough to maintain competence.

 

What happens if the operation cannot be performed or completed by the laparoscopic method?

 

In a number of patients the laparoscopic method cannot be performed. Factors that may increase the possibility of converting to an open procedure may include:

 

  • Obesity

  • A history of prior abdominal surgery causing dense scar tissue (adhesions) which are making it difficult an unsafe to safely proceed with the laparoscopic technique

  • Inability to visualize organs or vital structures safely

  • Bleeding problems encountered during the operation

  • Large advanced tumors

  • The decision to perform the open procedure is a judgment decision made by your surgeon either before or during the actual operation. When the surgeon feels that it is safest to convert the laparoscopic procedure to an open one this is not a complication, but rather sound surgical judgment. The decision to convert to an open procedure is strictly based on patient safety.