Advanced Laparoscopy

The advent of laparoscopic surgery has created a revolution in abdominal surgeries. Initially applied just for diagnostic purpose, it has rapidly gained popularity for the management of appendicitis and gallstone disease, making it the gold standard treatment for these conditions. With improvement in the instrumentation and surgical skills today almost all of the abdominal surgeries are safely possible by laparoscopic method in expert hands and after proper patient selection. All this has led to a low threshold for surgical treatment for many conditions as the morbidity related to surgery has gone down significantly with laparoscopic surgeries.

Laparoscopic or “minimally invasive” surgery is a specialized technique for performing 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.” 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 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.

Compared to traditional open surgery, patients often experience less pain, a shorter recovery, and less scarring with laparoscopic surgery. Many of the complications of open surgery like huge incisional hernias and intestinal adhesions leading to intestinal obstruction (blockage of the intestinal passage) that requires surgical management can be reduced significantly by routine use of the laparoscopic method. Also, laparoscopic surgery keeps the integrity of the abdominal wall intact, which keeps the abdominal wall in its best functional state (which is required for body movements like getting up from lying and bending down position). Hence laparoscopic surgery has many functional advantages apart from cosmetic advantages.

Most intestinal surgeries can be performed using the laparoscopic technique. 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 properly selected colorectal, small bowel, esophageal and pancreatic cancers and provides benefit in terms of improved recovery after surgery and low morbidity.

Laparoscopic surgery is as safe as traditional open surgery in expert hands. 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 to 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.

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