What Is Laparoscopic Surgery ?

Laparoscopic Surgery also referred to as Minimally Invasive Surgery describes the performance of surgical procedures with the assistance of a video camera and several thin instruments. During the surgical procedure, small incisions of up to half an inch are made and plastic tubes called ports are placed through these incisions. The camera and the instruments are then introduced through the ports which allow access to the inside of the patient.

The camera transmits an image of the organs inside the abdomen onto a television monitor. The surgeon is not able to see directly into the patient without the traditional large incision. The video camera becomes a surgeon’s eyes in laparoscopy surgery, since the surgeon uses the image from the video camera positioned inside the patient’s body to perform the procedure.

Benefits of minimally invasive or laparoscopic procedures are : 

• Less post operative discomfort since the incisions are much smaller
• Quicker recovery times
• Shorter hospital stays
• Earlier return to full activities
• Much smaller scars
• There may be Less Internal Scarring when the procedures are performed in a minimally invasive fashion compared to standard open surgery.

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Advance laparoscopic surgery with hand-access devices in India

The human hand performs many functions during surgery that are difficult to reproduce with laparoscopic instruments. The loss of the ability to place the hand into the abdomen during traditional laparoscopic surgery has limited the use of laparoscopy for complex abdominal surgery on the pancreas, liver and bile duct.

Hand-access devices are new laparoscopic devices that allows the surgeon to place a hand into the abdomen during laparoscopic surgery and perform many of the different functions with the hand that were previously possible only during open surgery. Dilip Parekh M.D. at USC has utilized these new devices to develop a variety of laparoscopic pancreatic, liver and biliary procedures such as the Whipple operation, distal pancreatectomy and liver resection that were not possible previously by standard laparoscopic techniques.

Laparoscopic surgery for liver, pancreas and bile duct disease have had considerable success in our hands. Patients with laparoscopic surgery have much shorter hospital stays, less pain, rapid recovery and early return to work compared to patients with open surgical procedures.

How the Test is Performed ?

The procedure is usually done in the hospital under general anesthesia. A catheter (a small flexible tube) is inserted through the urethra into the bladder. An additional tube may be passed through the nostril into the stomach (NG tube). The skin of the abdomen is cleaned, and sterile drapes are applied.

After a small cut is made above or below the belly button (navel), a tube is inserted. A tiny video camera passes through the tube. Carbon dioxide gas is injected into the abdomen to lift the abdominal wall, making a larger space in which to work. This allows for easier viewing and moving of the organs.

The laparoscope is then inserted, and the organs of the pelvis and abdomen are examined. Additional small openings are made for instruments that let the surgeon move, cut, stitch, and staple structures during the operation.

After the examination, the laparoscope is removed, all openings are stitched closed, and bandages are applied. Depending on the operation performed, a tube may be left through one of the cuts to let fluids drain.

How the Test Will Feel ?

With general anesthesia, you will feel no pain during the procedure. However, the stitched cuts may throb and be slightly painful afterward. Your doctor may give you a pain reliever.

You may experience shoulder pain for a few days, because the gas can irritate the diaphragm, the large muscle at the top of the belly. Some of the nerves in the diaphragm also go to the shoulder.

Finally, you may experience an increased urge to urinate, because the gas can put pressure on the bladder.

Why the Test is Performed ?

A diagnostic laparoscopy may be done if your doctor cannot tell what type of problem or injury you have based on the results of a physical exam or other tests.

A diagnostic laparoscopy may be done if you have:

• Pain or other symptoms that cannot be explained
• An injury
• Cancer that may have spread (cancer staging)

How do we perform our surgery?

All of our patients are administered general endotracheal anesthesia. This means the child is completely asleep with anesthesia. The endotracheal tube protects the airway and allows for us to breathe for the patient. We perform formal cystoscopy at the start of our procedures. Here we use a camera to look inside the bladder and pass a stent with an infrared laser fiber (Infravision infrared ureteral stent, Gabriel Medical, Inc., Lafayette, LA) for assistance in identification and dissection of the ureter if need be. Three small skin incisions are made in order to place the laparoscopic camera and surgical instruments. The incisions are 1.5 cm in size usually; small enough to be dressed with a Band-Aid at the end of the case.

The first incision is made in the upper portion of the umbilicus. Carbon Dioxide gas is used to insufflate the belly allowing us to have room to visualize and perform the procedure. The other two incisions are made just below the rib overlying the affected kidney, and over the region of the hipbone. Now with all of the instruments in place, the kidney and ureter can be freed from surrounding tissues and all portions of the kidney that need to be removed can be done laparoscopically. At the end of the procedure, the abdominal cavity is inspected for any sites of bleeding. Once all is bleeding is stopped, the skin incisions are covered with Band-Aids or appropriate sterile dressings.

The patient is immediately transported to the recovery room after being wakened up in the operating room. Most of the children are eating a regular meal the same day and can go home that day. Some of the older children spend an extra day in the hospital until they are tolerating a regular meal.

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