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ABOUT
LAPAROSCOPIC SURGERY
1. What
is Minimally Invasive Surgery?
Minimally
Invasive Surgery, some people
refer to this simply as MIS,
is a broad term for any procedure
performed with small incisions
(or sometimes no incisions at
all).
Laparoscopic
Surgery refers to MIS in the
abdominal cavity. A telescope
and long, fine caliber instruments
are inserted into the abdomen
to see and perform the surgery.
The incisions used are 5 to
10 mm in size. These incisions
heal quickly after surgery,
resulting in small "keyhole"
scars. Sometimes, even finer
instruments are used (2 to 3
mm) in what we call Needlescopic
Surgery. This results in "pinhole"
scars that are hardly discernable.
The
same technique is called Thoracoscopic
Surgery when used in the thoracic
cavity (to approach the esophagus,
for example) or Endoscopic Surgery
when used elsewhere (for example
in the neck for Endoscopic Thyroid
Surgery).
2.
Can my operation be done using
Laparoscopic Surgery?
Almost
any conventional operation can
be done laparoscopically. This
can something simple, like the
removal or a gallbladder or
appendix, to something very
complex, like the resection
of the stomach for cancer. Some
of the complicated operations
can be technically demanding,
and a good outcome depends on
the skill and experience of
the surgeon. In general, we
believe that, under our hands,
the laparoscopic options gives
a better result. Occasionally
however, laparoscopic surgery
is contraindicated in certain
patients, and some operations
may be too difficult to offer
any substantial benefit over
conventional open surgery.
3.
What are the contraindications
to Laparoscopic Surgery?
The
only absolute contraindications
are an unstable patient (for
example, someone who is bleeding
actively from trauma) or a patient
who is unfit for general anaesthesia
(since GS is always required
for laparoscopy). In certain
patients, the contraindications
are relative and have to be
evaluated individually. These
patients include those who have
severe heart or lung disease,
have previous abdominal surgery,
bowel obstruction or bleeding
problems.
4.
What about pregnant patients?
In
general, we try to not to do
elective surgery during pregnancy.
In those cases where we must,
we try to delay the operation
until the second trimester,
or until fetal viability, or
till after delivery. If surgery
is absolutely essential, laparoscopic
surgery is as safe as open surgery,
and even offers certain advantages.
However, great care has to be
taken with surgery and anaesthesia
as the dangers are real: about
12% risk of miscarriage in the
first trimester, 5 to 8% risk
or preterm labour in the second
trimester and 30% risk of preterm
labour in the third trimester.
5.
What are the benefits of Laparoscopic
Surgery?
Since
only "keyhole" incisions
are used, the post operative
functional recovery is rapid.
Most patients are discharged
from hospital faster and return
to work earlier. There is less
wound pain and the cosmetic
outcome is excellent. In the
long term, there are fewer problems
with post-surgery bowel adhesions.
There is also recent evidence
to suggest that the reduced
disturbance to the immune system
during laparoscopy results in
better survival after cancer
resection when compared to open
surgery. This is because the
minimal insults allow the body
to fight off circulating cancer
cells more effectively.
6.
Are there any disadvantages
of Laparoscopic Surgery?
Laparoscopic
surgery is technically more
difficult than conventional
open surgery. Moreover, as some
of these procedures have only
evolved in the last few years,
not all surgeons are trained
to perform them. Surgeon related
errors can occur. Finally, laparoscopic
surgery often takes longer to
perform and may cost more in
terms of equipment used - although
this is not always so!
Links
to specific laparoscopic procedures:
Diagnostic
Laparoscopy for Abdominal Pain
Laparoscopic
Groin Hernia Repair
Laparoscopic
Incisional / Umbiliacal Hernia
Repair
Laparoscopic
cholecystectomy
Laparoscopic
Splenectomy
Laparoscopic
Adrenalectomy
Laparoscopic
Fundoplication
Laparoscopic
Myotomy for Achalasia
Laparoscopic
Gastric Banding for Morbid Obesity
Laparoscopic
Staging and Laparoscopic Ultrasound
Laparoscopic
Bypass and Laparoscopic Palliation
for Cancer
Endoscopic
Thyroidectomy
Thoracoscopic
Sympathectomy for Sweaty Palms
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