Kaushlya Hospitals

Departments

Laparoscopic Surgery


kaushlta Hospital
What is Laparoscopic surgery?

It is a surgery done on organs inside the abdomen,through small punctures,without opening the abdomen.


Does it need Anaesthesia?

Yes, it is done under General Anaesthesia, like any other surgery, since it is not a minor procedure, but a full fledged surgery like any other surgery.


Are the instruments used for it different than routine surgery?

Yes, it needs a totally different instrument setup: The type of equipment needed can be classify follows:

Imaging Equipment

This consists of following

  • Camera :
    This is a small video-camera which is hand held and captures all video pictures inside the abdomen. It can be either a simple single chip camera or state of the art three-chip High Definition camera.
    This camera is connected to a processor on one end and is fitted on to a telescope.
  • Processor :
    This is the heart of imaging system and is technology very advanced it is HD.
    It processes the video captured by the camera and sends it to a Video screen. It is equipped with multiple digital outputs, so that the same video can be transmitted to more screens or recording systems.
  • The Screen or Monitor :
    This is a screen like a T.V., but an advanced high definition medical grade screen, which has many functions and preset programs to show the live image of inside the abdomen. It is technologically more advanced than an ordinary T.V. screen, be it an LCD or Led.
  • Telescope :
    This is a rigid steel tubes of 5mm or 10mm thickness, which has rod-lens system inside to transmit light inside the abdomen, and also carry back the live picture from inside the abdomen.
    This can carry brilliant light inside abdomen to light up the cavity. It also carries back a live video image in High definition and brilliant true colours outside for the surgeon to see and operate.
  • Light Source :
    This needs to be very bright and also cold at the same time. Hence, common types of light sources used are
    1. a. Xenon Light Source : This gives a very brilliant white light like sun and is costly to use.
    2. b. LED : The new lid on the block, is a long lasting source to use.
    The intensity, brightness can be adjusted.
  • Light cable :
    This is a fibre optic cable which carries brilliant light from light source to the telescope.
  • Recording system :
    Many varieties are available from a simple DVD recorder, to Grabbing card based computers to High definition recorders.
  • Insufflator :
    The abdomen has to be distended with carbon dioxide gas in order to have space for manouversing instruments and operating.
    The insufflators are hitch instruments sending the gas at a measured flow rate and maintains a set pressure with all safety presets.

Surgical Instruments:

  • Hand Instruments :
    These are long instruments of almost 1 foot long, only 5mm in diameter and the operating part is at the tip only 1cm long. The handles remain outside the abdomen and the long instrument goes inside the abdomen.
    Most of them are covered with insulation and can be connected to electro cautery.
    All varieties like scissors, graspers, dissectors are available even needle holders for suturing are available.
  • Cannula :
    These are cannula is meaning narrow tubes, which are used to puncture the abdominal wall and through which, long instruments can be put inside the abdomen. The also serve as a conduit for carbon dioxide gas ans have valves so that the gas does not escape.

T.V - Energy sources

Surgery needs a method to make the surgery blood loss. The tissues and blood vessels need to be sealed to stop or prevent bleeding. For this various electrical and non electrical devices are used.

  • a. Electro cautery :
    all instruments can be connected to a coutery which generates electrical current. When a blood vessel is held in an instrument and electrical current is passed through the jaws, the vessel opening gets sealed and bleeding stops. This can be unipolar, Bipolar, or advanced vessel sealing device.
  • Harmonic scalpel :
    In this, the blades of instrument vibrate 55,000 times per second, thereby producing heat and energy and this seals the blood vessels. This instrument can cut and seal the tissues at different settings, hence can be used for cutting through tissues and stopping bleeding.

How is Laparoscopic Surgery done:
kaushlta Hospital
  1. After Anaesthesia, the abdomen is cleaned and draped with sterile cloths.
  2. First step is to make entry into abdomen with a cannula and trocar through a small opening of 1cm incision- a small hole, for this commonly, first a special needle is passed into abdominal cavity and CO2 gas is introduced so that the abdominal cavity is filled with gas and space is created between abdominal wall and intestines. Then a 10mm cannula with trocar is introduced in to the abdomen.
  3. Through this cannula, Telescope is introduced inside the abdomen. Since, this telescope is connected to camera, the surgeon can seen a brilliant view of inside the abdomen. Surgeon surveys the entire abdomen and then focuses on the area of surgery to be performed.
    e.g. Right lower abdomen for appendix, upper abdomen for Gall bladder etc.
  4. After this additional two or three 5mm cannula’s are inserted in abdomen to allow surgeon to insert two or three instruments inside abdomen to operate.
  5. The surgeon stands besides the patient and holds the handles of instruments outside the abdomen and looks up at the screen.
  6. Continuously looking at the screen, surgeon operates with instruments which have gone inside abdomen.
  7. An assistant nurse or surgeon holds the camera and shows the inner picture continuously.
  8. After completion of surgery, the organ like Appendix and Gall bladder are removed through the hole of camera and all the cannulas are removed.
  9. All these puncture hole are closed by a single stitch.

What are advantages of Laparoscopic surgery?
  • No big incision / opening on/off abdomen.
  • Two to four single stitches for the holes made for instruments
  • Patient goes home on second or third day- very short hospital stay.
  • Patient can start working in four to ten days time very early return to work.
  • Minimal postoperative pain.
  • Less need for prolonged injections, saline or medicine
  • Blood transfusion rarely required.

What surgeries can be done Laparoscopically?
  • The surgeries can be classified as Basic and advanced surgeries.
  • Basic surgeries are done by most laparoscopic surgeons.
  • Advanced surgeries are technically more demanding, need special training and expertise, hence they are done by few Laparoscopic surgeons.

Examples of these are

  • Basic Surgeries
    1. 1. Basic Surgeries
    2. 2. Laparoscopic Appendicectomy
    3. 3. Cholecystectomy ( Gall Bladder removal)
    4. 4. Infertility procedures.
  • Advanced Laparoscopic Surgeries
    1. 1. Inguinal Hernia Repair
    2. 2. Incisional Hernia repair
    3. 3. Hiatus Hernia
    4. 4. Achalasia Cardia
    5. 5. Acute abdominal conditions
    6. 6. Colonic Resections
    1. 7. Rectopexy
    2. 8. Splenectomy
    3. 9. Nephrectomy
    4. 10. Adrenalectomy
    5. 11. Rectal Cancer surgery
    6. 12. CBC exploration
    1. 13. Colonic Cancer
    2. 14. Gastric cancer
    3. 15. Liver Surgery
    4. 16. Thoracic surgery
    5. 17. Bariatric (Obesity) surgery

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