In cases where the size of the specimen is large, the length of the incision can be larger (usually 10mm). For example, in surgeries like nephrectomy or colectomy where the size of the specimen is larger the incision is also a little larger when compared to regular laparoscopic surgery. Sometimes the large size of a specimen warrants a larger incision in which case surgeons prefer using their hands as it allows them to palpate the tissue and also offers greater manoeuvrability; in such cases surgeons use a specialized device called a hand access port (a sleeve with a seal that allows passage of the hand). Surgery that involves using a hand access port is known as hand-assist laparoscopy.
Most surgeons agree that even in cases that require hand-assist laparoscopy the surgery time is much lower, and the incision is smaller compared to conventional surgery. Apart from reducing the size of the incision, laparoscopic surgery is considerably less invasive when compared to traditional surgery this means post-operative recovery is much faster. The purpose of laparoscopic surgery is to reduce post-operative pain and also to reduce the recovery time. For example, laparoscopic cholecystectomy patients are usually discharged in 2 or 3 days. Studies have also concluded that post-operative infection and the incidences of incisional hernias are much lower in laparoscopic surgeries. In fact, laparoscopic surgery was initially designed to carry out routine procedures much faster without complications and minimal post-operative care.
If you are scheduled for surgery make sure you speak to your surgeon and find out if you are eligible for laparoscopic surgery. Not only is laparoscopic surgery much safer, it will also ensure you are discharged from the hospital much faster. Today laparoscopic surgery is a highly competitive and specialized field of surgery. Remember, it pays to spend a little extra to be free from post-operative pain and enjoy a quicker recovery.
Laparoscopic cholecystectomy is the most common laparoscopic procedure performed. In this procedure, 5-10mm diameter instruments (graspers, scissors, clip applier) can be introduced by the surgeon into the abdomen through trocars (hollow tubes with a seal to keep the CO2 from leaking). Rather than a minimum 20cm incision as in traditional cholecystectomy, four incisions of 0.5-1.0cm will be sufficient to perform a laparoscopic removal of a gallbladder. Since the gall bladder is similar to a small balloon that stores and releases bile, it can usually be removed from the abdomen by suctioning out the bile and then removing the deflated gallbladder through the 1cm incision at the patient's navel. The length of postoperative stay in the hospital is usually 2-3 days.
In certain advanced laparoscopic procedures where the size of the specimen being removed would be too large to pull out through a trocar site, as would be done with a gallbladder, an incision larger than 10mm must be made. The most common of these procedures are removal of all or part of the colon (colectomy), or removal of the kidney (nephrectomy). Some surgeons perform these procedures completely laparoscopically, making the larger incision toward the end of the procedure for specimen removal, or, in the case of a colectomy, to also prepare the remaining healthy bowel to be reconnected (create an anastomosis). Many other surgeons feel that since they will have to make a larger incision for specimen removal anyway, they might as well use this incision to have their hand in the operative field during the procedure to aid as a retractor, dissector, and to be able to feel differing tissue densities (palpate), as they would in open surgery. This technique is called hand-assist laparoscopy. Since they will still be working with scopes and other laparoscopic instruments, CO2 will have to be maintained in the patient's abdomen, so a device known as a hand access port (a sleeve with a seal that allows passage of the hand) must be used. Surgeons that choose this hand-assist technique feel it reduces operative time significantly vs. the straight laparoscopic approach, as well as providing them more options in dealing with unexpected adverse events (i.e. uncontrolled bleeding) that may otherwise require creating a much larger incision and converting to a fully open surgical procedure.
Conceptually, the laparoscopic approach is intended to minimise post-operative pain and speed up recovery times, while maintaining an enhanced visual field for surgeons. Due to improved patient outcomes, in the last two decades, laparoscopic surgery has been adopted by various surgical sub-specialties including gastrointestinal surgery (including bariatric procedures for morbid obesity), gynecologic surgery and urology. Based on numerous prospective randomized controlled trials, the approach has proven to be beneficial in reducing post-operative morbidities such as wound infections and incisional hernias (especially in morbidly obese patients), and is now deemed safe when applied to surgery for cancers such as cancer of colon.
The restricted vision, the difficulty in handling of the instruments (new hand-eye coordination skills are needed), the lack of tactile perception and the limited working area are factors which add to the technical complexity of this surgical approach. For these reasons, minimally invasive surgery has emerged as a highly competitive new sub-specialty within various fields of surgery. Surgical residents who wish to focus on this area of surgery, gain additional training during one or two years of fellowship after completing their basic surgical residency.
The first transatlantic surgery (Lindbergh Operation) ever performed was a laparoscopic gallbladder removal.
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Dr.R.K.Mishra has sinced written about articles on various topics from Medical Condition. Resource BoxDr. R. K. Mishra is the author of textbook "Text Book of Laparoscopic Surgery for General Surgeons and Gynaecologists". Dr. Mishra is also Chairman of Delhi Laparoscopy Hospital Private Limited and is one of the leading laparoscopi. Dr.R.K.Mishra's top article generates over 2900 views. to your Favourites.
Aksatech Solutions Pvt. Ltd has sinced written about articles on various topics from Medical Condition, Software and SEO Search Engine Optimization. About the Author: Dr. M G BhatMBBS , MS, FRCS ( England), FRCS (Edinburgh), FICS DMLE (Medical Law), DMIRCSEd (Informatics) Consultant Surgical Gastroenterology and Laparoscopy,. Aksatech Solutions Pvt. Ltd's top article generates over 2900 views. to your Favourites.