• Rukmani Birla Hospital,Gopalpura Bypass Road, Near Triveni Bridge,Gopalpura,Jaipur – 302018.

Category Archives: Minimal Invasive surgery

Laparoscopic Surgery for Gastrointestinal Disorders

Gastrointestinal surgery is a treatment for diseases of the parts of the body involved in digestion. This includes the esophagus (food pipe), stomach, small intestine, large intestine, and rectum. It also includes organs like the liver, gallbladder, and pancreas.

Surgery may be used to remove any growth or damaged part of the body, such as the intestine. It may also be used to rectify a problem like a hernia (a hole or weak spot in the wall of the abdomen). Minor gastrointestinal surgical procedures are used to screen and diagnose problems of the digestive system.

Gastrointestinal surgery is done by taking incisions into the abdomen with a scalpel (a surgical knife) and other tools. Some surgery is done with a scope — a thin tube with a camera and small surgery tools.

How does laparoscopic surgery help in gastrointestinal surgery?

Laparoscopic surgery and hand-assisted laparoscopic surgery (HALS) are “minimally invasive” procedures commonly used to treat diseases of the gastrointestinal tract. Unlike traditional surgery on the colon or other parts of the intestines where a long incision down the center of the abdomen is required, laparoscopic surgery requires only small “keyhole” incisions in the abdomen. In the case of hand-assisted surgery, a 3 to 4 inch incision is also used to allow the surgeon’s hand access to the abdominal organs. As a result, the person undergoing the procedure may experience less pain and scarring after surgery, and a more rapid recovery.

During Gastrointestinal laparoscopic surgery, ideally three or more small (5-10 mm) incisions are made in the abdomen to allow access ports to be inserted. The laparoscope and surgical instruments are inserted through these ports. The surgeon then uses the laparoscope, which transmits a picture of the abdominal organs on a video monitor, allowing the operation to be performed.

Which gastrointestinal conditions can be treated with laparoscopic surgery?

  • Appendicitis. When the appendix becomes infected and inflamed, it may be removed (appendectomy).
  • Colon cancer and other gastrointestinal cancers. Surgery is done to remove cancerous tumors in the digestive system and parts of the digestive system that have cancer. Diverticular disease. A diverticulum is a small pouch or pocket in the colon (large intestine).Sometimes they can become inflamed and cause pain (diverticulitis).
  • Gallbladder disease. When there is a problem with the gallbladder usually gallstones, the gallbladder can be removed. Surgery to remove the gallbladder is also called a cholecystectomy.
  • Gastroesophageal reflux disease (GERD) and hiatal hernias. GERD, or acid reflux is when the acid from the stomach backs up into the esophagus (food pipe) and causes heartburn. Sometimes it happens because of a hiatal hernia.
  • Hernia. A hernia is when a part of the body (like the intestine) comes through a hole or weak spot in the wall of muscle or connective tissue that’s supposed to protect it (like the abdomen).
  • Inflammatory bowel disease (Crohn’s disease and ulcerative colitis). With inflammatory bowel disease, the immune system attacks the intestines and causes pain and inflammation.
  • Rectal prolapse. Surgery is used to treat rectal prolapse, a condition in which part of the intestine comes through the anus.
  • Weight loss. Different types of bariatric surgery (for example, gastric bypass) may be done to treat obesity.

Pre-operative precautions for laparoscopic surgery

Before laparoscopic surgery is scheduled, your surgeon will take a detailed history and do a thorough evaluation and examination. Your intestine will require cleaning and you will be given a prescription for a laxative medicine to take the evening before the surgery.

All patients are generally asked to provide a blood sample. Depending on your age and general health, you may also have an ECG (electrocardiogram), a chest X-ray, lung function tests, or other tests.

Finally, you will meet with an anesthesiologist, who will discuss the type of pain medication (anesthesia) you will be given for surgery, and you will learn about pain control after the operation.

The evening before surgery you will need to take the prescribed laxative medicine. It is important to follow the directions carefully and drink all of the laxative. This step will decrease your risk of developing an infection from bacteria normally present in the intestine.

Food and any other drinks by mouth is prohibited after midnight or the evening before surgery.

Post-operative precautions after laparoscopic surgery

Post-operative the patients are kept on assisted respiration and intubated. Pain medication will be given as per progress of recovery. It is important to document all the intake of and measure and collect any liquid outputs, like urine and also including those from tubes or drains placed during the operation.

Nausea and vomiting happen in approximately 5%-10% of people and occur because your intestines are temporarily disabled from the operation. In addition, anesthesia makes many people nauseous. For this reason, food and drink are given slowly for the first few days.

You will be encouraged to get out of bed and walk, starting the first day after the operation. The length of your hospital stay will depend on the type of procedure you have and how quickly you recover.

Advantages of minimally invasive gastrointestinal laparoscopic surgery:

  • Quicker recovery
  • Quicker return to normal activities and work
  • Shorter hospital stay
  • Reduced rate of infection
  • Reduced recurrence rate
  • Minimal scarring

UNDERSTAND ROBOTIC LAPAROSCOPIC SURGERY

Robotic surgery or robot-assisted surgery is an innovative method, associated with non-invasive or minimally invasive surgeries such as laparoscopy. A surgical robot is a device controlled by a computer which has been programmed to help the placement and usage of surgical instruments. The most widely used robotic surgical procedure involves mechanical and camera arms, containing surgical instruments controlled by the surgeon from a computer. The surgery is being increasingly accepted since it allows better clarity, high-definition vision of the surgical site and also allows conducting complex procedures with enhanced precision, flexibility and control.

Robotic laparoscopic surgery has been conducted since the 1980s to overcome the limitations of a general laparoscopy such as a two-dimensional view, partial articulation of surgical instruments, and lack of efficiency. Robotic laparoscopic surgery helps to overcome these limitations and convert invasive surgeries such as laprotomy into minimally-invasive methods. 

Advantages

Several advantages of robotic laparoscopic surgery include:

  • Improved precision, flexibility and control
  • Better view of the problem area
  • Promotes complex surgical methods
  • Fewer complications
  • No infections
  • Minimum and bearable pain
  • Lesser trauma
  • Less blood loss
  • Less scarring – which can be cosmetically treated
  • Easy and fast recovery
  • Faster resuming of normal activities

Surgeries Done

Some laparoscopic surgeries that have been successfully done by through the robotic-technique are:

  • Repairing of hernia
  • Pyloroplasty – Widen the opening of the lower stomach
  • Removing of the adrenal gland
  • Appendix removal
  • Gallbladder removal
  • Removal of colon
  • Kidney removal
  • Reinforcing the valve between esophagus and stomach
  • Prostate removal
  • Uterus removal
  • Treating fibroids

Complications

Robotic laparoscopic surgery has rare complications, though some general problems that may arise during or post the surgery include:

  • Possible damage to surrounding organs and tissues
  • Infection
  • Bleeding
  • Reactions or allergies to anaesthesia
  • Failure of surgery and need for an invasive traditional method

Risk Factors

A few factors increase the likelihood of complications in Robotic Laparoscopic Surgery. These factors include:

  • Smoking
  • Chronic heart problems
  • Existing lung issues
  • Obesity
  • Diabetes
  • Excessive alcohol
  • Drug and substance abuse
  • History of abdominal or pelvic operation
  • Certain medications

All factors must be discussed with the doctor before the surgery to avoid serious problems.

Procedure of the Surgery

Similarly, like a normal laparoscopic surgery, even in Robotic Laparoscopic Surgery, the doctor will conduct physical exams and several other tests such as blood tests, urine tests, ECG, X-ray, ultrasound or a CT scan to assess the condition of the organ.

All current medications, health problems, allergies must be discussed with the doctor beforehand and medications, diet, etc. as suggested by the doctor must be taken as advised. Moreover, a family or friend in assistance must be called for.

Before beginning the procedure, the doctor will place the patient under anaesthesia – general or local – depending on the intensity of the procedure. Post this, the doctor makes small incisions, also called keyhole incisions to allow carbon dioxide to enter the abdomen for it to expand, making it easier to visualize the area.

Post this, an endoscope is inserted into the area through one of the incisions, which provides clear, magnifying images of the organ on a monitor. This endoscope is attached to a robotic arm, while the other robotic arm holds forceps, scissors, dissectors and scalpels – needed to hold, cut, dissect and close the surgery. All this while, the doctor monitors the screen images and then guides the robotic arms to perform the surgery. The surgery is about 1-2 hours long and does not cause pain because of the influence of anaesthesia. However, even post-operative pain is very less and can easily be managed with some medications. That said, gas problems might occur for a few days post the surgery but will eventually smoothen. A person recovers easily within 3-5 days and can resume normal, routine activities post complete recovery unless there are any complications.

Post the procedure, the doctor will also advise on the steps to be followed to enhance recovery and ensure no complications. You may be advised to:

  • Clean the incisions with soft soap and water
  • Avoid rigorous activities
  • Take one day at a time; do not rush the recovery process
  • Undertake physical therapy, if required

Also, it is also important to understand the alarming symptoms that must be noted, if they appear to post a robotic laparoscopic surgery. Some of the symptoms that would need you to call the doctor are:

  • Infection
  • Fever and chills
  • Excessive bleeding
  • Uncontrollable pain
  • Discharge, redness, swelling at the incision site
  • Bloody stool
  • Nausea and vomiting
  • Bowel problems
  • Loss of consciousness
  • Extreme headache
  • Extreme vaginal bleeding or discharge
  • Breathlessness
  • Chest pain
  • Swelling and pain in the abdomen
  • Inability to eat or drink
  • Digestive problems
  • Swollen legs and feet

Overall, the benefits of a robotic laparoscopic surgery outweigh the few, rare complications and risks. However, each case needs to be evaluated individually; hence, advice from a doctor should be taken before deciding on the procedure.

BREAST AUGMENTATION SURGERY – PROCEDURE, RISK AND RECOVERY

Breast Augmentation surgery also referred to as augmentation mammoplasty is a surgical method to increase the size of the breasts by inserting saline or silicone implants. These implants are inserted behind the breast tissue or the chest muscle to fulfil either of the below purposes:

  • Enlarge naturally small breasts
  • Reshape and restore the size of breasts post-pregnancy and breastfeeding
  • Restore the size of the breasts after weight loss
  • Repair the breasts post-surgery
  • Correct the symmetry of breasts

Breast augmentation surgery is performed under general anaesthesia and takes about 60-90 minutes. It is a very important decision and hence, must be taken after careful consideration and evaluation of all risks, procedures, after-effects and recovery process. 

Risks of Breast Augmentation Surgery

Breast augmentation surgery can involve various risks and complications; some of these include:

  • Pain in the breasts
  • Infection
  • Modifications in the nipple
  • Damage to nerves of the nipples (this can make the nipples more or less sensitive or can completely lose feeling)
  • Sensation in the breasts
  • Leakage from the implants
  • Rupture of implants
  • Distortion of the breast shape due to scar tissue
  • Swelling and bruising
  • Tight feeling in the chest (this may last for a few weeks)
  • Thick, noticeable scarring
  • Hardening of the breast tissue
  • Prominent creases or folds in the implants
  • Inability to breastfeed or produce less milk comparatively
  • Excessive bleeding
  • Allergic reaction to anaesthesia
  • Blood clots in veins

In some rare cases, women also become highly prone to develop a special type of cancer which affects the immune system cells and is called the anaplastic large cell lymphoma (ALCL). Different implants come with varied risks; hence, it is very important to evaluate all risks and advantages before breast augmentation surgery.

In case, a patient experiences any of the above risks, there might be need to perform another surgery to correct the risk or remove or replace the implants. In some cases, the results of the surgery might not be as per expectations leading to the dissatisfaction of the patient; in some cases as these, people do consider another breast augmentation surgery.

Procedure for Breast Augmentation Surgery

Before the patient proceeds with the surgery, a detailed discussion regarding the expectation and need from the surgery will be discussed with the surgeon. Depending on the preference of size, feel and shape of the breasts, the suitable implants will be suggested – smooth or textured, round or teardrop-shaped, or saline or silicone. Moreover, the surgical method will be discussed in detail. Before the surgery, the following points should be considered:

  • The implants will not prevent sagging
  • Implants have a specific life, and they do not last forever
  • The surgery might hamper breastfeeding

The doctor will also advise you to refrain from certain specific medications and activities such as smoking to ensure the procedure is successful. A breast augmentation surgery is conducted in a surgical centre, and the patient is discharged on the same day in most cases. The surgical procedure is under the influence of general or local anaesthesia (depending per case) and lasts for about 90 minutes.

To place the implants, the surgeon will make an incision in any of these places:

  • Crease under the breast
  • Under the arm
  • Are around the nipple

Once that is done, the surgeon will then divide the breast tissue from the muscles and the connective chest tissue. This step is done to create a small pocket in the outermost chest wall muscle (in front or behind); the surgeon then places the implants in this pocket and sets them correctly with the nipple places in the centre. In the case of saline implants, the implants are inserted empty and then filled with sterile water, while in the case of silicone implants, the implants are pre-filled with silicone. Once the implants are appropriately placed and have set-in well, the surgeon closes the incision with sutures. 

Recovery after a Breast Augmentation Surgery

Post the surgery, the patient might experience some soreness or swelling in the area; some other issues such as pain and bruising are also quite common. These tend to fade away automatically; however, there may be some scars that might fade but not disappear completely.

The recovery process after a breast augmentation surgery is not very long but requires attentive care and certain precautions. One must wear a compression bandage or a well-fitted sports bra to provide extra support to the new implants. The doctor might prescribe certain medications as well to improvise healing and reduce pain, if any.

Careful consideration must be taken before returning to normal activities, and the same should be discussed with the doctor. However, in general cases, it might take a few weeks to resume everyday functioning completely. During the recovery period, all types of physically strenuous activities are to be avoided, since that can raise the blood pressure or pulse. Moreover, during this time, physical contact and sudden movements should be avoided since the breasts will be really sensitive.

In cases, where the sutures do not dissolve on their own post the surgery, a follow-up appointment will be needed. Also, if the surgery was followed with placing drainage tubes near the breasts, another appointment to remove the tube will be required.

That said, it is very critical to be alert for any abnormal symptoms or risk factors that can possibly cause a lot of harm. In case there is any doubt or concern, the doctor should be contacted immediately.

PROCEDURES WHICH CAN BE DONE THROUGH LAPAROSCOPIC SURGERIES

Laparoscopic surgery is a minimally invasive, specialized medical technique for performing a surgery. Unlike an open surgery, a laparoscopic surgery uses multiple small incisions – 0.5-1 cm – known as ports to insert the laparoscope in the body. A laparoscope is a long, thin, flexible tool mounted with a tiny, high resolution video camera and high-intensity light, which when inserted into the body provides insights into the inner functioning of the targeted body organ or area. As the tool moves in the body, it sends images on a video monitor. This enables the doctor to know the exact condition of the area, decide the course of treatment and also perform surgeries to treat problems. The procedure can also be used to collect a biopsy or a sample tissue from the targeted organ or area. A laparoscopic surgery is also known as keyhole surgery and is recommended since it barely uses any cuts – generally four including the incision made to enter the body.

In all, a laparoscopic surgery can be used to treat problems affecting the body organs such as:

  • Appendix
  • Gallbladder
  • Liver
  • Pancreas
  • Small intestine
  • Large intestine
  • Spleen
  • Stomach
  • Pelvis
  • Other reproductive organs

Benefits of a laparoscopic surgery

A laparoscopic procedure is one of the safest procedures when all non-invasive techniques fail. A laparoscopic surgery has many benefits such as:

  • In-depth and realistic insights into the body organ or area
  • Minimum and smaller cuts
  • Barely any scars
  • Less painful
  • Quick healing
  • Minimum side-effects
  • Quick recovery time
  • Less internal scarring
  • Economical
  • Higher success rates
  • Low chances of infection

Procedures performed through laparoscopic surgery

Some procedures which can be performed through a laparoscopic surgery include:

  • Biliary Tract Operations: Procedure to remove gallstones and treat biliary tract diseases can be performed through laparoscopic surgery. Moreover, all uncomplicated cases of chronic cholecystitis can be treated with the help of laparoscopic cholecystectomy.
  • Tubal Sterilisation:  A laparoscopic surgery can be used to perform a hysterectomy in which the uterus is detached from the inside of the body. It is then removed from the body in pieces through small abdominal incisions or in one-time through the vagina.
  • Gastrointestinal Procedures: Various gastrointestinal conditions – such as infected appendix, abnormal adrenal growth, obesity, gallstones, problems of large intestine, gastric tract problems, hiatal hernia, inguinal hernia, gastroesophageal reflux disease (GERD), diseased/cancerous kidney, infected pancreas, testicular cancer, spleen removal, and others – can be treated through laparoscopic surgery.
  • Abdominal Procedures: Various abdominal procedures including splenectomy, adrenalectomy and nephrectomy can be performed through laparoscopic surgeries. Moreover, in case of intra-abdominal malignant tumours, laparoscopy surgery is also very useful. Also, gastric (gastrojejunostomy), biliary (cholecystoen-terostomy), intestinal and colonic bypass – can be done through laparoscopy.

Moreover, with more advancement in medical technology, laparoscopic surgeries are increasingly being used in more complicated procedures to reduce complications, improve results, minimise scarring, enhance recovery and improve chances of success.

Risks of a Laparoscopic Surgery

While a laparoscopic surgery is an easy and simple procedure with minimum risks or side effects, yet one must be aware of the potential risks that might occur in some rare cases. These risks include:

  • Infection
  • Damage to organs
  • Damage to internal structures such as bowel, bladder, blood vessels, nerves, etc.
  • Allergic reactions
  • Adhesions
  • Blood clots
  • Internal bleeding

Also, the overall health of a person and history of diseases plays a critical role in risks associated with laparoscopic surgery. Some conditions that put one at a higher risk are:

  • Previous surgery
  • Chronic health conditions such as cardiovascular diseases, etc
  • Diabetes
  • Obesity
  • Malnutrition
  • Extreme endometriosis
  • Compromised immunity

That said, there are minimum chances of occurrence of risks but some symptoms to watch out for include:

  • Fever
  • Chills
  • Intense pain in the affected organ
  • Nausea or vomiting
  • Fatigue
  • Dizziness
  • Swelling and bleeding at the incision
  • Hernia
  • Inflammation

However, even in cases where risks or symptoms post a laparoscopic procedure do occur, they can easily be resolved and cured to ensure 100 percent safety. Generally, as of today a laparoscopic procedure is one of the safest surgical methods with low risks and faster recovery time. Further, during the period of recovery, a person might experience symptoms for a few days, including:

  • Fatigue
  • Sore throat
  • Discomfort at incision
  • Bloating and gas

These symptoms will fade away depending on case-to-case. In case, the symptoms do not go away and instead are aggravated by the following problems, one must immediately get medical help:

  • Shortness of breath
  • Fever
  • Vomiting
  • Heavy menstrual bleeding
  • Loss of conscious
  • Worsening pain
  • Increasing severity of infection at incision with fever, chills, swelling, discharge, etc.

For cases, where the risks or complications during or after the surgery arise – another treatment procedure might be required to resolve the problem.

Overall, there are multiple procedures which can be effectively performed through a laparoscopic surgery. It is the ideal surgical method and works effectively in conditions that can be treated with minimally-invasive medical techniques.

Laparoscopic Urological Procedure

Laparoscopy is a surgical diagnostic procedure used to examine the organs inside the abdomen. It’s a low-risk, minimally invasive procedure that requires only small incisions. Laparoscopy uses an instrument called a laparoscope to look at the abdominal organs.

The procedure takes its name from the laparoscope, a tool that has a tiny video camera and light on the end. When a surgeon inserts it through a small incision into your body, they can look at a video monitor and see what’s happening inside your body.

Laparoscopic entry with regard to urologic illnesses might be received via several routes viz. transperitoneal, retroperiponeal and extraperitoneal, peritoneum is the membrane covering the abdomen.

Laparoscopic surgeries have been performed as early as 20th century. However, technical limitations prevented the widespread use of the technique.

Laparoscopic and robot-assisted approaches in urology have fostered significant advances in minimally invasive surgery and in some instances completely replaced previously performed standard open procedures such as robotic prostatectomy and laparoscopic live-donor nephrectomies.

Types of urologic laparoscopic surgeries

Transperitoneal approach: A pneumoperitoneum is established prior to a laparoscopic procedure. Pneumoperitoneum means the presence of gas in the peritoneal cavity. Usually, CO2 is used for insufflation in laparoscopy.

Extraperitoneal approach: In extraperitoneal approach, ample space is not available as compared to intraperitoneal approach and therefore space is artificially created. A small incision is made at the 12th rib in the mid-axillary line; then mostly a balloon dilatation is performed for making room for the surgery.

There are a number of operations that can be performed laparoscopically in urology disorders some are-

  • Adrenal Gland, Laparoscopic approach to adrenal gland has been used for various benign adrenal diseases.
  • Kidney and Ureter, Simple Nephrectomy and Nephroureterectomy, Radical Nephrectomy
  • Laparoscopic Surgery for Female Urology, vaginal prolapse, Laparoscopic repair of vesicovaginal and vesico­ureterine fistula
  • Urological Laparoscopic Surgery in Renal Transplantation
  • Removal of gallbladder (laparoscopic cholecystectomy),
  • Repair of hernia (laparoscopic hernia repair).
  • Removal of the spleen (laparoscopic splenectomy).
  • Removal of part of the liver (laparoscopic hepatectomy).
  • Removal of part of the pancreas (laparoscopic pancreatectomy).

Why and when is urologic laparoscopic surgery advised?-

Urologic laparoscopy is often used to identify and diagnose the source of pelvic or abdominal pain. It’s usually performed when noninvasive methods are unable to help with diagnosis.

Laparoscopy is performed when these tests don’t provide enough information or insight for a diagnosis. The procedure may also be used to take a biopsy, or sample of tissue, from a particular organ in the abdomen.

By observing these areas with a laparoscope, your doctor can detect:

  • An abdominal mass or tumor, Fluid in the abdominal cavity, Liver disease.
  • The effectiveness of certain treatments.
  • The degree to which a particular disease has progressed.

Advantages of Laparoscopic Urological Surgery-

The most significant advantages of laparoscopic urological surgery include:

  • Reduced Bleeding: This reduces the chances of requiring a blood transfusion.
  • Smaller Incision: This not only reduces pain but also shortens recovery time, resulting in less post-surgery scarring and surgery marks.
  • Less Pain: Because it is a minimally invasive surgery, patients experience minimal pain.
  • Short Hospital Stay: Although the surgery time is usually slightly longer, the hospital stay is comparatively less, some patients are even discharged the same day.
  • Reduced Risk of Catching Infections: The surgery decreases the exposure of internal organs to external contaminants thereby reducing the risk of catching secondary infections.

Some of the challenges of Urologic Laparoscopicsurgery are it is technically more demanding and requires specialized team with skill set and experience, it is also slightly more expensivebut the advantages outweigh the challenges.

General Precautions post Laparoscopic Urological Surgery

  • Activity is important after any surgery, slow activity is good for your healing process after Urologic Laparoscopicsurgery.
  • Bowel Function, due to the anesthesia given during your surgery and the pain medications used during and/or after surgery, normal bowel function is depressed.
  • Catheter, urinary catheter is used after surgery some patients only require this for a day or two after surgery. It will be removed and we will make sure you can urinate on your own without any problems prior to your discharge from the hospital.
  • Constipation is fairly common after surgery a stool softener maybe prescribed while in the hospital. 
  • Fluids, drink plenty of fluids as you recover as long as you do not have any fluid restrictions. Water is recommended.
  • Pain Control, anti-inflammatory pills or non-narcotic medications maybe prescribed as per requirement.
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