Introduction to Laparoscopic Surgery
In the last twenty years the laparoscopic approach to the treatment of general surgical conditions has developed in an exponential fashion. For nearly all conditions of the abdomen and abdominal wall requiring surgery the laparoscopic approach has become the gold standard of care around the western world.
All operations of the abdomen and pelvis from the stomach to the rectum and from the gall bladder to the groin are routinely performed laparoscopically when possible. The benefits and risks of laparoscopic surgery compared to conventional open operations have been exhaustively investigated and reported by surgeons over many years and in many countries.
Laparoscopic surgery has been indisputably proven to be of benefit to patients over and above that of open surgery. When outcomes are compared by variety of different measures including “pain-scores” and length of stay in hospital, the laparoscopic option is superior without an increase in complications.
If you are undergoing a general surgical operation of any kind, your surgeon should have offered you a laparoscopic option for your treatment or explained to you why it is not possible. If they have not discussed this, ask them why not.
The Surgery
Laparoscopic surgery for the most part takes longer, costs more money and is more technically demanding than open, conventional approaches to general surgical diseases. It is highly technologically dependent and it is the recent advances in material sciences and medical engineering as well as specialised surgical training that have made these exciting and beneficial developments possible.
In every case the operation to be performed should be identical to the accepted best open procedure available. All laparoscopic surgery may result in “conversion” to an open operation, although across all operation types the likelihood of this occurring is decreasing all the time.
Who is not suitable for laparoscopic surgery?
Some patients will not be suitable for laparoscopic surgery for three reasons:
- The problem is not physically amenable to such surgery (diseased organs that are too large or stuck to other structures)
- Co-existing medical conditions prevent the use of laparoscopy (usually lung problems)
- Previous surgery has made it impossible to access a body cavity that is required to complete the operation.
Colorectal Surgery
Virtually all common colorectal operations in the abdomen and pelvis may be completed laparoscopically. These include.
- Right Hemicolectomy
- High Anterior Resection of the rectum
- Low Anterior Resection of the rectum
- Abdominoperineal excision of the rectum
- Total colectomy and Procto-colectomy.
Broadly speaking such surgery halves in-hospital length of stay and significantly reduces many other common post operative infections and complications.
Upper Gastrointestinal Surgery
Laparoscopic surgery is the gold standard of care for the majority of commonly performed upper gastrointestinal surgical procedures, these include
- Gall bladder surgery (for stones)
- Anti-reflux surgery (for indigestion)
- Swallowing problems
Laparoscopic surgery for upper gastrointestinal cancers (oesophagus, stomach, liver and pancreas) is becoming more and more commonly performed.
Hernia Surgery
Nearly all hernias are ideally managed with laparoscopic surgery, these include
