Surgical Associates: Minimally Invasive Procedures

Diagnostic Laparoscopy
Laparoscopy is the use of a viewing tube called a laparoscope to see the inside of the abdomen and pelvis. It can be performed to diagnose and surgically treat conditions of the abdomen. Through a small incision in the abdominal cavity the instruments can be inserted to perform the various steps in the procedure. The abdominal cavity is distended and made visible by the instillation of absorbable gas (generally carbon dioxide). Most patients receive general anesthesia during the procedure.

The advantages of laparoscopy include a shortened post-operative period and less pain during recovery. The avoidance of large abdominal incisions decreases some of the post- operative complications related to the heart and lungs.

A disadvantage to any laparoscopic procedure derives from the use of gas to distend the abdominal cavity. After the procedure, many patients experience bloating, gas, and discomfort.

Today, the use of laparoscopy has been extended to surgical procedures involving the appendix, colon, uterus, repair of hiatal hernias, and more. The procedure has come full circle from one of diagnosis to what is now known as "minimally invasive" surgery.

Cholecystectomy
Laparoscopic cholecystectomy is the operation to remove the gallbladder. The patient is put under general anesthesia and antibiotics are given intravenously before the surgery to reduce the rate of infection. A laparoscope is put into the patient through a tiny cut made just below the navel. The surgeon can then see the gallbladder on a television screen and do the surgery with tools inserted in three other small cuts made in the right upper part of the abdomen. The gallbladder is then taken out through one of the incisions.

With this procedure, patients may return to work sooner, have less pain, and have a shorter hospital stay and a shorter recovery time. Surgery to remove the gallbladder with a laparoscope does not require that the muscles of the abdomen be cut. The incisions are much smaller, which makes recovery go quicker.

Laparoscopic Cholecystectomy is usually an out patient procedure and has a 1 - 2 week recovery period. In 5% of patients Laparoscopic Cholecystectomy is not possible because of adhesions, infections, or inflammation.

Appendectomy
Laparoscopic Appendectomy is the removal of the appendix with the use of a laparoscope. The laparoscope allows the surgeon to inspect the inside of the abdomen through a small puncture wound. If appendicitis is found, the appendix can be removed with special instruments that can be passed into the abdomen, just like the laparoscope, through small puncture wounds.

If appendicitis is not found the inside of the the abdomen can be examined to help make a diagnosis.

Inguinal and Ventral Hernia Repair
Inguinal hernias are in the groin area. During a laparoscopic Inguinal Hernia Repair, the laparoscope is introduced through a small incision at the navel. Two or three small incisions are made and the hernia is repaired from the inside of the abdominal cavity by separating the hernia sac from the spermatic cord (the cord suspending the testis). The excess sac is tied off and removed. A flat mesh is placed over the internal inguinal ring to prevent tissues or organs from protruding through the opening.

Postoperatively the patient may experience local wound pain, scrotal swelling, retention of urine, or bruising. These are only temporary problems.

Ventral hernias occur on the abdominal surface usually in an area of previous surgery. Ventral hernias are sometimes also called incisional hernias. Ventral hernias occur when previous surgical incisions break down. A scar is never as strong as the original tissue (even if it looks thicker) and therefore all incisions are at some risk of breaking down. If they do, ventral hernia is the result. Often these are massive in size, usually much larger than inguinal hernias.

Laparoscopic surgery is a tension-free repair, using mesh. Complications are very low. The repair is a very secure one, with excellent recurrence statistics. Because the incisions are small and the muscles are left in their natural positions, postoperative pain and discomfort is minimal. It is done as an outpatient procedure and most patients can get back to normal activities within a week. Even strenuous exertion is allowed.

The major disadvantage of this technique is that it is more expensive and more difficult than other techniques.

Hiatal Hernia and Anti-reflux Fundoplication
A hiatal hernia is an anatomical abnormality in which part of the stomach protrudes through the diaphragm and up into the chest. Treatment of large para-esophageal hernias causing symptoms requires surgery. During surgery, the stomach is pulled down into the abdomen, the esophageal hiatus is made smaller, and the esophagus is attached firmly to the diaphragm. This procedure restores the normal anatomy.

Since sliding hiatal hernias rarely cause problems themselves but rather contribute to acid reflux, the treatment for patients with hiatal hernias is usually the same as for the associated GERD (Gastroesophageal reflux disease), the condition wherein stomach contents regurgitate or back up (reflux) into the esophagus. If the GERD is severe, complicated, or unresponsive to reasonable doses of medications, surgery often is performed. At the time of surgery, the hiatal hernia is eliminated in a manner similar to the repair of para-esophageal hernias. However, in addition, part of the upper stomach is wrapped around the lower sphincter to augment the pressure at the sphincter and further prevent acid reflux.

In some patients suffering from GERD, the lining that is in the esophagus is replaced by an abnormal epithelium. This condition is called Barrett’s condition and has been linked to esophageal cancer and must be monitored carefully. A new endoscopic treatment of GERD and Barrett's is being developed.

**Surgical Associates of the Mid-Cities offers both laparoscopic and traditional surgery on hernias. The technique that is chosen depends on the patient’s desire and physiology.

Colon Resection
During a laparoscopic Colon Resection several small incisions are made in the skin to provide entry of tubes, which facilitate passage of instruments. A thin telescope-like instrument called a laparoscope is inserted into one of the openings, allowing your surgeon to see the bowel clearly. Surgical instruments, inserted into the other openings, are used to move the intestines and cut, sew and remove a section or piece of the intestine through incisions.

Patients who have laparoscopic colon surgery may leave the hospital in 4-5 days; however, each patient is different in their recovery time. Laparoscopic colon surgery is currently only approved for non-malignant disease.

Splenectomy
The spleen is an organ located in the upper left portion of the abdomen, behind the stomach. Its functions are to filter blood, remove bacteria, make blood, and store blood. Laparoscopic Splenectomy is the removal of the spleen with the use of a laparoscope.

The advantages of a laparoscopic splenectomy include having only three or four tiny scars instead of one large abdominal scar, shorter hospital stay, less pain, shorter recovery time and quicker return to daily activities, including work.

Adrenalectomy
An adrenalectomy is the removal of one adrenal gland (unilateral adrenalectomy), the removal of both adrenal glands (bilateral adrenalectomy), or partial removal of one or both adrenal glands. Laparoscopic adrenalectomy involves insertion of a laparoscope through a small incision in the fleshy area between the ribs and hip. Two or three additional small incisions are made near the laparoscope through which the surgeon inserts specialized surgical instruments. The surgeon manipulates these instruments to perform the adrenalectomy. Following the procedure, the small incisions are closed with sutures and covered with Band-Aids. After a few months, they are barely visible.

The recovery time is generally a few days rather than weeks, which is the normal amount for an open adrenalectomy. The patient often leaves the hospital 1or 2 days after the surgery.