1. What is Gastrointestinal Surgery?
Diseases of the gastrointestinal tract involve the esophagus, stomach, duodenum, small intestines, colon and rectum. Surgery done on these organs and abdomen is called Gastrointestinal Surgery.
2. What is Laparoscopy Surgery?
Minimally-invasive, or laparoscopic, surgery is done through small incisions. Using specialized techniques, miniature cameras with microscopes, tiny fiber-optic flashlights and high definition monitors, surgeons in many specialties can perform surgery through an incision that requires only a stitch or two to close. Many abdominal surgeries can now be performed in a minimally invasive fashion through small incisions. A laparoscopic procedure can often shorten a patient’s recovery and hospitalization..
3. What Are The Advantages Of The Laparoscopic (Minimally Invasive) Approach?
The advantages of the minimally invasive or laparoscopic technique are:
Small incisions and little blood loss
Less post-operative pain and need for pain medication
Earlier discharge from the hospital
Shorter post-operative disability at home
4. What are the difference between Laparoscopic and traditional open surgery?
The word “laparoscopy” means to look inside the abdominal cavity with a special camera or “scope”. Laparoscopy, also known as “keyhole” surgery, has been used for many years to diagnose medical conditions inside the abdominal cavity. Intestinal laparoscopic surgery uses this same technique to remove diseased sections of the intestinal organs for selected patients.
Traditional intestinal surgery requires a long incision down the center of the abdomen and a lengthy recovery period. Laparoscopic intestinal surgery eliminates the need for this large incision. As a result, the patient may experience less pain and scarring after surgery, more rapid recovery and less risk of infection.
5. What are the basic laparoscopic procedures which can be performed?
6. What are the advanced Laparoscopic procedures which can be performed?
Laparoscopic Cholecystectomy (for gall stones)
Laparoscopic Appendicectomy
Laparoscopic Hernias (all types of hernias are being done by laparoscopy)
Laparoscopy in Acute Abdominal traumas
Laproscopy for Paediatric problems
Diagnostic Laparoscopy
MIPH (minimally invasive procedure for piles i.e. stapled haemorrhoidectomy)
Laparoscopy for Common bile duct stones.
Laparoscopy for Cardiac Achalasia
Laparoscopy for Hiatus Hernia & Diaphragmatic hernias
Laparopscopic Splenectomy
Laparoscopic Gastrectomy
Laparoscopy for Pseudo cyst pancreas
Laparoscopy for Liver cysts (Hydatid)
Laparoscopy for benign and malignant conditions of small & large intestines
Rectal prolapsed (STARR) Stapled Rectopexy by transanal surgery
7. What are the common conditions for which laparoscopic surgery can be done?
Laparoscopic surgery is used to treat conditions including:
Crohn’s disease
Colorectal cancer
Diverticulitis
Familial polyposis
Bowel incontinence
Rectal prolapse
Ulcerative colitis
Colon polyps which are too large to be removed by colonoscopy
Chronic severe constipation that is not successfully treated with medications
8. What are the types of intestinal surgeries that can be performed laparoscopically?
Proctosigmoidectomy – Surgical removal of a diseased section of the rectum and sigmoid colon. Used to treat cancers, non-cancerous growths and complications of diverticulitis.
Right colectomy, or ileocolectomy – Surgical removal of a section of the colon which is adjacent to the small intestine. Used to remove cancers, non-cancerous growths and inflammation from Crohn’s disease.
Total abdominal colectomy – Surgical removal of the large intestine. Used to treat ulcerative colitis, Crohn’s disease and familial polyposis.
Fecal diversion – Surgical creation of an ileostomy (opening between the surface of the skin and the small intestine) or colostomy (opening between the surface of the skin and the colon). Used to treat complex rectal and anal problems, including poor bowel control.
Abdominoperineal resection – Surgical removal of the anus, rectum and sigmoid colon. Used to remove cancer in the lower rectum or in the anus, close to the sphincter (control) muscles.
Rectopexy – A procedure in which stitches are used to secure the rectum in its proper position. Used to correct rectal prolapse.
9. What are the types of Gynecological procedures that can be performed
laparoscopically?
Laparoscopic surgery can be used to address a number of gynecologic conditions that used to require large incisions. These newer procedures include:
Laparoscopic Hysterectomy
Laparoscopic Supracervical Hysterectomy
Laparoscopic Burch Procedure
Laparoscopic Vault suspension
Operative Hystereoscopy
Endometrial Ablation
Tension-free Vaginal Tape Sling
10. What are the Gastrointestinal Surgeries which can be done laparoscopically?
Laparoscopic Adrenalectomy – Using small abdominal incisions for access, surgeons use a laparoscope to remove an adrenal gland.
Laparoscopic Anti-Reflux – Used to treat Gastroesophageal Reflux Disease (GERD). Using small abdominal incisions for access, surgeons use a laparoscope to view internal organs and reinforce the valve between the esophagus and thestomach.
Laparoscopic Bariatric Surgery– Using small abdominal incisions for access, surgeons use a laparoscope and minimally invasive instruments to create a small stomach pouch and to bypass the remainder of the stomach and a short segment of the small intestine. This operation is performed for the purpose of weight loss.
Laparoscopic Colon Resection – Laparoscopic approaches to colon and rectal disease are performed routinely by our surgeons for patients with colon cancer, colon polyps that can not be removed by a colonoscope, diverticulitis, ulcerative colitis and Crohn’s disease. Removing the abnormal section of colon with laparoscopic techniques results in less pain, a smaller incision, and a shorter stay in the hospital.
Laparoscopic Gallstone Removal – Using the navel and small abdominal incisions for access, surgeons use a laparoscope to view the gallbladder, detach it, deflate it and remove it through the navel.
Laparoscopic Myotomy for Achalasia – Using small abdominal incisions for access, surgeons use a laparoscope to view the esophagus and repair the muscle of the lower esophagus.
Laparoscopic Removal of Stomach Tumors – Using small abdominal incisions for access, surgeons use a laparoscope to view and remove a tumor.
Laparoscopic Spleen Removal – Using small abdominal incisions for access, surgeons use a laparoscope to view the spleen, detach it, place it in a surgical bag and remove it through an incision.
Laparoscopic Ventral Hernia Repair – Using small abdominal incisions for access, surgeons use a laparoscope to view internal organs, remove existing scar tissue and place a surgical mesh under the hernia defect and attach it to the strong tissues of the abdominal wall.
11. Can Laparoscopic Surgeries be done as a day care surgeries?
Most of the procedures can be done as day care surgeries but some might require more than 25 hours stay.
12. What are the selection criteria for Laparoscopic Gastrointestinal surgeries?
Refers to the best practice guidelines for day care surgery by Royal College of Surgeons of England, 1992 and 2000)
The American Society of Anaesthesiologists’ (ASA) classification
Of physical status
Class 1: Patient has no organic, physiological, biochemical or psychiatric disturbance. The pathological process for which surgery is to be performed is localised and does not entail a systemic disturbance.
Examples: a fit patient with an inguinal hernia; a fibroid uterus in an otherwise healthy woman.
Class 2: Mild to moderate, systemic disturbance caused either by the condition to be treated surgically or by other pathophysiological processes.
Examples: slightly limiting organic heart disease; mild diabetes; essential hypertension; anaemia.
Class 3: Severe systemic disturbance or disease from whatever cause, even if it may not be possible to define the degree of disability with finality.
Examples: severely limiting organic heart disease; severe diabetes with vascular complications; moderate to severe degrees of pulmonary insufficiency; angina pectoris; healed myocardial infarction.
In the previous years, ( 1980s and 1990s) patients classified as ASA 1 and ASA 2 were thought to be more suitable for surgery . In the recent years, criterias have expanded to include patients in ASA 3 for day care surgery provided their disease is well in control.
13. What are the advantages of day care surgery for Minimal Invasive surgery?
1) Patient can start mobilizing early
2) Lesser cost incurred to the patient
3) Less hospital infections are acquired by the patient due to less stay in the hospital
4) Minimal disruption of personal life for the patient and relatives
5) Reduced time of disruption from work and early return to the normal environment
6) Same quality of care as provided to the hospital patients
7) Patients recover faster at home than in hospitals because of the amenable environment of home
8) Is safer than hospitalised surgery
9) Pre-booked dates less likely to be cancelled
10) No longer waiting periods for surgery
11) Patient can return home the very same day after surgery
12) High patient satisfaction
14. How is laparoscopic procedure performed?
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.
15. How the patient prepares for surgery?
Patients surgeon will meet with patient to answer any questions patient may have. Patient will be asked questions about your health history and a general physical examination will be performed. Patients intestine will require cleaning and 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 age and general health, an ECG, chest x-ray , lung function tests, or other tests may be ordered by the surgeon..
There will be a meeting with the anesthetisit, who will discuss the type of pain medication (anesthesia) given for surgery,
The evening before surgery patient will need to take the prescribed laxative medicine. It is advised not to eat or drink anything by mouth after midnight the evening before surgery.
16. What happens the day of the surgery?
Patient will come to the center on the day of the surgery . An intravenous (IV) tube will be inserted into a vein to deliver medications and fluids. Patient will be taken to the operating room when it is available and ready.General anesthesia is used.Surgery is done.
17. What happens post surgery?
When patient wakes up from the operation, patient will be in a recovery room. Patient will have an oxygen mask covering your nose and mouth. Pain medication will be given as you recover.
After your operation, the nurses will begin to document all the fluids that you drink and measure and collect any urine or fluids you produce, including those from tubes or drains placed during the operation.
Patient may be allowed to drink liquids the evening of the operation and will resume a solid diet the next morning. Patient will be encouraged to get out of bed and walk,the same evening or the first day after the operation. Ambulation prevents complications such as pnuemonia or the formation of blood clots in your leg veins.
The length of hospital stay will depend on the type of procedure and patients recovery
18. How will the patients recovery at home be?
Patient will be encouraged to walk more. Walking would help to increase the muscle strength and keep the circulation of blood to prevent clots and also help the lungs to stay clear. Soft diet should be followed at home, which means patient can eat almost everything except raw fruits and vegetables. A registered dietitian can provide more specific guidelines.
19. What is the most common complication after laparoscopic surgery?
Infection is the most common complication of any surgical procedure. In laparoscopic surgery rate of infection is very less than open surgery but many statistical studies shows that infection is still the most common complication after laparoscopic surgery. This complication is not related to the laparoscopic technique itself but depends on the sterilization and theatre environment of the hospital.
20. What are the other complications related per se to laparoscopic surgery?
The Injury to the bowel is the second most common cause of morbidity and mortality after laparoscopic surgery. The Injury to bowel and blood vessels is specially related to the technique of laparoscopic surgery. There is a small risk of complications that include, injury to the abdominal organs, intestines, urinary bladder or blood vessels. If the surgeon is not experienced than he can perforate an innocent bowel with the long pointed instruments of laparoscopic surgery. If complication is severe an additional operation may be required with a larger incision to either stop bleeding or repair an injury that cannot be fixed by laparoscopy. In case of infection and other mild complication short course of appropriate antibiotic is sufficient to overcome the problem. In experienced hands, complications may occur but are not frequent. Patient safety should be surgeon’s strongest concern.
21. How can hernia develop through the tiny hole made during laparoscopy?
Incisional bowel herniation is a complication of operative laparoscopy. Herniations occur through ports 10 mm in size at both umbilical and extraumbilical sites if not closed properly after operation. Surgeons should recognize the importance of closing fascia at these larger port sites and should maintain a high degree of suspicion in any patient who has a slow recovery with intermittent nausea and vomiting after an operative procedure. The underlying fascia and peritoneum should be closed not only when using trocars of 10mm and larger as previously suggested but also when extensive manipulation is performed through a 5mm trocar port, causing extension of the incision.
22. When should the patient suspect a complication?
If patient have fever, chills, vomiting, are unable to urinate, developed increasing redness at an incision site, or if pain is worsening, distension of abdomen or any discharge from the port site, patient should contact their surgeon promptly.
23. What are the contraindications of laparoscopic surgery?
Contraindications for laparoscopy are relative and include the uncooperative patient, uncorrectable coagulation defects, severe congestive heart failure, respiratory insufficiency, suspected acute, diffuse peritonitis, and the presence of distended bowel. Previous laparotomy incisions may necessitate alteration of the usual trocar insertion site, or may represent a contraindication to the procedure. Patients with cardiac diseases and COPD should not be considered a good candidate for laparoscopy. Laparoscopy may also be more difficult in patients who have had previous abdominal surgery. The elderly may also be at increased risk for complications with general anaesthesia combined with pneumoperitoneum. Laparoscopy does add to the surgical risk in patients with a lowered cardio-pulmonary reserve with regard to the consequences of the pneumoperitoneum and a longer operative time.
24. What is Robotic surgery?
Robotic surgery is an advanced form of minimally invasive surgery, plays an increasingly important role at Mayo Clinic. Robotic technology provides magnified, three-dimensional views of the surgical site and gives surgeons greater precision, flexibility and control than is possible with standard laparoscopic instruments and techniques. Important benefits for patients include less blood loss, a considerably faster, less painful recovery and reduced scarring.
25. What is Bariatric Surgery?
Weight loss surgery (Bariatric surgery) has provided the longest period of sustained and healthy weight loss in patients of Obesity.
The following weight loss procedures are available:
LAGB (Laparoscopic Adjustable Gastric Banding)
Laparoscopic Sleeve Gastrectomy
Laparoscopic Gastric By-Pass
Gastric banding is a “restrictive” form of bariatric surgery for the treatment of morbidly obese patients (BMI >40), or for those with severe obesity (BMI >35) who have weight-related co-morbidities.
Restrictive obesity surgery aims to promote weight loss by restricting the volume of food the stomach is capable of accommodating.
Gastric banding achieves this food reduction by through the use of a band placed around the proximal aspect of the stomach, which reduces the the functional size of the stomach to that of an egg. Although functionally similar to vertical banded gastroplasty, unlike gastric stapling, bariatric banding uses no staples, instead a silastic ring is used (about 2 inches in circumference). Unlike gastric bypass, it does not alter the anatomy of the digestive process or reduce calorie absorption in the gastrointestinal tract, and the banding operation is completely reversible.