LAPAROSCOPIC CHOLECYSTECTOMY (GALL BLADDER REMOVAL)
Laparoscospic cholecystectomy (gall bladder removal) for gall stone disease, laparoscopic appendicectomy (removal of the appendix), laparoscopic adhesiolysis (removal of intestinal adhesions), and also laparoscopic gynaecological procedures (Hysterectomy removal of the Uterus) are regularly performed. The advantage of performing surgery, laparoscopically, are given below.
The patient recovers quickly from surgery and can get back to work early.
The surgical scar is hardly visible unlike in conventional surgery.
The cost is almost the same as in conventional surgery.
THE LAPAROSCOPIC REVOLUTION
The discipline of surgery is changing. Traditional concepts and approaches to the treatment of surgical illnesses are giving way to a new type of operative intervention variously referred to as minimally invasive surgery, limited exposure surgery or endoscopic surgery. Several factors have driven this change. The most important impetus has been the heightened awareness of patients. Advanced imaging techniques, improved optics and new classes of instruments have paved the way for these innovative procedures; this is just the beginning of the technology transfer we are witnessing. New techniques to gain access to the body cavity without the need for external exposure present an exciting challenge for this and the next generation of surgeons. These are exciting times to be a surgeon.
Although not widely recognized for almost two years, an event occurred in the summer of 1987 that dramatically changed the practice of general surgery. In that year, P. Mouret and his colleagues performed the first laparoscopic cholecystectomy (removal of the gall bladder) in Lyons, France. What has happened since is without precedent in modern surgery.
In a few years medical historians will begin describing the most important achievements affecting surgery during the twentieth century. It is the belief of several leading surgeons of the world that laparoscopic surgery will be considered a milestone as significant as the discovery of antibiotics, the introduction of blood transfusion therapy, and advances in anaesthesia.
WHAT IS LAPAROSCOPIC SURGERY?
In laparoscopic surgery a telescope is introduced into the abdominal cavity via the umblicus after the cavity has been inflated with carbondioxide. A video camera is connected to the telescope and so what is inside the abdominal cavity is visualized on the television screen. Additional punctures are made as and where required and watching the television screen various surgeries are performed.
WHAT SORT OF SURGERIES CAN BE PERFORMED BY THIS METHOD?
Various surgeries can be performed using the laparoscope. Eg: Cholecystectomy (removal of the gall bladder), hysterectomy (removal of the uterus), appendectomy ( removal of the appendix), surgery for peptic ulcer etc. In fact, at the centre in Melbourne, Australia, where Dr. H. Krishna Hande was trained, more advanced procedures like the removal of the adrenal glands for various conditions are done routinely laparoscopically.
WHAT IS THE ADVANTAGE OF PERFORMING A PROCEDURE LAPAROSCOPICALLY?
The greatest advantage is for the patient. All the morbidity and pain associated with a long scar is avoided. In fact in most instances the patient should be up and about performing normal day to day activities within three days of surgery. Cosmetically also there is no disfigurement. If conducted safely, endoscopic surgery offers savings in total health care as a result of shorter hospital stays and a more rapid return to work. Though the initial investment is high laparoscopic surgery need not be more expensive than open surgery.
CAN A SURGERY ALWAYS BE PERFORMED LAPAROSCOPICALLY?
No. There may be instances where a procedure has been started using the laparoscope but may have to be reverted to the traditional open method. If for example the anatomy is unusual or the disease is such, a surgeon may abandon the laparoscopic method and perform the surgery by opening the abdomen. Patients should always be told that this as a possibility.
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