What is laparoscopic surgery?
Laparoscopic or "minimally invasive" surgery is a specialized technique for performing surgery. In the past, this technique was commonly used for gynecologic surgery and for gall bladder surgery. Over the last 10 years the use of this technique has expanded into intestinal surgery. In traditional "open" surgery the surgeon uses a single incision to enter into the abdomen. Laparoscopic surgery uses several 0.5-1cm incisions. Each incision is called a "port." At each port a tubular instrument known as a trochar is inserted. Specialized instruments and a special camera known as a laparoscope are passed through the trochars during the procedure. At the beginning of the procedure, the abdomen is inflated with carbon dioxide gas to provide a working and viewing space for the surgeon. The laparoscope transmits images from the abdominal cavity to high-resolution video monitors in the operating room. During the operation the surgeon watches detailed images of the abdomen on the monitor. This system allows the surgeon to perform the same operations as traditional surgery but with smaller incisions.
In certain situations a surgeon may choose to use a special type of port that is large enough to insert a hand. When a hand port is used the surgical technique is called "hand assisted" laparoscopy. The incision required for the hand port is larger than the other laparoscopic incisions, but is usually smaller than the incision required for traditional surgery.
What are the advantages of laparoscopic surgery?
Compared to traditional open surgery, patients often experience less pain, a shorter recovery, and less scarring with laparoscopic surgery.
What kinds of operations can be performed using laparoscopic surgery?
Most intestinal surgeries can be performed using the laparoscopic technique. These include surgery for Crohn's disease, ulcerative colitis, diverticulitis, cancer, rectal prolapse and severe constipation.
In the past there had been concern raised about the safety of laparoscopic surgery for cancer operations. Recently several studies involving hundreds of patients have shown that laparoscopic surgery is safe for certain colorectal cancers.
How safe is laparoscopic surgery?
Laparoscopic surgery is as safe as traditional open surgery. At the beginning of a laparoscopic operation the laparoscope is inserted through asmall incision near the belly button (umbilicus). The surgeon initially inspects the abdomen to determine whether laparoscopic surgery may be safely performed. If there is a large amount of inflammation or if the surgeon encounters other factors that prevent a clear view of the structures the surgeon may need to make a larger incision in order to complete the operation safely.
Any intestinal surgery is associated with certain risks such as complications related anesthesia and bleeding or infectious complications. The risk of any operation is determined in part by the nature of the specific operation. An individual's general heath and other medical conditions are also factors that affect the risk of any operation. You should discuss with your surgeon your individual risk for any operation.
What is a colon and rectal surgeon?
Colon and rectal surgeons are experts in the surgical and non-surgical treatment of diseases of the colon, rectum and anus. They have completed advanced surgical training in the treatment of these diseases as well as full general surgical training. Board-certified colon and rectal surgeons complete residencies in general surgery and colon and rectal surgery, and pass intensive examinations conducted by the American Board of Surgery and the American Board of Colon and Rectal Surgery. They are well-versed in the treatment of both benign and malignant diseases of the colon, rectum and anus and are able to perform routine screening examinations and surgically treat conditions if indicated to do so.
Laparoscopic surgery is also called minimally invasive surgery, keyhole surgery or bandaid surgery. Laparoscopic procedures can be performed using small incisions of around 0.5 to 1.5 cm that can be made far away from the surgical site. Small, thin surgical instruments can then be passed through the incision and threaded through to the operational site. The whole procedure is carried out using a laparoscope which is a small tube with a camera at the tip that can be used to relay images from inside the body to a TV monitor.
Laparoscopic surgery is commonly used in the diagnosis of a wide range of abdominal and pelvic conditions. It is also widely used to carry out surgical procedures such as the removal of diseased or damaged tissue and biopsies. The procedure is most commonly used in the study and treatment of the female reproductive system (gynecology), followed by conditions of the digestive system (gastroenterology) and conditions affecting the urinary system (urology).
Some of the main advantages of laparoscopic surgery over traditional open surgery are described below:
- Laparoscopic procedures often require a shorter hospital stay than traditional open surgery
- Patients also experience less pain and bleeding after surgery
- As the incision wound is so much smaller than the large incision made in traditional open surgery, post-surgical scarring is significantly reduced.
The main procedure involves the following steps:
A patient is given a general anesthetic and feels no pain throughout the procedure.
One or more small incisions are made in the abdomen, usually around the belly button area.
A tube is inserted at the incision site and the abdomen is inflated with carbon dioxide gas. This allows the surgeon a better view of the internal organs, as well as more room to work. The laparoscope is inserted through the tube and images of the internal structures are relayed to the TV monitor.
Surgical instruments can then be inserted via further small incisions that can be made, depending on what the surgeon finds and what procedures they need to perform.
Once the operation is finished, the gas is expelled from the abdomen and the incision is closed using stitches.
Yale is considered a laparoscopic center of excellence. Our fellowship trained surgeons have extensive experience in using laparoscopic and other minimally invasive techniques for the screening, diagnosis, treatment, and management of a variety of abdominal, colorectal, and gastrointestinal conditions and diseases. Laparoscopic and minimally invasive techniques allow patients to recover more quickly, with less scarring and less postoperative discomfort.