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Laparoscopic Surgery

What is laparoscopic surgery?

Laparoscopic surgery also referred to as minimally invasive surgery or minimal access surgery describes the performance of surgical procedures with the assistance of a laparoscope, video camera and several thin long cylindrical instruments. During the surgical procedure, CO2 gas is introduced inside the abdominal cavity and small incisions of up to 5 to 10 mm are made. The laparoscopic instruments are placed through these small incisions inside the abdomen to perform surgery.

The camera transmits an image of the organs inside the abdomen onto a medical grade monitor. The surgeon is not able to see directly into the patient without the traditional large incision. The telescope becomes a surgeon’s eyes in laparoscopic surgery, since the surgeon uses the image from the video camera positioned inside the patient’s body to perform the procedure.

Laparoscopic surgery is now accepted all over world as an important skill and it is no more luxury it is considered as necessity.

All the good hospital of world is now equipped with laparoscopic surgery but it is important that surgeon who is doing laparoscopy should be qualified.

Benefits of laparoscopic procedures are

  • Less post operative discomfort since the incisions are much smaller
  • Quicker recovery times
  • Shorter hospital stays
  • Earlier return to full activities
  • Much smaller scars
  • There may be less internal scarring when the procedures are performed in a minimally invasive fashion compared to standard open surgery.

Why perform laparoscopy?

Open traditional surgery requires making a large incision, which leaves a large ugly looking scar. Laparoscopic surgery has changed that because surgeons now operate using small incisions. Even advanced surgery can be performed by this technique nowadays.

Here are a few common examples of laparoscopy?

  • Gallbladder removal
  • Hernia repair
  • Appendix removal
  • Tubal ligation (having your “tubes tied”)
  • Uterus removal
  • Kidney donation or removal
  • Spleen removal
  • Repair of hiatus and GERD
  • Removal of Ovarian Cyst etc…

Many advanced specialized hospitals perform more complex surgeries. New tools are being invented recently and so that more operations can be done. This is an exciting area in the world of surgery and slowly becoming a Necessity not luxury.

Sometimes laparoscopic surgery is used just to look inside the body known as Diagnostic Laparoscopy. You may be having some pain or you might be suffuring from infirtility and your doctor may not be sure what’s wrong. By looking inside your body, the answer may be found and your surgeon can correct the problem. This is usually done after you’ve had some x-rays, Untrasound and other non invasive tests.

Advanced laparoscopic surgery with hand-access devices

The Human hand is the best Instrument. The human hand can performs many functions during surgery that are difficult to reproduce only with laparoscopic instruments. The loss of tactile feedback and inability to place the hand into the abdomen during laparoscopic surgery has limited the use of laparoscopy for complex abdominal surgery on the pancreas, liver and bile duct. Hand-access devices like lapdisk, omniport are new laparoscopic devices that allows the surgeon to place a hand into the abdomen during laparoscopic surgery and perform many of the different functions with the hand that were previously possible only during open surgery. At Laparoscopy Hospital, New Delhi, This technique is utilized to develop a variety of laparoscopic pancreatic, liver and biliary procedures such as the Whipple operation, distal pancreatectomy and liver resection that were not possible previously by standard laparoscopic techniques.

What is Robot assisted surgery?

The most popular Robot to perform laparoscopic surgery is Da Vinci™, a computer-assisted robotic system that expands a surgeon’s capability to perform laparoscopic surgery in a less invasive way. Da Vinci™ system allows greater precision and better visualization compared to standard laparoscopic surgery.

The operations with the Da Vinci robotic system are performed with no direct mechanical connection between the surgeon and the patient. The surgeon is sitting remote from the patient, working a few feet from the operating table while seated at a computer console with a three-dimensional view of the operating field. The roboting surgery is possible thousands of mile away for the surgeon also through the internet. This is also known as trans atlantic Minimal Access Surgery.

The surgeon operates with two joysticks that control the two mechanical arms on the robot. The mechanical arms are armed with specialized instruments with hand-like movements which carry out the surgery through small holes in the patient’s abdomen or chest. Three small incisions are made just like tradistional laparoscopic surgery in the abdomen, through which a video camera and the robotic arms with the highly-specialized instruments are introduced. The video camera of the robotic surgery provides high resolution, high magnification three dimensional vision with depth perception.

The da Vinci system for pancreas, bile duct and liver surgery

The world experience on the use of the Da Vinci Robotic System for surgery on the pancreas, bowel duct, and liver is limited because of the cost. Radical Prostectomy, Bile duct reconstruction, Hepaticojejunostomy, Distal pancreatectomy, Reconstruction of the gastrointestinal tract after a Whipple operation, Laparoscopic adrenalectomy, are the few surgery which can be performed by the robot very nicely.

Laparoscopic Hernia Surgery - A New Innovative Approach

Hernia is one of the oldest and commonest disease of human mankind. It can happen in anybody regardless of his age, race and sex. Hernia is basically a protrusion (something coming out) of an internal organ through a defect in abdominal wall. Hernia can occur at any site of the body. like groin (inguinal) umbilicus (umbilical), upper part of abdominal wall (epigastric), & any previous site of surgical scar (incisional). The most common is inguinal Hernia.

The most common symptoms of Hernia is swelling which is reducible initially, but if left untreated may become irreducible. Pain in Hernia occur only in case of complication.

If not treated early any kind of complication can happen mainly obstruction or strangulation of organ which may lead to gangrene of the organ. This situation demands emergency surgery. The dictum is earlier the treatment better the result.

Initially, Hernia surgery is done by open method. But nowadays laparoscopic hernia surgery has emerged as a new technique for the hernia treatment.

The basic advantages of laparoscopic hernia surgery over the conventional open surgery are minimal cutting, minimal or no pain, early mobilization, early recovery, early return to work, minimal restriction of daily activities and cosmetically better scar.

Usefulness of laparoscopic hernia surgery become more in case of bilateral (both Side) inguinal hernia and recurrent hernia. Also it is a wonderful procedure for ventral (umbilical, incisional) hernia and paediatric (child group) hernia.

Total Laparoscopic Hysterectomy - A Step Forward?

Laparoscopic gynecological surgery has made tremendous progress in last decade and the introduction of laparoscopic hysterectomy has gained immense popularity amongst both gynecologist and patients in a very short span of time. Hysterectomy normally can be done by abdominal route, vaginal route and nowadays laparoscopically. Historically abdominal hysterectomy is the most commonly performed hysterectomy but it gives a big incision hence lots of pain, longer hospital stay and delayed recovery. Vaginal hysterectomy causes less post-operative morbidity and recovery is also little faster in comparison to abdominal hysterectomy but it does not allow the visualization of internal abdominal organs.

Why laparoscopic hysterectomy? Laparoscopic hysterectomy offers the combined advantage of excellent exposure and visualization of abdominal approach and better post-operative recovery as of vaginal approach. So with the help of laparoscopy we can visualize the uterus as well as adnexae (ovaries and tubes).

Ovaries & tubes if found unhealthy it can be removed simultaneously. Other pathology like endometriosis, adhesions can also be found out during laparoscopy which can be missed by ultrasound and in vaginal approach.

Overall laparoscopy surgery has several well known advantages over conventional surgery which includes less post-operative pain hence less pain killer requirement, faster recovery which may be translated into short hospital stay, reduced cost and early return to normal activity and professional work. It also gives better cosmesis.

Laparoscopic removal of Gall Bladder Stone - Myths and Facts

Gall bladder stone disease is a very common condition, also reported in ancient times. Classically this disease is commonly found in fatty, fertile, female of forty / fifty yrs of age. Nowadays it is becoming more common in men also.

During last several centuries numerous innovative & creative techniques have been introduced in an effort to manage the patients with gall stone disease. Many kinds of medicines also have been used in earlier years but none has been proved to be effective in long term and recurrence rate were very high within few months. So surgery remains the only option for the treatment of gall stone disease.

Even in surgical, treatment, historically initially some surgeons attempted to remove the stone only, leaving the gall bladder in situ. But again recurrence rate is very high, so removing the gallbladder along with stones is the only available treatment for this disease till date.

First open cholecystectomy (Conventional) i.e. removal of gall bladder, is done in 1882. Since then open cholecystectomy has remained the treatment of choice for the gall stones disease till the introduction of laparoscopic cholecystectomy (laparoscopic removal of gall bladder in late 1980s & early 1990s. Since then laparoscopic choleyslectomy is the gold standard treatment for the disease.

1

Myth: Gall stones diseases can be treated by medicines?
Fact: Gall stones disease cannot be treated by medicine, only treatment available for the disease is surgery (Nowadays laparoscopic removal of gallbladder is the main treatment option) till date.

2

Myth: Some dietary restrictions can help in removing & dissolving stone?
Fact: No, dietary restrictions & increased fluid intake do not help, only fat restrictions is advised for symptoms (pain) control.

3

Myth: Stones can be passed through the urinary symptoms?
Fact: Gall stones disease is a disease of digestive (hepatobiliary) systems and not related to urinary systems.

4

Myth: In small size & single gall stone, one can wait?
Fact:
Treatments of small, large, single or multiple stone is same i.e. surgical removal of gall bladder.

Small & multiple stone can be more dangerous, due to fear of slippage of small stones in biliary ductal systems causing Jaundice or acute pancreatitis necessating other additive procedure (ERCP) for the treatment that increase the risk and expenses.

5

Myth: Treatment in old aged, diabetic or cardiac patient is not advisable?
Fact: Again, treatment is these group remains the same. Surgery can be done in old aged, diabetic and cardiac patient also, after proper planning & work - up by a experienced surgeon in a well equipped hospital.

6

Myth: Only stone can be removed, leaving the gall bladder in situ?
Fact: Recurrence rate is very high if only stone is removed so, removal of gall bladder with stones is necessary.

7

Myth: Removal of gall bladder can hamper the digestive function?
Fact: Removal of gall bladder does not cause any malfunction in the body.

8

Myth: After removal of gall bladder some dietary restriction is required?
Fact: No dietary restriction is required after surgery. Only some fat restriction is advised is some patient with dyspeptic Symptoms (symptoms due to excessive acidity).

9

Myth: By laparoscopic method, some part of gall bladder or some stone is left inside?
Fact: No, whole gall bladder with stones is removed by laparoscopic method, same as open method. But the advantage of laparoscopic surgery over the open method are minimal cut, so minimal pain, shorter hospital stay, early mobilization, early recovery and early resume to work.

10

Myth: Laparoscopic surgery is more costly than open surgery?
Fact: No, one of the benefits of laparoscopic surgery is its cost effectiveness. Since patient has to remain in hospital for short duration (1-2 days), total cost of surgery with medicine should be less than in the open surgery. Also because patient can resume or join his duty or work earlier there is less work loss, so less financial loss.



 
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