Advanced Laparoscopic Surgery
Laparoscopic gallbladder surgery and benefits: A cholecystectomy is a surgical procedure designed to remove the diseased gallbladder. Laparoscopic gallbladder surgery uses several small incisions near the belly button to remove the gallbladder, rather than one long incision (“open” surgery). During the surgery, the surgeon inflates the abdomen with carbon dioxide for better visualization and access to the affected area. Through the small incisions, the surgeon inserts a small camera on the end of a tube (a laparoscope) and several small instruments in order to remove the gallbladder. Laparoscopic gallbladder surgery requires general anesthesia (the patient is completely asleep), and takes about an hour. The benefits of having laparoscopic versus open gallbladder surgery include less scarring, less pain and discomfort after the procedure, and a shorter recovery time (most patients return to normal activities within a week).
A hiatal hernia occurs when part of the stomach pushes through the opening in the diaphragm. Large hiatal hernias can cause symptoms such as difficulty breathing, difficulty swallowing, or chest pain. Surgical repair of a hiatal hernia can involve several different procedures, such as reducing the size of the opening in the diaphragm, reconstructing the valve that keeps food from returning up into the esophagus, or removing the part of the stomach that is protruding into the diaphragm. Hiatal hernia surgeries can be done with a single incision in the chest wall or abdomen, or with several small incisions in the abdomen (laparoscopic surgery). Laparoscopic surgery uses small instruments and a camera on the end of a tube to allow the surgeon to see the internal area of focus.
A Heller Myotomy is a surgical procedure designed to treat achalasia. Achalasia is disease in which the muscular valve between the lower esophagus and stomach fails to properly relax and open, creating a problem with swallowing food. During a Heller Myotomy, the muscle around the lower esophagus is cut. This procedure is performed under general anesthesia (the patient is asleep) using one large incision (“open surgery”) or several smaller incisions (laparoscopic surgery). First, the abdomen is filled with gas in order to inflate the area for better visualization and access to the affected area. During laparoscopic Heller Myotomy procedures, 3 or 4 small incisions are made in the abdomen. Through these incisions, the surgeon inserts a tube with a camera on the end of a tube (laparoscope) and small surgical instruments. A lengthwise incision is then made in the muscle around the lower esophagus, allowing it to open more easily. Sometimes, surgeons perform an additional procedure after a Heller Myotomy to prevent acid reflux (i.e., stomach acid flowing up the esophagus). This procedure, called a low-resistance fundoplication, involves wrapping the upper portion of the stomach around the esophagus.
An inguinal hernia occurs when abdominal tissue or intestine protrudes through a weak point or tear in the lower abdominal wall in the region of the groin. The tissue pushes through the inguinal canal, an opening in the front of the lower abdomen (in men, this canal has the spermatic cord running through it). There are two general types of surgeries to repair inguinal hernias. During a herniorrhaphy, the surgeon makes a groin incision and pushes the protruding tissue back into the abdomen. The weakened or torn abdominal muscle is repaired by sewing it together. During a hernioplasty, the surgeon inserts a piece of synthetic mesh to cover the entire inguinal area. The patch is then secured in place with stitches, clips or staples. Hernioplasties can be done with a single long incision or laparoscopically.
A ventral hernia occurs when the thin inner lining of the abdomen protrudes through a weakened part or tear in the thin wall that holds the abdominal organs in place. The bowel or intestines can also protrude through this opening. A hernia which occurs at the site of an old surgical scar is called an incisional hernia. If circulation to the protruding loop of intestine or bowel is cut off, immediate medical attention is necessary. Traditional surgeries to repair ventral hernias are done with a single incision in the abdominal wall. The surgeon then pushes the protruding tissue back into place and sews the abdominal tear or weakness back together. During laparoscopic ventral hernia repair the surgeon uses several small incisions and a tube with a small camera on the end (laparoscope). Special mesh or a screen is placed under the hernia to strengthen the abdominal wall and is secured into place with sutures or staples.
An adrenalectomy is a surgical procedure designed to remove one or both adrenal glands (located above the kidney). Adrenalectomies are used to treat cancerous or benign (non-cancerous) tumors that develop in the adrenal gland. The procedure is performed using traditional long incisions or laparoscopically. Traditional adrenalectomies use a horizontal incision under the rib cage, a vertical incision in the middle of the stomach, an incision along the back under the rib cage, or incisions on both sides of the body. The adrenal glands are then disconnected from associated blood vessels and removed. Laparoscopic adrenalectomies use 3 to 4 small incisions, small instruments, and a small tube with a camera on the end (the laparoscope). The abdomen is expanded by filling it with gas, and the camera is used to visualize the adrenal glands. A small plastic bag is inserted into the abdomen and used to collect the glands. Then, the bag is removed through an incision located in the belly button.
A splenectomy is a surgical procedure designed to remove a diseased or damaged spleen (the organ that helps filter the blood and fight infections). A splenectomy may be necessary if a patient has an injury to the spleen, a blood clot in nearby blood vessels, blood cell disease (e.g., hemolytic anemia), sickle cell anemia, an abscess or cyst in the spleen, a tumor or cancer that affects the spleen, or cirrhosis of the liver. Prior to a splenectomy procedure, the surgeon will inflate the abdomen with gas for better visualization and access to the affected area. For an “open” splenectomy, the surgeon will then use 1 long incision that runs across the middle of the abdomen or on the left side of the abdomen below the ribs to remove the spleen. For a “laparoscopic splenectomy” the surgeon will make several small incisions. A small tube with a camera on the end (a laparoscope) and small instruments will be used to remove the spleen.
The large intestine, or colon, is the lower part of the digestive tract. Colon surgery or resection is used to treat diseases of the colon, such as colon cancer, diverticular disease, gastrointestinal bleeding, inflammatory bowel disease, polyps, or a blockage in the bowel. During colon surgery, the surgeon removes the diseased part of the bowel before reconnecting the healthy sections of the colon (a procedure called “end-to-end anastomosis”). Patients with severe colon disease may require a colostomy, a procedure in which the surgeon connects part of the colon to the abdominal wall, leaving an external opening called a stoma. Colon resections can be performed using an open surgery or laparoscopic technique. Open colon surgeries utilize a long abdominal incision that allows the surgeon access to the colon. Laparoscopic surgery uses 4 or 5 small abdominal incisions. A tiny tube with a camera on the end (laparoscope) and small surgical instruments are then used to perform the procedure.