The name Laparoscopic surgery stems from two Greek words Laparoon (abdomen) and skopeo (to look).
It is a relatively new (25-30 years old) surgical specialty which involves performig surgical procedure through small, key-hole incisions utilizing long camera and special slender instruments. Laparoscopic surgery is known by many other names including minimally invasive, minimal access, needlescopic surgery or a broader name - endosocpic surgery. Endoscopic surgery can be applied to the chest cavity (Thoracoscopic) and joints (Arthroscopic). Term - Laparoscopic - implies only abdominal cavity surgery.
How is Laparoscopic Surgery Done?
Usually there will be several less then 1/2 inch incisions located on the abdominal wall in different areas depending on a particular procedure. Abdomen is insuflated with carbon dioxide (areactive gas which body can easily metabolize) creating a dome shape working space. The internal organs are seen by inserting a laparoscope (lens) via special airtight cannula. Camera attached to a laparoscope projects image on TV screen. Long slender instruments of the surgeon and assistant are introduced through other cannulas and used to perform operation which principally does not differ from that performed with open surgery.
Benefits of Laparoscopic Surgery
Advantages come from minimizing trauma to abdominal wall and reduced physiologic stress to the body. By avoiding long insicion through the muscles, many postoperative problems are eliminated while pain is markedly reduced. That results in lesser use of pain medications, improved breathing and fatigue compared to open surgery. As a results you stay in the hospital is shorter and you complete your recovery faster. Head to head comparison of several intestinal surgical procedures done old fashion way and laparoscopically demonstrated clear benefit of the minimally invasive approach in reducing risk of death, complications and long-term costs.
Risks of Laparoscopic Surgery
Though complications tend to be less frequent with laparoscopic surgery, they still might occur. Each procedure has set of complications similar to other surgeries as well as unique for a particular procedure. We shall discuss them during seminar presentation and office consultation in detail. Generally speaking some difficulties experienced during laparoscopic surgery can not be safely managed laparoscopically and may require conversion to a conventional open procedure. That can occur due to a dense scar from previous surgery, very stiff abdominal wall, extremely enlarged liver, abnormal variants of anatomy, bleeding, injury to surrounding organs and patients inability to tolerate needed high carbon dioxide pressure inside the abdomen. Statistically speaking this happens only in 1-2% of our cases. Preoperative conditioning, optimization of the lung function, cessation of smoking, liquid protein diet before surgery to induce 20-30 lbs weight loss to soften abdominal wall and shrink liver engorged with fat are the tools we are using to increase your chances to have laparoscopic surgery.
If we feel that your best interest will not be served by laparoscopic surgery, the procedure will be completed with conventional, open approach.
Who Does Laparoscopic Surgery?
Most general surgeons do simple laparoscopic procedures like gall bladder or hernia surgery. If we take complexity of laparoscopic gall bladder surgery as a reference point of 1 on a scale of 10, then gastric bypass complexity would be 9.5, sleeve gastrectomy - 7 and Lap Band - 6. It is obvious that special skills, training and experience are an absolute must to perform advanced laparoscopic bariatric surgery safely. Not every general and/or bariatric surgeon is able to do that. A few surgeons, including myself, have obtained specialty training in new and very complex laparoscopic procedures. Our safety record is excellent and confirmed by Surgical Review Committee of ASMBS. We are the active members of American Society for Metabolic and Bariatric Surgery (ASMBS) and Society of American Gastrointestinal Endoscopic Surgeons (SAGES).