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Minimal Access Surgery
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What is Minimal Access
Surgery or Laparoscopy?
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Laparoscopic surgeries
in gynecological problems
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Urology
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General Surgery
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Bariatrics
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What is Minimal Access Surgery or
Laparoscopy?
Laparoscopic surgery is a modern surgical
technique in which operations of the abdomen
are performed through small incisions
(usually 0.5 to1.5 cm) as compared to the
larger incisions needed in laparotomy (open
surgery). Keyhole surgery uses images
displayed on TV monitors for magnification
of the surgical elements. A telescope with a
sophisticated medical grade camera attached
to it is introduced in to the abdomen and
the organs are viewed on a high resolution
monitor and surgery is carried out by
looking at monitor. The video camera becomes
a surgeon’s eyes in laparoscopy surgery.
Conventional surgical procedures consist of
three main stages: cutting the patient open;
removing or repairing an organ or tissue;
and closing the patient up again. In minimal
access surgery, the impact of the first and
last of these is reduced as far as possible,
either by gaining access to the body through
natural orifices or by operating through
very small holes cut into the body.
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Laparoscopic surgeries in gynecological
problems
What is ’Laparoscopic myomectomy’ (removal
of fibroids through laparoscopy) and how is
it treated?
Fibroids are benign tumors in the uterus
which occurs in 25% of women who are in the
reproductive age group of 20 to 50 yrs. The
symptoms are usually excessive bleeding
during periods, heaviness, pain, and if
large then lump in the abdomen and depending
on where the pressure is difficulty in
passing urine and constipation. In the
Laparoscopic fibroids removal surgery, the
fibroid is separated from the uterus; the
capsule is sutured and removed. Performed
correctly the average time taken for the
surgery, bleeding and post-operative pain is
minimal and requires only one day hospital
stay. Depending on the size of the fibroids
and expertise of the surgeon, one can remove
them with a single incision near the
umbilicus.
What is ‘Laparoscopic hysterectomy’ (removal
of uterus through laparoscopy) and how is it
treated?
Hysterectomy is the surgical removal of the
uterus (womb) and is performed when a woman
(after the age of 45) has health problems
after her child bearing is complete. The
common reasons are fibroids (non-cancerous
tumors of the uterus), heavy bleeding during
periods, prolapsed (condition in which the
uterus moves down from its normal position),
endometriosis (presence of the lining of the
uterus in nearby organs causing severe pain
and bleeding) and cancer of the uterus and
cervix. In most cases, it is done through
key hole surgery except in very few patients
where uterus is so big where there is no
place for putting laparoscope and other
instruments in to the abdomen. In
hysterectomy, the uterus and its supports
are separated with special equipment, which
reduce blood loss and time of surgery. The
uterus is then removed through the birth
passage or if it is large, removed by
morcellation. After hysterectomy, a woman
will no longer have her periods.
What is ‘Laparoscopy for ovarian cysts’ and
how is it treated?
Ovarian cysts are small fluid-filled sacs
that develop in a woman's ovaries. The cysts
can be simple cysts that are commonly found
among younger women and just need
observation. The other type of cyst is
benign (non-cancerous cysts) which need
close monitoring. Surgery is mostly needed
only in cases where there is a large size
cyst and there is fear of it turning in to
malignancy (cancer). Most cysts are
harmless, but some may cause problems due to
rupturing, bleeding, or torsion. Symptoms of
cysts are fullness in the abdomen, painful
periods and abnormal bleeding, problems
passing urine completely and pain with fever
and vomiting. A laparoscopic surgery can be
done for most of these ovarian cysts except
when it is in the advanced ovarian cancer
cysts. After the cysts are located with
laparoscopy, one or two tinier incisions are
made through the body, after which surgical
instruments are inserted to remove the cyst.
The cyst can be removed intact or it can be
aspirated and cyst wall can be either
excised or ablated.
What is ‘Pelvic organ prolapse?
Pelvic prolapse is a weakness or laxity in
the supporting structures of the pelvic
region. The bladder, rectal, or uterine
tissue which may then bulge into the vagina
is called pelvic organ prolapse Pelvic organ
prolapse is a very common condition,
particularly among older women. It's
estimated that half of women who have
children will experience some form of Pelvic
Organ Prolapse in later life. A Prolapsed
Uterus refers to a collapsed uterus, or
descended uterus, or other change in the
position of the uterus in relation to the
surrounding structures within the pelvis.
The various types of pelvic organ prolapse
are Cystocoele (bladder prolapse),
Rectocoele (rectal wall prolapse),
Enterocoele (prolapse of the small bowel)
and uterine prolapse. Vaginal vault prolapse
(prolapse following hysterectomy).
What is ‘Ectopic pregnancy’? (Pregnancy
outside the uterus)
Ectopic pregnancy is pregnancy where the
fetus develops outside the womb, usually in
one of the fallopian tubes. It is hence also
known as a tubal pregnancy. However, this
term is also used when the fetus grows in
the ovaries or the abdomen. It happens in
about 2 of every 100 pregnancies in India.
As the fetus grows, it causes pain and
bleeding to the pregnant woman. If not
recognized in time, the tube can rupture,
causing internal bleeding. This is a medical
emergency and can be fatal. The causes of
ectopic pregnancy are pelvic infection,
tubal endometriosis, previous abdominal
surgeries and intra uterine contraceptives.
The most common symptom is severe and
persistant pain in one-side of the lower
abdomen. Many women describe it as an
intense stabbing pain. Collapse preceded by
feeling faint, dizziness, diarrhea, vomiting
and/or pain. Treatment options for ectopic
pregnancy include observation, laparoscopy,
laparotomy. For those who require
intervention, the most common treatment is
surgery. Under optimal conditions, a small
incision can be made in the Fallopian tube
and the ectopic pregnancy removed, leaving
the Fallopian tube intact. In some
instances, the location or extent of damage
may require removal of a portion of the
Fallopian tube, the entire tube, the ovary,
and even the uterus. However, certain
conditions make laparoscopy less effective
or unavailable as an alternative. These
include massive pelvic scar tissue and
excessive blood in the abdomen or pelvis.
How can laparoscopy be used to diagnose
Infertility?
Laparoscopy can be used to determine the
abnormalities of the uterus, fallopian tubes
and ovaries, any defects such as scar
tissue, endometriosis, fibroid tumors,
congenital abnormalities and polycystic
ovaries. In some women, the fallopian tubes
are blocked. This can prevent the sperm and
egg from coming together, causing
infertility .With laparoscopy, if any such
defects are found, they can be corrected
with operative laparoscopy.
What is ‘Laparoscopic sterilization’?
Laparoscopic Sterilization or Tubal ligation
is also known as "tying the tubes“. This
procedure involves tying the woman’s
fallopian tubes so that she cannot get
pregnant. The fallopian tubes are on either
side of the uterus and extend toward the
ovaries. They receive eggs from the ovaries
and transport them to the uterus. Once the
fallopian tubes are closed, the man's sperm
can no longer reach the egg. Stertilization
can be done with laparoscopy or mini
laparotomy. In mini laparotomy, a 3-4 cm cut
is made in the abdomen. In laparoscopy, a
complete tubal ligation is carried out by
making a small incision near the navel.
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Urology
How are Kidney stones removed?
Kidney stones are also called renal calculi.
They can form anywhere in the urinary
system,. It, however, most commonly develops
in the kidneys. Kidney stones range in size
from microscopic groups of crystals to
objects as large as golf balls. Most
calculi, however, pass through the urinary
tract without causing problems. If the
stones are large, a procedure known as
‘Percutaneous nephrolithotomy’ (PCNL) is
carried out. PCNL is a minimally invasive
procedure for removal of kidney stones and
is suitable to remove stones that are more
than 2 cm in size.
How is the Prostate gland removed?
The prostate gland is a fibrous organ that
surrounds the urinary urethra in men. An
enlarged prostate gland can compress the
urethra, thus causing problems with
urination. Men over the age of 40 have a
greater risk of developing prostate disease.
Transurethral resection of the prostate (TURP)
is a simple surgical procedure to remove the
whole or part of the prostate gland. TURP is
the preferred treatment mode for Benign
Prostatic Hyperplasia (BPH) which effects up
to 80% men. This procedure reduces symptoms
in 88% of BPH patients.
What is ‘Laparoscopic nephrectomy’?
The kidneys are paired organs that lie
posterior to the abdomen, in the area of the
lower back. They serve the body as a natural
filter of blood and remove wastes which are
diverted from the body to the urinary
bladder. Nephrectomy is the surgical removal
one of the kidneys. This can be done through
`open surgery` or through laparoscopic
surgery. The Laparoscopic nephrectomy
surgery is performed under general
anesthesia. A laparoscope (thin tube with an
attached camera and light source) is
inserted through incisions (single or
multiple) in the body. Surgical Instruments
are passed through the laparoscope and the
kidney is removed.
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General Surgery
What is ‘Inguinal hernia repair’?
A hernia, often referred to as a protrusion
of tissues, is the fascia of an organ that
bulges out of the weakened abdominal wall.
When the abdominal muscle pushes its way
through the abdominal wall due to an opening
or muscle weakness, it causes a small
balloon-like sack to bulge. Hernia repair is
the latest and most advanced laparoscopic
procedure for correcting hernia with proven
outcomes. In this procedure, a laparoscope
(telescope) connected to a camera and other
surgical instruments are inserted through
incisions allowing the surgeon to view
hi-res images of the hernia and surrounding
tissues, on a monitor. The hernia is
repaired from behind the abdominal wall. A
small piece of surgical mesh is placed over
the hernia defect and is secured in position
with small surgical staples. This surgery is
usually performed with general anesthesia or
occasionally using regional or spinal
anesthesia.
What is ‘Laparoscopic cholecystectomy’ ?
Laparoscopic Cholecystectomy is the surgical
removal of the gallbladder due to the
presence of stones in it or to remove an
infected or inflamed gallbladder. The common
symptoms are acute pain in the upper centre
or right abdomen, low fever, nausea and
feeling bloated. This happens because, when
we eat, bile is added to the food as it
passes out into the duodenum. This bile is
stored in the gallbladder. When we eat fatty
foods, the gallbladder contracts and pushes
extra bile out through the common bile duct
and into the duodenum. Bile helps to break
the fatty material of food into tiny
fragments that can be more easily absorbed
by the intestine. Gallstones can block the
normal flow of bile if they move from the
gallbladder and lodge in any of the ducts
that carry bile from the liver to the small
intestine. The ducts include the hepatic
ducts (which carry bile out of the liver),
cystic duct (which takes bile to and fro
from the gallbladder) and common bile duct
(which takes bile from the cystic and
hepatic ducts to the small intestine). The
liver produces bile to digest a normal diet.
Once the gallbladder is removed, bile flows
out of the liver through the hepatic ducts
into the common bile duct and directly into
the small intestine, instead of being stored
in the gallbladder. Laparoscopic
cholecystectomy has now replaced open
cholecystectomy as the first-choice of
treatment for gallstones and inflammation of
the gallbladder.
What is ‘Appendectomy’?
Appendicitis is an infection of the appendix
which results in decreased blood supply to
the wall of appendix. The appendix is a
narrow, small, finger-shaped portion of the
large intestine that generally hangs down
from the lower right side of the abdomen.
This leads to tissue death causing the
appendix to rupture or burst. This results
in bacteria and stool getting released into
the abdomen. The symptoms of appendicitis
are stomach pain around the navel, loss of
appetite, low grade fever, nausea, diarrhea
or constipation. In laparoscopic
appendectomy, the surgeon makes 1 to 3
incisions in the abdomen to insert the
laparoscope and other surgical instruments.
The surgeon operates on with aid of video on
the monitor and removes the appendix. This
procedure helps in minimal tissue damage,
minimal post-operative infections, less
scarring and faster recovery.
What is ‘GERD’ (Gastro-Esophageal Reflux
Disease) and how can it be treated?
Laparoscopic fundoplication is a safe and
effective treatment for GERD
(Gastro-esophageal reflux disease). It is a
common condition in which the contents of
the stomach reflux into the lower esophagus
causing a variety of symptoms. This happens
due to weakening of the lower end of food
pipe(lower esophageal sphincter) or due to
hiatus hernia(protrusion of stomach into
chest). When left untreated, GERD may
increase the risk of developing cancer of
the esophagus.
The procedure is performed under general
anesthesia. A few incisions are made in the
abdomen and a tiny tube shaped instrument is
passed into these incisions. A laparoscope
is inserted through this incision. Another
incision is used to insert surgical
instruments into the body, by which the
procedure is carried out. The operation
usually takes between 1 and 1½ hours.
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Bariatrics
What is ‘Bariatric surgery’?
Bariatric surgery is done to help one lose
weight. Bariatric surgical procedures are
only considered for people with severe
obesity and not for individuals with a mild
weight problem and overweight. If other
methods to lose weight haven’t worked for
you, a bariatric surgery may help. There are
2 types of Bariatric surgery – Restrictive
(like Lap band and Sleeve gastrectomy) and
Combined restrictive and malabsorptive (like
Roux-en-Y gastric bypass). The benefits of
Bariatrics surgery include weight loss up to
50 -75%, reduction in high blood pressure,
reduced cholesterol and triglyceride levels
(few months after gastric bypass surgery),
improved sleep apnea, reduction in asthma,
arthritis and joint pain.
How is ‘Lap band ‘surgery conducted?
Lap band is short name for Laparoscopic
Gastric Band. In this procedure, surgeons
use keyhole surgical techniques to implant a
medical device, composed of silicone rubber,
around the upper portion of the stomach.
That results in the creation of an hour
glass stomach, with a small outlet that
allows food to enter into the lower part of
the stomach. The band proves to be effective
in weight loss as it restricts food intake;
moreover, food stays in the stomach for a
longer period thus leading to early satiety,
thereby leading to decreased consumption.
Lap band is a reversible procedure for
weight loss. Lap Band surgery is a procedure
especially beneficial for large eaters, or
those who have tried to lose weight several
times but haven't been able to. Generally
Lap Band surgery is recommended for younger
patients, as it is reversible. With this
procedure one can lose about 40-50% of their
excess weight within 18 months.
How is ‘Sleeve gastrectomy’ conducted?
Sleeve gastrectomy is a minimally invasive
procedure in which, the stomach is reduced
to about 25% of its original size by
surgical removal of a large portion of the
stomach. This is done using surgical staples
to form a sleeve or tube that takes the
shape of a banana. This limits the capacity
of the stomach to 60 cc - 150 cc. Unlike
other forms of bariatric surgery, the outlet
valve and the nerves to the stomach remain
intact. This procedure permanently reduces
the size of the stomach. The procedure is
performed laparoscopically and is not
reversible. This procedure also eliminates
the hunger inducing hormone called 'Ghrelin',
hence patients feel full after consuming
small amounts of food, and lose weight
quickly.
What is ‘Roux-en-Y gastric bypass’?
Roux-en-Y gastric bypass reduces stomach
capacity and bypasses the upper part of the
small intestine, which causes a reduction in
the number of calories and nutrients which
the body can absorb. Patients typically lose
50-75 percent of their initial excess
weight, which is a sufficient weight
reduction to cure or reduce most of the life
threatening medical conditions associated
with severe clinical obesity.
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