Laparoscopic abdominal surgery
Laparoscopic abdominal surgery is an advanced, minimally invasive procedure that ensures faster recovery, reduced pain, and minimal scarring. Using small incisions and a high-definition camera, Dr. Mahesh Krishna, a skilled laparoscopic surgeon, performs precise and effective treatments for conditions like gallbladder issues, hernias, and digestive disorders.
Laparoscopic abdominal surgery
Laparoscopic surgery is now widely established. Benefits include reduced postoperative pain, improved cosmetic results and patient satisfaction, and reduced hospital stays. The range of surgical techniques is increasing in complexity and now includes cholecystectomy, adrenalectomy, nephrectomy, fundoplication, hernia repair, bowel resection, and gynecological procedures. There has also been an increase in emergency operations performed laparoscopically. Most patients undergoing gynecological procedures are young and fit. However, gastrointestinal or emergency surgery patients may be sick and elderly; such patients may have significant associated co-morbidity.
Gastroesophageal Reflux Disease
Laparoscopic fundoplication for gastroesophageal reflux disease is the fastest-growing area of laparoscopic surgery. Symptoms of severe reflux disease can usually be relieved with proton pump inhibitors; however, there are several indications for surge. Rarely will side effects of medical therapy cause a patient to choose surgery.
Laparoscopic fundoplication is performed through five trocar sites. The laparoscope is placed near the umbilicus on the left side, and two trocars are placed just below the costal margin on both sides of the midline. The operation involves identifying the crura of the diaphragm and dissection around the esophagus, dissection of the short gastric vessels, and wrapping the stomach fundus around the esophagus. If esophageal peristalsis is expected, the wrap will be placed entirely around the esophagus (called a Nissen fundoplication), or if the peristalsis is poor, the wrap will be placed only partially around the esophagus. A partial gastric wrap puts less pressure than a full wrap on the lower esophageal sphincter and decreases the risk of the wrap causing dysphagia. A partial wrap is usually placed posteriorly around the esophagus, called a Toupet fundoplication. A laparoscopic esophageal lengthening procedure is performed if the esophagus is too short. The stomach is stapled so that a tube is formed distal to the lower esophageal sphincter, and the fundoplication is performed around this tube.
Splenic Diseases
Laparoscopic splenectomy is performed mainly for hematologic diseases such as idiopathic thrombocytopenic purpura (ITP), thrombotic thrombocytopenic purpura (TTP), autoimmune hemolytic anemia, and heredity spherocytosis. It is very difficult if the spleen is enlarged.
Open splenectomy is performed through an upper midline incision or an incision below the rib cage on the left side, a procedure requiring a 4-day hospital stay and 4–6 weeks off work.
The laparoscopic procedure is performed through four trocar sites under the left costal margin. In the laparoscopic procedure, the spleen is detached from the stomach, diaphragm, colon, and retroperitoneum. The hilum is divided, and the edges of a bag are brought through one of the trocar incisions. The spleen is then removed in small pieces. Most patients are discharged the day after surgery and return to normal physical activities in 2 weeks.
Adrenal Gland Diseases
Adrenal disease requiring surgery is rare. Most adrenal resections are for benign lesions called adenomas that can be functional and secrete adrenal hormones such as aldosterone, which causes hypertension (primary hyperaldosteronism). Other lesions are removed because their size, growth, or appearance on a CAT scan suggests the possibility of adrenal cancer.
Laparoscopic adrenalectomy is indicated for any adrenal lesion less than 10 cm. Both the right and left adrenal glands are easily resected laparoscopically, and bilateral adrenalectomy can also be performed. We perform laparoscopic adrenalectomy through the flank on the side of the lesion with three to four trocars placed just below the costal margin. The spleen is freed from its lateral attachments and brought medially on the left side. Once the adrenal gland is identified in the retroperitoneum, the adrenal vein is ligated and divided. The gland is then separated from the surrounding tissue, placed in a visceral bag, and removed from the abdomen. On the right side, the liver edge is lifted to reveal the posterior edge of the liver. The peritoneum is incised along the posterior edge of the liver from lateral to medial until the inferior vena, and the incision is brought along the inferior vena cava caudad. The adrenal vein is ligated and divided along the inferior vena cava’s lateral border. The gland is identified, freed from the surrounding tissue, placed in a visceral bag, and removed from the abdomen.
Appendicitis
Laparoscopic appendectomy, which has several advantages over open appendectomy, is indicated whenever appendicitis is suspected. Although the recovery time is shorter than for open appendectomy, the length of hospital stay is nearly the same. The main advantages of the laparoscopic approach are for cosmesis, a complicated appendectomy, or a diagnosis that turns out not to be appendicitis. The latter two are advantages for laparoscopy because, in open surgery, these difficulties often require enlarging an incision, which increases recovery time. Laparoscopy allows the surgeon to evaluate the entire abdomen without changing incisions.
The laparoscopic procedure is performed through three trocar sites, one within the navel and two in the midline below the navel. After the appendiceal mesentery is divided with bipolar electrocautery, the appendix is resected from the cecal base between ligatures, placed in a visceral bag, and removed from the abdomen. If the appendix appears normal, the abdomen is explored, and the appendix is removed unless contraindicated.
Conclusion
Laparoscopy is now the standard of care for cholecystectomy, and many surgeons would call it the gold standard for reflux disease and achalasia. Laparoscopic cholecystectomy and appendectomy are relatively easy to perform, but many other procedures require advanced laparoscopic techniques and should be performed by experienced surgeons. Laparoscopic procedures provide a better cosmetic outcome, shorter recovery time, and an earlier return to normal activity than open surgery, and with increasing experience, they are becoming viable alternatives to an ever-increasto-growing variety of traditional open surgical procedures.
