Surgical Precision, Compassionate Care

Minimally invasive surgical techniques

What are the benefits of minimally invasive surgery?
What happens during a minimally invasive procedure?
What are some common minimally invasive procedures?
What is Diagnostic Laparoscopy?
Why is Diagnostic Laparoscopy Performed?
– Abdominal pain
Abdominal mass
Ascites
Liver disease
“Second look” procedure or cancer staging
Adrenal gland surgery
What are the Advantages of Laparoscopic Adrenal Gland Removal?
Large bowel resection
Is a patient a candidate for Laparoscopic Colon Resection?
Appendix surgery
Is a patient a candidate for Laparoscopic Appendectomy?
Esophageal surgery
Stomach surgery
Gallbladder surgery
Liver surgery
Hernia repair
Pancreas surgery
Small intestine surgery
Spleen surgery
Soft tissue surgery


What are the benefits of minimally invasive surgery?

Minimally invasive surgery has been shown to shorten hospital stays, decrease pain and provide patients with a more rapid recovery, as well as cost savings. When compared to traditional surgery, minimally invasive surgery can result in much less pain and faster recovery while providing an alternative for repairing and preventing a wide range of conditions. Depending on the procedure, patients may leave the hospital the same day, or in a few days, and return to normal activities more quickly than patients recovering from open surgery.

What happens during a minimally invasive procedure?

During a minimally invasive procedure, a surgeon makes several small incisions (often less than an inch) or no incisions performing a procedure through the mouth or rectum. A miniature camera (usually a laparoscope or endoscope) is then placed through one of the incisions, the mouth, or rectum, and images from the camera are projected onto monitors in the operating room so surgeons can get a clear and magnified view of the surgical area. Specialized surgical tools inserted through small incisions or through an endoscope are used to perform the procedure.

What are some common minimally invasive procedures?

Minimally invasive surgery is the optimal choice for patients for a significant number of surgical procedures including: hernia repair, colon resection, appendectomy, procedures to prevent heartburn, gallbladder removal, and many others.

What is Diagnostic Laparoscopy?

A laparoscope is a telescope designed for medical use. It is connected to a high intensity light and a high-resolution monitor. In order for the surgeon to see inside the abdomen, a hollow tube (port) is placed through the abdominal wall, and the laparoscope is inserted into the port. The image of the inside of the abdomen is then seen on the monitor. In most cases, this procedure will be able to diagnose or help discover what the abdominal problem is.

Why is Diagnostic Laparoscopy Performed?

Abdominal pain

Laparoscopy has a role in the diagnosis of both acute and chronic abdominal pain. There are many causes of abdominal pain. Some of these causes include appendicitis, adhesions or intra-abdominal scar tissue, pelvic infections, endometriosis, abdominal bleeding and, less frequently, cancer. It is used in patients with irritable bowel disease to exclude other causes of abdominal pain. Surgeons can often diagnose the cause of the abdominal pain and, during the same procedure, correct the problem.

Abdominal mass

A patient may have a lump (mass or tumor), which can be felt by the doctor, the patient, or seen on an X-ray. Most masses require a definitive diagnosis before appropriate therapy or treatment can be recommended. Laparoscopy is one of the techniques available to your physician to look directly at the mass and obtain tissue for biopsy in order to discover the diagnosis.

Ascites

The presence of fluid in the abdominal cavity is called ascites. Sometimes the cause of this fluid accumulation cannot be found without looking into the abdominal cavity, which can often be accomplished with laparoscopy.

Liver disease

Non-invasive imaging techniques such as ultrasound, CT scan (computed tomography) and MRI (magnetic resonance imaging) may discover a mass inside or on the surface of the liver. If non-invasive imaging cannot give the physician enough information, a liver biopsy may be needed to establish the diagnosis. Diagnostic laparoscopy is one of the safest and most accurate ways to obtain tissue for diagnosis. It is an accurate way to collect a biopsy to sample the liver or mass without actually opening the abdomen.

“Second look” procedure or cancer staging

A doctor may need information regarding the status of a previously treated disease, such as cancer. This may occur after treatment with some forms of chemotherapy or before more chemotherapy is started. Also, information may be provided by diagnostic laparoscopy before planning a formal exploration of the abdomen, chemotherapy or radiation therapy.

Adrenal gland surgery

Removal of one or both adrenal glands is called adrenalectomy. The adrenal glands are two small glands located just above the kidney on each side of the body. Indications for this surgery include benign or cancerous tumors of the adrenal gland, often with excess hormone production. This surgery can be done through an open incision or through a laparoscope. Open adrenalectomy involves incisions on the sides of the body adjacent to the ribs. Surgeons will disconnect the gland from the surrounding blood vessels and tissues. The glands are then removed. Laparoscopic adrenalectomy performed using small incisions in the abdomen near the navel. The surgical inserts a tiny camera and instruments into the incisions. The gland is then removed with visualization through the camera with the use of small instruments.

Surgical removal of incidentally discovered adrenal tumors is indicated only if the tumor is found to make excess hormones, is large in size (more than 4-5 centimeters in diameter), if there is a suspicion that the tumor could be malignant. Adrenal gland cancers (adrenal cortical cancer) are rare tumors that are usually very large at the time of diagnosis. Removal of these tumors is usually done by open adrenal surgery. Surgical removal of the adrenal gland is the preferred treatment for patients with adrenal tumors that secrete excess hormones and for primary adrenal tumors that appear malignant.

What are the Advantages of Laparoscopic Adrenal Gland Removal?

In the past, making a large 6 to 12 inch incision in the abdomen, flank, or back was necessary for removal of an adrenal gland tumor. Today, with the technique known as minimally invasive surgery, removal of the adrenal gland (also known as “laparoscopic adrenalectomy”) can be performed through three or four 1/4-1/2 inch incisions. Patients may leave the hospital in one or two days and return to work more quickly than patients recovering from open surgery. Common advantages of laparoscopic removal are: Less postoperative pain. Shorter hospital stay, quicker return to normal activity, improved cosmetic result, reduced risk of herniation or wound separation.

Large bowel resection

A large bowel resection is also known as a colectomy. Patients undergo colon surgery for a number of conditions including: colorectal cancer, polyps, inflammatory bowel disease (Crohn’s and ulcerative colitis), colonic inertia, stricture of the colon and diverticulitis surgery. Surgery can be performed open or using a laparoscope. The surgeon removes the diseased section of the large intestine and reconnects the healthy parts. If there is not enough healthy intestine left after surgery, the surgery may perform a colostomy. In a colostomy, the large intestine ends outside of the abdominal wall and a colostomy bag attached to the abdomen. The content from the colon passes into the bag. Colostomy is usually temporary. Indications a large bowel resection include: Colon cancer, intestinal blockage, diverticulitis, polyps, infection, bleeding, abnormal twisting of the bowel called volvulus, ulcerative colitis and other inflammatory bowel diseases and intussusception.

Traditional “open” colon surgery procedures may require a single long abdominal incision. Traditional surgery results in an average hospital stay of a week or more and usually 6 weeks of recovery. Less invasive options are available to many patients facing colon surgery. The most common of these is laparoscopic surgery, in which smaller incisions are used. A technique known as minimally invasive laparoscopic colon surgery allows surgeons to perform many common colon procedures through small incisions. Depending on the type of procedure, patients may leave the hospital in a few days and return to normal activities more quickly than patients recovering from open surgery. In most laparoscopic colon resections, surgeons operate through 4 or 5 small openings (each about a quarter inch) while watching an enlarged image of the patient’s internal organs on a computer monitor. In some cases, one of the small openings may be lengthened to 2 or 3 inches to complete the procedure. Common advantages of laparoscopic surgery are: Less postoperative pain, shorter hospital stay, faster return to solid-food diet, quicker return of bowel function, quicker return to normal activity, and improved cosmetic results.

Is a patient a candidate for Laparoscopic Colon Resection?

Although laparoscopic colon resection has many benefits, it may not be appropriate for some patients. The surgeon or primary care physician will perform a thorough evaluation to find out if the technique is appropriate for one’s condition.

Appendix surgery

Appendicitis is one of the most common surgical problems. Treatment requires an operation to remove the infected appendix. The appendix is often removed when appendicitis occurs. Removal of the appendix and be done with open incisions or through a laparoscope.<

Traditionally, the appendix is removed through an incision in the right lower abdominal wall. In most laparoscopic appendectomies, surgeons operate through 3 small incisions (each ¼ to ½ inch) while watching an enlarged image of the patient’s internal organs on a computer monitor. In some cases, one of the small openings may be lengthened to complete the procedure.

Advantages of Laparoscopic Appendectomy are: Less postoperative pain, shorter hospital stay, quicker return to bowel function, quicker return to normal activity, and better cosmetic results.

Is a patient a candidate for Laparoscopic Appendectomy?

Although laparoscopic appendectomy has many benefits, it may not be appropriate for some patients. Early, non-ruptured appendicitis usually can be removed laparoscopically. Laparoscopic appendectomy is more difficult to perform if there is advanced infection or the appendix has ruptured. A traditional, open procedure using a larger incision may be required to safely remove the infected appendix in these patients.

The words “laparoscopic” and “open” appendectomy describes the techniques a surgeon uses to gain access to the internal surgery site. Most laparoscopic appendectomies start the same way. Using a cannula (a narrow tube-like instrument), the surgeon enters the abdomen. A laparoscope (a tiny telescope connected to a video camera) is inserted through a cannula, giving the surgeon a magnified view of the patient’s internal organs on a computer monitor. Several other cannulas are inserted to allow the surgeon to work inside and remove the appendix. The entire procedure may be completed through the cannulas or by lengthening one of the small cannula incisions. A drain may be placed during the procedure. This will be removed later by the surgeon.

People who have had appendectomies do not have an increased risk toward infection. Other organs in the body take over this function once the appendix has been removed.

Esophageal surgery

In the event of esophageal cancer, partial resection of the esophagus may become necessary. Resection of the esophagus cancer can be done through open incisions or through a laparoscope. The surgery may also reconstruct the esophagus. If one suffers from moderate to severe “heartburn” the surgeon may have recommended Laparoscopic Antireflux Surgery. Surgery for GERD includes a procedure to strengthen the lower esophageal sphincter function and thereby prevent reflux. It is usually performed laparoscopically. In the event of achalasia, the inability to move food easily through the esophagus there is a Laparoscopic procedure performed to dilate a tight lower esophageal sphincter. In order to correct an esophageal diverticulum, whereas there is an outpouching of the lining of the esophagus through with muscular wall, there is a Laparoscopic procedure performed.

Stomach surgery

In the event of stomach cancer part of the stomach is removed. For a small tumor, this can be performed laparoscopically. For larger tumors, an open incision is required. When medical treatment for peptic ulcer disease fails, surgery may be performed in order to decrease secretion, stop bleeding and repair preparation or redirect the flow of gastric contents in the case of an obstruction. In hiatal hernias where the stomach can twist up next to the esophagus, called gastric volvulus, surgery is performed in order to repair the hernia as well as replace the stomach to its normal location.

Gallbladder surgery

Surgical removal of the gallbladder is a safe treatment of gallbladder disease. Treatments to break up or dissolve gallstones are largely unsuccessful. Surgical removal of the gallbladder is the most effective and safest treatment of gallbladder disease. Gallbladder removal is one of the most commonly performed surgical procedures. Removal of the gallbladder is not associated with any impairment of digestion in most people. Gallbladder removal surgery is usually performed with minimally invasive techniques called Laparoscopic Cholecystectomy or Laparoscopic Gallbladder Removal. It is usually performed using 4 small incisions for the laparoscope and instruments. It is often indicated for problems of the gallbladder including gallbladder polyps, biliary colic, gallstones, and infection of the gallbladder called cholecystis.

Advantages of Performing Laparoscopic Gallbladder Removal: Rather than a five to seven inch incision, the operation requires only four small openings in the abdomen. Patients usually have minimal post-operative pain. Patients usually experience faster recovery than open gallbladder surgery patients. Most patients go home the same day of the surgery and enjoy a quicker return to normal activities.

Is a patient a candidate for Laparoscopic Gallbladder Removal? Although there are many advantages to laparoscopic gallbladder removal (cholecystectomy), the procedure may not be appropriate for some patients who have severe complicated gallbladder disease or previous upper abdominal surgery. A thorough medical evaluation by a primary care physician, in consultation with the surgeon trained in laparoscopy, can determine if laparoscopic gallbladder removal (cholecystectomy) is an appropriate procedure.

Liver surgery

Liver biopsy is performed laparoscopically often to diagnose liver problems or tumors. Partial resection the liver is performed when there is liver cancer present. It may be done with open incisions or through a laparoscope. The surgeon will decide how much of the liver needs to be resected based on the size of the tumor. Sometimes an entire lobe of the liver is removed called a lobectomy or hemi hepatectomy. Sometimes an ablation procedure can be performed to kill cancer cells using heat generated from a radiofrequency waves call radiofrequency ablation.

Advantages of performing laparoscopic liver surgery: Rather than a large incision, the operation requires only a few small openings in the abdomen. Patients usually have minimal post-operative pain. Patients usually experience faster recovery than open liver surgery patients. Most patients go home the same day of the surgery and enjoy a quicker return to normal activities.

Is a patient a candidate for laparoscopic liver surgery? Although there are many advantages to laparoscopic liver surgery, the procedure may not be appropriate for some patients who have severe complicated liver disease or previous upper abdominal surgery. A thorough medical evaluation by a primary care physician, in consultation with the surgeon trained in laparoscopy, can determine if laparoscopic liver surgery is an appropriate procedure.

Hernia repair

Surgical hernia repair is based on what type of hernia is present. Hernia surgery can be performed laparoscopically or through open incisions. In general, the surgeon will gently push the herniated tissue back into place. It may be tied off and removed as well. The surgeon will then close the weak area of the abdominal wall. Oftentimes, a synthetic mesh is used to reinforce the area. For inguinal hernia, the intestine is pushed back into the abdomen and a patch is anchored with sutures over the weekend area of the abdominal wall. For hiatal hernias, surgery is performed in order to repair the lower esophageal sphincter and the hernia. Incisional hernias are repaired by anchoring a synthetic mesh to the abdomen wall and the abdominal wall hole is closed. Umbilical hernias can be repaired by closing the small hole around the umbilicus and the abdominal wall. Laparoscopic Hernia Repair is a technique to fix tears in the abdominal wall (muscle) using small incisions, telescopes and a patch (mesh). Laparoscopic repair offers a shorter return to work and normal activity for most patients. Only after a thorough examination can a surgeon determine whether laparoscopic hernia repair is right versus open repair. The procedure may not be best for some patients who have had previous abdominal surgery, prostate surgery, or underlying medical conditions.

Pancreas surgery

The only way to cure pancreatic cancer is through surgery. The surgeon may remove part of the pancreas or the entire pancreas along with other digestive organs including part of the stomach, small intestine, gallbladder, and common bile duct. The type of surgery depends on the stage of the cancer.

Small intestinal surgery

Surgery of the small intestine performed open or through a laparoscope. Surgery may be indicated for intussusception of the small intestine. This occurs when one portion of the intestine enters inside itself. It can cause dangerous bowel obstruction. Surgery is often needed to repair the intussusception and repair of the obstruction. Surgery may be indicated for adhesions of the small intestine. Cancer of the small intestine can be removed surgically as well whereas part of the small intestine is removed and the healthy parts are reattached.

Spleen surgery

There are a number of disorders of the spleen that may require removal of the spleen, called splenectomy. Some disorders of the spleen cause excessive destruction of red blood cells, destruction of platelets, and types of lymphoma or leukemia may require splenectomy as well. Sometimes the blood supply to the spleen becomes blocked (infarct) or the artery abnormally expands (aneurysm) and the spleen needs to be removed. Rarely, the spleen can become infected and is best treated with removal. Splenectomy can perform the laparoscopically or through open incisions.

Soft tissue surgery

Soft tissue masses, both benign and malignant occur in many parts of the body. These can occur in many types of tissue including connective tissue, fat, skin, and muscle. They can be solid masses or fluid-filled cysts. Depending on the location and consistency of the mass, surgery will differ. The masses are sent to a pathologist for biopsy to determine their origin. If the masses found to be malignant, further surgery and other treatments may be indicated.