What is Laparoscopy and Cholecystectomy
Written by : Raksha. M, Dr. Praveen Kumar Gupta
Laparoscopy(the term) has Greek roots, where ‘lapara’ means “flank” and ‘skopeo’ means “to see”. It is also called as key hole surgery or bandaid surgery or minimally invasive surgery(MIS) which involves the use of a laparoscope. This device is a narrow tube which contains a light source and also a small video camera. What happens inside is usually same as the open surgery procedure but the procedure to access is different. When compared to traditional open surgery, this surgery requires only 3 small incisions in the patient’s abdomen. This was started in 1901, when Georg Kelling of Dresden performed the first ever laparoscopic surgery in dogs. However first laparoscopic surgery in humans was performed in 1910 by Hans Christian Jacobaeus of Sweden.
Some of the advantages of this surgery is that it has faster wound healing, quicker recovery time, less discomfort, less morbidity, slight scarring, and hence better outcomes.
This surgery is normally performed for all abdominopelvic surgeries. And some of them include:
- Urological surgery: e.g. pyeloplasty (to relieve a blockage in the UPJ or the uretral pelvic junction), nephrectomy (removal of kidneys in the case of either kidney cancer or kidney donation).
- Gastrointestinal surgery: e.g. cholecystectomy (gall bladder removal), appendectomy (removal of appendix), bowel resection ,hernia repair etc.
- Gynaecological surgery: Oophorectomy (removal of ovaries), hysterectomy (removal of woman’s uterus).
- Diagnostic laparoscopy: it is performed to visualize the abdominal cavity, collection of peritoneal fluid, collection of biopsies etc.
Some of the instruments used in this surgery includes:
- Trocar: they are placed inside the hollow cannulas to assist in the drainage of fluids.
- Laparoscope: they include various parts like CCD camera, lens cleaner, viewing device , energy-supply device. There are different laparoscopes available based on the difference in their diameter such as 4mm,5mm,7mm,10mm ,12 mm etc. Also a device called as a stereoscope is used for robotic surgery to provide 3D vision and it is most expensive.
- Grasper: they enable the surgeon to grasp and also manipulate the abdominal tissue. They enable excision, biopsy and also observation procedures.
- Surgical mesh: they help to reinforce the area. It provides minimal support for the natural tissue to grow.
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Procedure of cholecystectomy:
Gall bladder is a place where the bile produced by the liver is stored and it pushes the bile juice to the common bile duct. When bile hardens into small pieces, gall stones are formed that block the common bile duct.
These gall stones are usually made up of calcium, blood, cholesterol etc. some of the symptoms of this condition include nausea/ vomiting, moderate to severe pain etc. This condition can be treated by laparoscopic surgery.
In this method the patient is subjected to anesthesia. A trocar is used to make a keyhole incision near the belly button. Now carbon-dioxide gas will be pumped through this port to puff up the abdomen so as to view the contents easily. One or more incision are made depending on the requirement. Later 5-10 mm diameter devices such as graspers, laparoscope, scissors, clip applier are introduced into the abdomen through trocars. Now the gall bladder is cut and it is placed in the specimen bag and removed through one of the ports. Finally, the devices are withdrawn and carbon-dioxide is permitted to escape and muscle layers and other tissues are stitched together.
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Laparoscopic surgery has revolutionized surgery process by improving patient outcomes and by decreasing patient suffering despite the tricky nature of the operation. The rate at which laparoscopic cholecystectomy has been adopted and popularized is very high. This led to an attempt of using laparoscopic surgery in almost all the fields of surgery. In modern world, technology is being employed to assist medical teams and to increase precision. However, this surgery cannot completely replace open surgery as the skill of open surgery will always remain vital.
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