Laparoscopic Surgery

Laparoscopic surgery is a minimally invasive surgical technique used in the abdominal and pelvic areas. It uses the aid of a laparoscope — a thin, telescopic rod with a camera at the end — to see inside your body without opening it all the way up. Instead of the 15-30cm cut necessary for open abdominal surgery, laparoscopic surgery uses two to four small incisions of half a centimetre or less. One is for the camera, and the others are for the surgical instruments. Minimally invasive surgery may also be called “keyhole surgery,” referring to these small incisions.

History and Pioneers of Laparoscopic procedures

• Endoscopy is derived from Greek and means “viewing the inner spaces of the human body” (“endo” and “skopein”)
• Georg Kelling was the first to describe the basic principles of endoscopy of the abdomen. Kelling performed the procedure in a dog. Almost exactly a hundred years ago, Jacobaeus performed the first endoscopy in humans. Major advancements in endoscopy were accomplished from the 1960s to the 1980s, accompanied by a transition from diagnostic to surgical laparoscopy. These developments are inseparably linked with the names of Raoul Palmer in Paris and Kurt Semm in Kiel.
• The first laparoscopic appendectomy was performed by Semm on 13 September 1980 at the department of obstetrics and gynaecology, University of Kiel. 

Advantages of laparoscopic surgery

• Smaller incisions and smaller scars
• Less pain than open procedures
• The chances of infection after the procedure are lower than with open procedures
• Faster recovery for the patient
• Shorter hospital stays
• Due to the increase in intra-abdominal pressure, patients bleed less than with open procedures.

Disadvantages of laparoscopic surgery

• Sometimes the procedure must be converted to an open procedure due to bleeding or other complications
• Limited degree of motion
• Increased operation time
• Increased technical difficulty

Procedures done laparoscopically by Dr Jeske

• Laparoscopic incisional hernia repair – This is a bulge or area of weakness in the muscles which form the lower front of the stomach in the groin region.
• Laparoscopic drainage of abscess in the liver, pancreas, and abdomen
• Laparoscopic liver resections and liver biopsies – The reason for removing part of the liver is likely due to one or more growths, cancerous or non-cancerous. Trauma to the liver is also a possible indication for this operation. A liver biopsy may be done to look for the cause of liver abnormalities, to assess if, and how much, the liver is damaged and/or to help in planning treatment.
• Laparoscopic cholecystectomy – Removal of the gallbladder due to gallstones, both the gallbladder and stones are removed.
• Laparoscopic appendicectomy – Removal of the appendix due to infection which causes pain and can ultimately rupture.
• Laparoscopy for diagnostic purposes
• Laparoscopic hemicolectomies – Removal of part of the large intestine due to cancer or other obstructions.
• Laparoscopic splenectomy – Removal of the spleen may be due to Splenic cysts, abscesses, or tumours. Spleen damaged because of certain auto-immune diseases or traumatic trauma may also be an indication to remove the spleen.

Myths and facts about laparoscopic surgeries

1.  Myth – Laparoscopic surgery is more costly than open surgery
   Fact – Since patients have a shorter hospital stay and can return to work quicker the costs of laparoscopic procedures are less than that of open surgeries.
2. Myth – Visualization of the abdomen is limited using lapscopes
   Fact – Laparoscopy provides better visualization of the abdomen when compared to the open approach.
3. Myth – Patients with multiple previous abdominal surgeries cannot have a laparoscopic procedure.
   Fact – Laparoscopy can be safely performed in patients with multiple prior surgeries regardless of the size or location of the prior skin incisions.