Laparoscopic Surgery

Background

Laparoscopic or keyhole surgery has been developed over the last twenty five years since the advent of fibre optic and camera technology made it possible to produce instruments that give good quality images yet are still compact enough to insert into the human body via small incisions.

Laparoscopy literally means telescopic examination of the abdominal cavity.

In general surgery most of the major advances have occurred in the last 10-15 years, indeed fifteen years ago the prospect of the laparoscopic revolution allowing complex major procedures to be performed safely without large incisions would have been ridiculed by many surgeons, across the world.

General techniques

Laparoscopy requires the patient to be unconscious and fully relaxed under general anaesthetic. This allows the abdomen to be entered via a short incision (2-3cm) under direct vision, a metal or plastic tube (port) with a gas tight valve is then inserted into this hole and connected to a machine which pumps carbon dioxide into the abdominal cavity under low pressure (10-15mm Hg). This causes the abdomen to blow up like a balloon (pneumo-peritoneum), with the organs and fluid lying at the back of the tummy and the gas above, it is now safe to introduce the camera via the port and look around and assess the sites for insertion of further ports. Most ports are 5, 10 or 12mm in diameter and most operations require between two and five port sites.

In general laparoscopy gives a better view of the abdominal structures than is achieved at open surgery because the picture is greatly magnified on a television screen. As a rule we aim to reproduce the techniques of open surgery when operating, although they may need some modifications for practical considerations. The reason for this is that laparoscopic surgery is not an excuse for a short cut or quick fix method; with suitable training and skills most abdominal operations can be carried out without compromising any of the established rules of open surgical practice.

Advantages of Laparoscopic Surgery

Less post-operative pain, due to smaller incisions.

Shorter hospital stay, smaller incisions and less pain mean that recovery is faster.

Less time off work, due to the rapid recovery.

Fewer respiratory complications. Fast mobilization and less pain after surgery reduces the risk of chest infections and pulmonary embolism (blood clots on the lung).

Faster return of gut function, because the abdomen is not opened and the intestines are not handled patients regain intestinal function faster and can eat and drink sooner than after open surgery.

Improved cosmetic appearance. Small incisions heal well and are less obvious or disfiguring.

Disadvantages

Risk of visceral injury during formation of pneumo-peritoneum. It is possible to inadvertently injure the bowel or other organs whilst opening the abdomen to introduce the first port. The risk of this is similar to that when making an incision for open surgery (if done correctly), however at open surgery the injury is nearly always noticed immediately, whilst with laparoscopic surgery it may be less obvious and be missed. In expert hands this risk is minimized, but still occurs in approximately 0.2% of cases. It can produce very serious consequences and nearly always requires further open surgery.

Risk of injury to other structures. The two dimensional view given by the cameras means that it is harder to judge depth of field than with an open view. The long instruments and lack of direct contact with the hands mean that there is a reduced tactile feedback from the organs and tissues being operated on. The combination of these two factors mean that occasionally the views can be misinterpreted and injury to structures around the operative field may occur. The risk of this is directly proportional to the experience, training and specialization of the surgeon performing the operation. Within the ALLPS group we do not support performing any specific laparoscopic operation if its risks are greater than those posed by equivalent open surgery.

Specific operations carry specific risks which are dealt with in the detailed sections describing these operations elsewhere on this web site.

Laparoscopic operations available with ALLPS surgeons

Laparoscopic cholecystectomy
(Keyhole removal of the gallbladder)

Laparoscopic bile duct exploration
(removal of bile duct stones)

Laparoscopic abdominal wall hernia surgery

Laparoscopic splenectomy
(removal of the spleen)

Laparoscopic appendicectomy
(removal of the appendix)

Laparoscopic diagnostic and staging examination
(keyhole assessment of intra-abdominal disease in particular investigation of abdominal pain and assessment of operability for upper abdominal tumours)

Laparoscopic ultrasound examination
(an internal examination of abdominal organs with an ultrasound probe placed inside the abdominal cavity, particularly useful for assessing liver, biliary, gastric and pancreatic conditions)

Laparoscopic adrenalectomy
(removal of the adrenal gland)

Laparoscopic pancreatic surgery (surgery for some benign or malignant tumours of the pancreas)

Laparoscopic liver resection surgery
(surgery for some benign or malignant tumours of the liver)

Laparoscopic deroofing / fenestration of liver cysts
(deroofing and drainage of fluid filled benign liver cysts)

Laparoscopic division of adhesions
(division of bands of intra-abdominal scar tissue after previous surgery)

Laparoscopic Lymph node biopsy

This is the current scope of our abdominal keyhole surgery. We offer a wide range and broad experience of specialist upper abdominal laparoscopic surgery which is equal to that of any other group of surgeons in the south of England.