Laparoscopic Surgery

Laparoscopic surgery name comes from a laparoscope, a long telescopic tube made of fiber glass which is introduced into a body during operation and allows to see even those areas that normally are not accessible. At present, laparoscope could be of two different types but both of them use the same principle of digital imaging translated onto a monitor, where surgeon is able to see an enlarged view of operational field. Laparoscopy is normally performed using special thin instruments through a few small cuts instead of one big incision that gives to this operation also another name – minimally invasive surgery. In modern medicine this method is widely used and most of the clinics in Germany

Fewer wound infections, less pain, shorter hospital stays, faster return to everyday life: Studies and meta-analyzes today prove many advantages for patients with many laparoscopic interventions in the abdomen. Gallbladder and appendix operations and now more than a third of all inguinal hernia operations in Germany are therefore performed with small incisions using the so-called laparoscopic technique.

In the past, abdominal surgery left a more or less long, visible scar. For example, to remove the gallbladder, surgeons had to open the abdomen with a larger incision. Today the operation is carried out over three or four small skin incisions with special instruments. The abdominal cavity is filled with gas, the doctor operates under the view of a video camera, and there are hardly any recognizable tiny scars. Laparoscopic surgiry was used more than twenty years ago to remove the gallbladder and is now the standard. They have been recommending the guidelines as the preferred surgical option since the mid-1990s because patients can recover faster and be discharged earlier. In Germany, between 92 and 98 percent of all gallbladder are removed with laparoscopic surgery.

Laparoscopic surgery is also the international standard for appendix surgery today. Patients experience less pain after the operation, wound infections are less common, and they can return home to school and work sooner.

Surgeons now operate the inguinal hernia laparoscopic in 20 to 40 percent of cases. Here the surgeon should make decisions based on the patient's individual situation. Laparoscopic surgery is advantageous for women with bilateral hernia, younger patients or after a second operation after previous surgery using conventional, open technique. A clinic should therefore offer both procedures today and adapt the procedure to the individual patient situation.

In operations to treat obesity, in which parts of the stomach are removed or gastric bypass is performed, doctors have been using the laparoscopic surgery for around 20 years. This is much gentler for the massively overweight patients. The proportion of laparoscopic surgery in obesity surgery in Germany is 97 percent.

The advantages of laparoscopy are obvious:

  • It causes less damage to the body;
  • Reduced recovery time comparing to traditional surgery;
  • Less risks of such complications as excessive bleeding, inflammation, infections, and fever;
  • Less pain in postoperative period;
  • Smaller scars after surgery, that means best cosmetic result.

But there are also a few disadvantages of minimally invasive technique, as following:

  • Iimited ability to surgeon to move tools;
  • distorted perception of depth as result of enlarged image;
  • absence of surgeon’s ‘intuitive feeling’ as operation is performed by special tools but not by hands;
  • it is difficult to coordinate tools movement as they moves in opposite direction, than it viewed on display.

Based on above shortcomings it is easy to see that laparoscopic surgery requires more skills of a surgeon. So if you are sure in professionalism of your doctor you could feel your safe having minimally invasive surgery.

It is difficult to follow back to the history of minimally invasive surgery, as first attempts were undertaken as far as in begging of 20th century, but from 80-th of last century it became spread over the world. First it was used mainly in gynecology, but after 90-th the technique had been applied in many others fields of surgery.

First of all, laparoscopy could be used both for diagnostics and treatment. Sometimes it is recommended for examination of abdominal area but, at the same time, it is possible immediate intervention if needed. In other cases, decision could be made to employ traditional open surgery.

Presently, there are many medical spheres where minimally invasive methods are used for diagnostic and operational invasions. Here are the areas where laparoscopy is used most frequently:

  • Abdominal surgery: appendectomy, cholecystectomy (gallbladder removal), distal pancreatectomy (removal of the bottom part of pancreas), splenectomy (spleen removal), liver resection, bile duct surgery, intestines and stomach surgery and diagnostics;
  • Gynecology: ovarian cysts removal, tubal ligation, hysterectomy (uterus resection), ectopic pregnancy, endometriosis treatment, uterine fibroids removal, pelvic inflammatory disease treatment;
  • Cardiovascular diagnostic and surgery: coronary catheterization, minimally invasive aortocoronary bypass
  • Orthopedics: minimally invasive technique for arthroplasty;
  • Oncology: laparoscopy is widely used for cancer removal in various organs.

Not far ago there was the only laparoscopic method but now you could name at least three of them:

  • Classical method, where surgery performed with special instruments;
  • Advanced technique with hand-access devices;
  • Robotic laparoscopy.

Hand-assisted laparoscopic surgery (HALS) is a newly introduced approach eliminating the above mentioned disadvantages of laparoscopy, which allows to have hand access with HandPort System to certain areas under the control of laparoscopic imaging, it is not widely used but, probably have a future.

Robotized minimally invasive surgery is growing popular with Da Vinci™ system which is already used in some of German clinics. In Da Vinci™ system a surgeon does not have direct contact with a body of a patient performing only function of control. Robot is able to provide better accuracy and preciseness and it is really tireless and quick. The robotic method is spreading more and more in abdominal surgery replacing classical minimally invasive surgery.

The most of modern clinics in Germany have equipment, conditions and fully professional staff to provide high-level minimal invasive surgery in numerous medical areas. Turning to German specialists you obtain a chance for safe and almost painless surgical treatment with following professional postoperative care. Minimally invasive methods reduce the risks for patients and make diagnostics and treatment even more accurate, smooth and affordable.

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