Laparoscopic surgery for gastrointestinal conditions and cancers
Since the advent of laparoscopic surgery in the late 1980s, there has been no looking back. Laparoscopic surgery has revolutionized the field of surgery and has improved the acceptance of surgery for both patients and clinicians alike.
What is Laparoscopic surgery?
Conventionally, an open abdominal operation is performed using a large cut in the abdomen ranging from 6 to 12 inches in size. This helps the surgeon in attaining a good exposure and performing the procedure on the organ of interest.
The term “minimally invasive surgery” is collectively used for any surgery which is performed using cuts smaller than the traditional open surgery. This includes laparoscopic and robot-assisted surgeries.
How is it done?
Laparoscopic surgery is performed using small cuts ranging from 5-15 mm in size. The number and location of such small cuts vary depending on the type of procedure, but usually range from 1-6. The laparoscopic surgery is hence also called “keyhole surgery”.
The initial step for any laparoscopic surgery is to generate space in the abdomen for the conduct of the procedure. This is done by filling the abdomen with carbon dioxide gas. This is followed by insertion of hollow tubes, which allow a safe entry of the instruments. The laparoscope is a long narrow instrument which transmits high-intensity light and has a high-resolution camera at its end. The camera transmits the image of the inside of the abdomen to a video monitor in real-time. The surgeon operates on the organ of interest using long slender instruments while looking at the video monitor.
What are the benefits of laparoscopic surgery?
The benefit of laparoscopic surgery is not only limited to a better cosmesis. Laparoscopic surgery decreases the overall stress of the procedure and is therefore associated with a decrease in pain, shorter hospital stay, earlier initiation of diet, early discharge and an enhanced overall recovery thus allowing the patients to return to their normal lives faster.
What is Diagnostic laparoscopy?
Laparoscopy can help in diagnosing conditions, when a conclusion cannot be reached using imaging modalities like ultrasound and CT scans. Laparoscopy done in such a situation is also called as “diagnostic laparoscopy” and a biopsy, if required, can also be obtained to establish the final diagnosis.
What is Staging laparoscopy?
Certain malignancies of the abdomen e.g: gallbladder and stomach cancer have a high propensity for peritoneal deposits. These cancerous deposits can be very small in size and are therefore not appreciated on a CT scan or PET scan. Laparoscopy done for the purpose of discovering these small deposits is called as staging laparoscopy and avoid an unnecessary procedure for these cancers.
What all gastrointestinal conditions can be treated with laparoscopic surgery?
Laparoscopic surgery is commonly used to treat conditions like
Gallbladder stones (laparoscopic cholecystectomy)
Appendicitis (laparoscopic appendicectomy)
Hernia (inguinal, incisional, umbilical)
The scope of laparoscopic surgery has now expanded to advanced laparoscopy and many more procedures are now performed using this approach.
- Laparoscopic antireflux procedures
- Laparoscopic surgery for emergency conditions like duodenal ulcer perforation, intestinal obstruction
- Laparoscopic repair of diaphragmatic hernia
- Laparoscopic procedures for pancreatic pseudocyst, pancreatic necrosis
- Laparoscopic procedures for biliary system- choledochal cyst, CBD stones
- Laparoscopic small bowel and large bowel resection and anastomosis
- Laparoscopic repair of rectal prolapse
- Laparoscopic procedures for gastrointestinal cancers involving esophagus, stomach, gallbladder, liver, pancreas, colon and rectum.
What patients need to know?
Laparoscopic surgery usually requires general anaesthesia. Patient needs to undergo blood tests, Chest X-ray and ECG prior to meeting the anaesthetist, who then evaluates the patient for fitness for anaesthesia and surgery. The patient is admitted one day prior to or on the day of surgery. The surgeon needs to explain all the benefits and risks associated with the patient and family in detail in the form of written informed consent. The chances of conversion to an open procedure should be clearly explained in all cases as such a step might be required for the safe conduct of the operation in some cases. The anticipated period of ICU and hospital stay and questions regarding postoperative recovery and follow up must also be explained by the surgeon.
Is laparoscopic surgery suitable for all patients?
Laparoscopic surgery is probably one of the greatest advancements in our field. However, it might not be suitable for all patients and situations. In some difficult situations, laparoscopy can be attempted by an experienced surgeon, but the patient must be explained regarding a high chance of conversion to open surgery in such cases. The surgeon should clearly understand the limitations of laparoscopic surgery and explain the same to the patient.
Laparoscopic surgery might not be suitable or chances of conversion are higher for:
- Patients not suitable for general anaesthesia
- Patients who are hemodynamically unstable
- Patients with bleeding disorders
- Patients who have undergone multiple previous open operations- in such cases the surgery becomes difficult because of dense adhesions from previous surgery
- Large tumors, especially those which require complicated procedures. These are better treated with open surgery.
Dr. Abhishek Mitra, Senior Consultant – Department of Gastrointestinal and HPB Surgery, Gastrointestinal Oncology, Minimal Access and Bariatric Surgery, Dharamshila Narayana Superspeciality Hospital, Delhi