Jaya Balan's Women's Health & Fertility Clinic offers our thoughts and prayers to the affected family of MH17. How do we say goodbye when we've never said hello? This one minute of silence to honour lives, loves and dreams cut short by madmen and madness is our way of saying we may not have known you, but we will never forget you. Rest In Peace.

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LAPAROSCOPIC SURGERY

What is laparoscopic surgery??

Laparoscopic surgery, also recognized as minimally invasive surgery is a modern surgical technique in which operations are executed through small incisions in the abdomen. The surgeon inserts a tiny telescope also known as laparoscope through the small incision at the umbilicus (belly-button). The laparoscope is an instrument rather like a miniature telescope with a fiber optic system which brings light into the abdomen. It is approximately as big as a fountain pen and twice as long. The laparoscope allows the surgeon to see the pelvic organs on a video monitor. Some additional smaller incisions are made in the abdomen to place specially designed surgical instruments that aids the surgeon to execute the same procedure as in open abdominal surgery. An instrument to move the uterus during surgery will be placed in the vagina and carbon dioxide gas is placed into the abdomen via a special needle which is inserted just below the navel. This gas will help to separate the organs inside the abdominal cavity making it easier for the surgeon to see the reproductive organs during laparoscopy. Not to worry, as the gas will be removed at the end of the procedure. Laparoscopic surgery is implemented for a range of operations including endometriosis and ovarian cysts.

  

The surgeon inserts  laparoscope through the small incision at the umbilicus (belly-button)

 

Carbon dioxide gas is placed into the abdomen via a special needle which is inserted just below the navel. 

 

The laparoscope allows the surgeon to see the pelvic organs on a video monitor.The carbon dioxide gas will help to separate the organs inside the abdominal cavity making it easier for the surgeon to see the reproductive organs during laparoscopy

 

After the surgery, there will be ONLY THREE small incisions.

What is a diagnostic laparoscopy?

A diagnostic laparoscopy is a procedure in which the surgeon uses a laparoscope to look at the organs and tissues inside the abdominal cavity.

Can endometriosis be treated laparoscopically?

YES. A laparoscopic biopsy is required to diagnose endometriosis. Endometriotic implants are ideally treated laparoscopically with excision. This treatment usually produces more immediate results in terms of pain relief and improves fertility compared with medical therapy.

What procedure can be done by laparoscopic surgery??

Almost all surgeries being done in open surgery are nowadays being performed using this method. The most common however are cholecystectomy (removal of the gall bladder), appendectomy (removal of the appendix), tubal ligation (sterilization), diagnostic laparoscopy, hernia repair. Below shows some pictograms of procedures done via laparoscopically:

What are the advantages/benefits of this method?

In conventional surgery, operations are carried out by making a long incision to gain entry into the abdominal cavity. Eventually this act, results in greater post-operative pain, extended stay in hospital, delayed recovery, long and ugly scars, respiratory problems, greater chances of wound infections, higher chance of incisional hernia, delayed feeding after surgery and etc. The prevalence of all of these is dramatically reduced by performing laparoscopic surgery.

ADVANTAGES to the patients with LAPAROSCOPIC SURGERY Vs. OPEN ABDOMINAL SURGERY are as follow:

-Reduced bleeding  -> (Reduces the chance of needing blood transfusion)
-Smaller incision     -> (Reduces pain and shortens the recovery time)
-Less pain              -> (Less pain medication required)
-Reduced exposure of internal organs to possible external contaminants  -> (Reduced risk of acquiring infection)
-Although procedure time consumptions are slightly longer  -> (Hospital stay is less, and often discharge on the same day).

What are the risks of laparoscopic surgery?

The risk factors are almost similar for both laparoscopic and open surgery. However, there is a small chance – 1:1000 that the surgeon may not be able to complete the procedures laparoscopically. This may be secondary to unexpected complication or could be because the surgery cannot be safely performed with a laparoscopic approach.

General risk factors:

-May have risk when given general anesthesia
- Chances of infection or bleeding
-Abdominal organs, glands, intestines, or blood vessels may be damaged if surgeon is not experienced
-Lining of abdominal wall may be inflamed knows an peritonitis
-Blood clot may enter the bloodstream and clogs the artery in the lung, pelvis or legs. The clot may break off and clogs an artery in the heart or brain causing heart attack/stroke. HOWEVER, THESE RISKS ARE VERY RARE.

Where can I get it done?

Laparoscopic surgery has become very common and is being done in almost every reputed hospital with minimal complication rates.

Is it more expensive than open abdominal surgery?

The equipment utilized, maintenance and procedure are more expensive but as the hospital stay and the intake of drug is reduced which makes the cost the same if not less than open surgery.

Will I need anesthesia?

Diagnostic laparoscopy and hernia repairs can be done under local anesthesia but the other procedures will require general anesthesia.

How do I prepare myself for laparoscopy surgery? 

-The day before – eat light and healthy food and drink lots of fluids.
- Do not eat or drink anything after 12.00 midnight (the night before the surgery).
-It is advised to have some supper around 11.00 pm so that you are not totally in starvation mode throughout the next day.
-Do not smoke after 12.00 midnight.
-Your Doctor will probably ask you to do enema to clean your bowel. This will be done during the surgery day.
-Pack a hospital bag including: warm, loose clothing to wear after the operation, clean socks to keep your feet warm after surgery. Leave your valuables at home.
-Remove nail polish, remover jewelry and contact lenses.
-Take a warm bath the night before and get a good night sleep.

What can I expect immediately following laparoscopy surgery?

Generally, you will experience any of the following symptoms within the first 24 to 48 hours:

-Nausea and lightheadedness

-Scratchy throat if a breathing tube was used during general anesthesia

-Pain around the incision

-Abdominal pain or uterine cramping

-Shoulder tip pain-secondary to the carbon dioxide gas

-Tender umbilicus (belly-button)

-Gassy or bloated feeling

-Vaginal bleeding or discharge (like a menstrual flow)

What is the normal recovery time following laparoscopic surgery?

Recovery time usually depends on the type of procedure performed. Most of the patients will feel well within days of surgery. Nevertheless, if major surgery has been executed, rest is still required. Most of the patients will require some form of pain medicine in the immediate postoperative period. Your doctor will discuss this with you after surgery and assist you to make an informed choice.

How long will it take for full recovery?

The following is a normal timetable for recovery of minimally invasive surgery on the abdomen:

-Groggy feeling from the anesthetic disappears the day after surgery and the individual is fully alert once again.

-Any pain in the shoulders or neck area usually goes away after a few days.

-Soreness in the incisions disappears within a few days and the incisions heal after about five days.

-The bloated feeling after abdominal or pelvic laparoscopy goes away within a few days. 

How long do I have to stay in hospital?

Healthy person without any other medical complications can be investigated on an out-patient basis. They can come in on the day of the surgery or the previous day. Following laparoscopic procedure for the gall bladder or appendix, patients can be discharged on the next day. However, for more advanced procedures three to four days in hospital would be normal.

Do I have to take absolute bed rest?

NO. The advantage of this laparoscopic procedure as it has been previously mentioned is that the incisions are very small thereby reducing pain and danger of hernia. Patients will be able to walk as soon as pain and anesthetic factors allows them do so.

When can I get back to work?

Generally, a week of rest from the day of the surgery should suffice. Still, it would be advisable for you to discuss with the surgeon based on your progress.

How soon can I start eating after surgery?

If the surgery runs smoothly without any other complications, feeding can be started on the same day once the patient has recovered completely from the effects of anesthesia, provided no procedure has been performed on the bowel.

I’m going to have a gynecological laparoscopy and dye test. What does this involve?

Answer
If you're having investigations for infertility, your doctor may ask you to have a gynecological laparoscopy and dye test. The dye test is used to check whether your fallopian tubes are blocked or not.

Explanation

Generally, an egg travels down to the fallopian tubes from your ovaries, to your womb. If you have unprotected sex, sperms will swim up to the fallopian tube and fertilize the egg, which results in pregnancy. However, if your fallopian tubes are blocked, the egg and sperm will not be able to meet. If you are having problems in getting pregnant, your doctor may suggest you to have a laparoscopy and dye procedure. During this procedure, your surgeon will be able to visualize whether there are any obvious reasons on why you were not able to get pregnant. At the same time, the doctor may also do a hysteroscopy. This is a procedure in which, it allows the surgeon to look inside your womb using a narrow tube-like telescopic camera called a hysteroscope. During laparoscopy, a harmless blue dye is injected through your cervix and into your womb and fallopian tube. The dye will run through your womb and fallopian tubes and will come out of the end of the tubes if they are normal. After the procedure, you may have a dark vaginal discharge for a day or two. Your surgeon will explain what to expect and how to look after yourself following the procedure.

Is laparoscopy useful in children?
Several procedures can be done by laparoscopy in children. Laparoscopy is most commonly done to find and treat the cause of abdominal pain in children when other investigations have not been helpful.  Appendicitis can be diagnosed and appendectomy can be done laparoscopically.  It may be equally easy and safe to do an open appendectomy. Other common indications are for treatments of benign ovarian cysts and when lower intestinal bleeding is suspected to be from a Meckel's diverticulum.

Is some operation like hydrocele, fistula and etc. is possible?

There is a common confusion about the procedures possible through laparoscopic method. We are getting letters from many patients asking about laparoscopic procedure for hydrocele, Fistula ano, abscesses, and even for procedure like circumcision, mastectomy, cysts and abortion. It should be understand clearly that minimal access surgery is possible inside hollow closed cavities of the body, like abdomen and chest. Most of the procedure of the diseased organ inside the chest and abdomen can be performed by minimally invasive techniques but operations on solid organ outside the abdomen and chest does not require and also not possible through this technique.

-If you have a dream, don’t just sit there. Gather courage to believe that you can succeed and leave no stone unturned to make it a reality,:Roopleen-

-Admin K