Laparoscopic surgery is a form of minimally invasive surgery rather than the old fashioned
type of surgery where we would make a large cut on the abdominal cavity and a surgeon
and his assistant will place their hands inside the abdomen. In laparoscopic surgery, we’re
using a number of smaller incisions into which ports are placed and then instruments or a camera
can be placed through those ports to enable the operation. The surgeon’s looking at
a TV screen usually above the patient and instruments are being utilised above the patient’s
abdomen so that the surgeon can then go ahead with the operation. We can introduce things
that can cut tissue that can stop bleeding that can join tissue together and that enables
us to do a whole host of different operations from rather minor surgery to more advanced techniques.
We utilise this type of minimally invasive technique depending on patient factors and
also depending on the operation we’re doing. If patients have had previous abdominal surgeries,
sometimes it can be difficult to use laparoscopic technique.
We’d often use it for more minor operations. Things like removal of a gallbladder, for
hernia repairs both in the groin or in the abdominal wall but we can also increasingly
use it for more complex operations and that would be potentially removal of part of the
pancreas gland, spleen, or even for sometimes things like liver resection where we’re
removing a tumour from the part of the liver.
This type of surgery will be performed under general
anaesthetic. It would normally involve making a small cut somewhere around the belly button
of about a centimetre through which a port and then a camera can be placed and gas can
be introduced into the abdominal cavity. We then place a number of smaller incisions in
different areas of the abdomen depending on what operation we’re performing.
For example, if we’re doing a removal of a gallbladder or a so-called laparoscopic
cholecystectomy, we would make a small cut by the belly button and then three smaller
cuts in the top of the tummy—one in the midline and two on the right side. We then
introduce instruments into those ports and we’re able to disconnect the gall bladder
from the liver and the surrounding bile ducts and then place the gallbladder in a bag
so that it can be removed from the umbilical cords. We then make sure that there is no
bleeding in the abdomen and no collections of abnormal fluid and we can then release
the gas from the tummy, remove the ports, and close the abdominal wounds. The patient
would often go home the day of surgery or the day after surgery with very little pain after
the operation.
The major benefits after the patient in terms
of the way they recover from an operation, if you think about old fashioned incisions
where a large cut would often be placed on the abdominal wall so that the surgeon could
put the hand inside the abdomen and the cut was going through muscle, that would create a
lot of pain for the patient and it would delay their discharge from hospital for several
days. It would also mean that the patient would require very strong painkillers which
were often morphine based and came with side effects. Those wounds had a high chance to
become infected or to even form hernias in the future.
The benefits of laparoscopic surgery is that the incisions are very small that creates
very little pain for the patient when they wake up from the surgery and also means a
requirement for strong painkillers is much less. The patient can be up and mobilising
very quickly after the operation and sometimes can be discharged the same day clearly depending
on the recovery and the type of operation they’re having. It also does make advantages
for the surgeon in certain operations. For example, in a larger patient where we try
to do a gallbladder operation through a small open incision, it can actually be quite difficult
to visualise the important structures whereas the view that we attain with laparoscopic
surgery enhances the ability to do the operation safely.