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LAPAROSCOPIC SURGERY

What was thought to be nearly impossible twenty years ago…laparoscopic surgery has become a mainstay of physicians’ approach to an ever-increasing list of conditions. Known better in its early days as "laser surgery," physicians now use the laparoscope – a very small video camera that is inserted into the body through a tiny incision – to control "joystick surgery" that is performed through two or three other half-inch-long incisions in the area of question.  Today, more that 90% of all gallbladder surgery is performed in this fashion, leaving patients with only 4 tiny marks and much less discomfort than with open surgery. This means most patients go home the same day or the day following surgery and, in many cases, can return to normal activities within a week. These dramatic patient benefits make gallbladder surgery as well as many other surgeries done laparoscopically.

While the laparoscopic approach is currently used most often today in the removal of gallbladders and in the assistance of performing a hysterectomy, this approach to surgery is quickly being applied to other areas as well, including removal of the appendix, repair of hiatal hernias, and removal of large or multiple colon polyps. Tools which are used for laparoscopic surgery are designed like traditional surgical instruments but on a much smaller scale. The tools are passed through hollow tubes called trocars. The tools function as "joysticks" that a surgeon maneuvers to perform the surgery while watching the action "on the inside" on an external video screen. This screen receives images from the very tiny laparoscopic camera. Carbon dioxide gas pumped into the abdominal cavity assists the surgeon in maneuverability in the abdomen, as well as providing room to access intraabdominal organs such as the gallbladder and colon.

A great advance that is becoming more and more popular is to treat severe reflux or complicated hiatal hernias with a surgery called laparoscopic Nissen fundoplication.  Nissen fundoplication involves constructing a new "valve" between the esophagus and the stomach by wrapping the upper portion of the stomach around the lower portion of the esophagus, forming a new antireflux barrier and eliminating the hiatal hernia..

Since the incisions used are much smaller than those during conventional surgery, the amount of healing and pain that occurs postoperatively are much less than with conventional surgery. Conversely, the amount of skill and specialization required for laparoscopic surgery often surpasses that of the average surgery. An experienced surgeon is a key factor in achieving a favorable outcome. Additionally, the laparoscopic approach is not applicable to everyone’s condition. Body habitus, patient’s coexisting medical conditions, and coexistence of infection can often exclude laparoscopic surgery as a choice in any given situation.

Click here for a photo tour of a laparoscopic (LASER) gallbladder removal, linking to Laparoscopy.com. (Warning - this is a graphic picture set of a real surgical procedure.)