Laparoscopic Surgery
Laparoscopy is a minimally invasive technique used to perform certain surgeries. Benefits to laparoscopic surgery include reduced risk of infection, faster healing time, shorter hospital stay and a quicker return to normal activities.
Laparoscopic procedures are performed using several small incisions in the abdomen; one for a laparoscope that enables the surgeon to visualize his work with fiber optic light and a video camera; the remaining incisions are for instruments used in completing the operation. In order for the surgeon to be able to see and maneuver the instruments, carbon dioxide is used to inflate the abdomen creating space between the abdominal wall and organs. After the procedure is completed, the carbon dioxide is released.
The physicians at Dayton Surgeons have extensive experience in successfully completing minimally invasive procedures such as the ones listed here. Your surgeon can further explain laparoscopic surgery and determine if you are a candidate for this technique.
If kidney damage is severe, transplantation may be necessary. A transplant provides a patient with a kidney that can keep up with the demands of a full, active life. During surgery, the patient will be under general anesthesia. The transplant surgeon begins by making an incision on the right or left side of the lower abdomen just above the groin. Once the diseased kidney is removed, the surgical team places the donor kidney into the abdomen and connects the kidney's blood vessels to the recipient's iliac artery and vein. The surgeons then connect the ureter to the bladder. A small drain may be placed into the abdominal cavity to drain excess fluid. Following a kidney transplant, the average hospital stay is about 10 days.
Cholecystectomy - Once it is determined that a patient has gallstones (based on an ultrasound, CT scan, etc.) or a diseased gallbladder (based on symptoms or other tests), there are really only two options; either live with the discomfort and the probability that symptoms will get worse or have your gallbladder removed. Previous attempts at dissolving gallstones and lithotripsy (breaking up gallstones with ultrasound) were largely unsuccessful.
Fortunately, most patients are now candidates for Laparoscopic Cholecystectomy. This is removal of the gallbladder through 3, 4, or 5 1/2 inch long incisions through the abdominal wall. The surgery is actually done with a 1/4 inch to 1/2 inch scope with a camera attached looking at your gallbladder inside the abdomen. The physician does the surgery while looking at a TV monitor. The gallbladder is detached from the common bile duct (division of the cystic duct) and the artery to the gallbladder is divided (ligation of cystic artery). The gallbladder is then released from its attachments to the liver and removed through one of the small incisions. After the procedure is completed (which takes between 3/4 to 1 1/2 hours), bile flows directly from the liver to the duodenum. Recovery time is usually 1 to 2 weeks after surgery.
Occasionally, because of severe inflammation of the gallbladder or difficulty identifying appropriate structure, an open Cholecystectomy is done. Prior to Laparoscopic Cholecystectomy in approximately 1990, open Cholecystectomy was the usual method of removal of the gallbladder. This is done through a 6 to 9 inch incision in the abdominal wall. The same structures identified in Laparoscopic Cholecystectomy are found and divided. The recovery time is slightly longer with the open technique than with Laparoscopic removal of the gallbladder.
Hernia Repair - A hernia is a tear or weak spot in the abdominal wall. Hernia repair is performed at a hospital or surgical center under local, regional, or general anesthesia. After the hernia is repaired, mesh may be used as part of the repair to avoid future hernias.
Many hernia repairs can now performed laparoscopically which can shorten a patient's recovery time. Talk to your surgeon to determine if you are a candidate for laparoscopic hernia repair.
The hiatus is an opening in the diaphragm through which the esophagus passes from the chest into the abdomen. The esophagus empties into the stomach normally just below diaphragm. When this opening becomes weakened or enlarged, a portion of the stomach and/or esophagus can bulge into the chest cavity.
You can have a hiatal hernia with or without gastroesophageal reflux disease (GERD). However, if you do have GERD, a hiatal hernia can increase the reflux symptoms.
Hiatal Hernia Repair - Bringing the stomach back into the abdominal cavity and closing the esophageal hiatus around the esophagus repairs a hiatal hernia. If it is repaired laparoscopically, you can expect a short recuperation of approximately 2 to 3 weeks.
See also gastroesophageal reflux (GERD) treatment to learn more about gastroesophageal reflux, which may accompany your hiatal hernia.
In patients with GERD, the lower esophageal sphincter (LES) is too weak to effectively hold food and fluids in the stomach, this allows stomach acid to escape into the esophagus, which irritates the esophagus which is often referred to as heartburn. Chronic heartburn can ultimately lead to chronic inflammatory changes, and then to ulcers and strictures (narrowing) of the esophagus. In some cases, it can also eventually lead to cancer of the esophagus.
Fundoplication - This is part of the surgical treatment of gastroesophageal reflux disease (GERD). Surgery recreates the LES by wrapping the top of the stomach around the bottom of the esophagus. There are two different types of wraps that may be used, the full wrap goes all the way around the lower esophagus while the partial wrap does not. Regardless of which type of wrap is selected, the surgeon permanently stitches it in place. The wrap creates extra support to prevent reflux by increasing the LES pressure.
If a hiatal hernia exists, it is repaired as part of the procedure.
Splenectomy - This is removal of the spleen. This can be done for traumatic injury to the spleen. The entire spleen can be repaired by various means or be removed entirely. The spleen can also be removed for treatment of hematologic diseases (such as idiopathic thrombocytopenic purpura).
When performed laparoscopically, the hospital stay for a splenectomy can be less than one week.
Adrenalectomy is the surgical removal of one or both of the adrenal glands. The adrenal glands are paired endocrine glands, one located above each kidney, that produce hormones such as epinephrine, norepinephrine, androgens, estrogens, aldosterone, and cortisol. Adrenalectomy is usually performed by conventional (open) surgery, but in selected patients surgeons may use laparoscopy. With laparoscopy, adrenalectomy can be accomplished through four very small incisions.
Adrenalectomy is usually advised for patients with tumors of the adrenal glands. Adrenal gland tumors may be malignant or benign, but all typically excrete excessive amounts of one or more hormones. A successful procedure will aid in correcting hormone imbalances, and may also remove cancerous tumors that can invade other parts of the body. Occasionally, adrenalectomy may be recommended when hormones produced by the adrenal glands aggravate another condition such as breast cancer.
A colectomy (ko-LEK-tuh-mee) is surgical removal of the colon, or large intestine. If only part of the colon is removed, the procedure is called a hemicolectomy. After the removal, the doctor may need to---at least temporarily---leave an opening to the intestine through the wall of the abdomen. Intestinal contents drain from this opening into a sealed pouch. The opening is known as a "stoma," and the operation to create it called an "ostomy." There are two types of ostomy:
Ileostomy - This operation creates an opening to the small intestine (ileum) through surface of the abdomen. Intestinal contents draining from this location are typically no thicker than toothpaste.
Colostomy - This operation establishes an artificial outlet for the large intestine (colon). Waste draining from this opening will be soft or more formed depending on the part of the colon involved.
Colectomies can be performed through a single long incision in the abdomen (an open colectomy), or several small incisions (a laparoscopic colectomy). Working through the incisions and the rectum, the surgeon will remove the diseased portion of the colon and, if possible, reconnect the remaining segments. If the operation is done laparoscopically, the surgeon will make a small incision under the belly button, and two other "Band-Aid" incisions near the diseased section of the colon. The surgeon then maneuvers miniature surgical instruments through these incisions with the help of a lighted scope. The abdomen is inflated with carbon dioxide to give the surgeon a better view. Both types of surgery will take from 1 to 4 hours, and may last longer.
Nephrectomy is the surgical procedure of removing a kidney or section of a kidney.
Nephrectomy, or kidney removal, is performed on patients with cancer of the kidney (renal cell carcinoma); a disease in which cysts (sac-like structures) displace healthy kidney tissue (polycystic kidney disease); and serious kidney infections. It is also used to remove a healthy kidney from a donor for the purposes of kidney transplantation.
Laparoscopic nephrectomy - is a form of minimally-invasive surgery that utilizes instruments on long, narrow rods to view, cut, and remove the kidney. The surgeon views the kidney and surrounding tissue with a flexible videoscope. The videoscope and surgical instruments are maneuvered through four small incisions in the abdomen. Once the kidney is freed, it is secured in a bag and pulled through a fifth incision, approximately 3 in (7.6 cm) wide, in the front of the abdominal wall below the navel. Although this surgical technique takes slightly longer than a traditional nephrectomy, preliminary studies have shown that it promotes a faster recovery time, shorter hospital stays, and less post-operative pain for kidney donors.
