Laparoscopy is a method of surgery where small incisions are made, and operations are done using special techniques and instruments. The advantages are, less pain, earlier recovery and even long term advantages such as lesser risk of adhesions and herniation. The bowel and viscera are packed together within our tummy. Normally there is minimal space between the organs as they lie together. During laparoscopy, gas (carbon- di-oxide) is pumped inside the abdomen. This creates an artificial space above the intestines and organs. Multiple small holes are then made through the abdominal wall. A camera is inserted through one of these holes. Instruments are also passed through and various operations can be done. Sometimes access and visibility are better than the ‘open’ operations, as the laparoscope provides a magnified view of the interior.
Appendicectomy used to be done as an ‘open’ operation. However this is increasingly being done by the key- hole method. Usually three small cuts (5-10mm) are made. A camera and special instruments are passed through these cuts. The main advantage is that a better and bigger view is obtained. Alternative diagnosis can be checked, especially in women where due to adjacent ovary, there can be difficulties and doubts in the diagnosis.
Laparoscopic views of inflamed appendices from various patients
Colonic cancer is being diagnosed with increasing frequency in India due to increasing longevity and also change to western styles of living. Initial concerns about key hole surgery for cancer were dismissed by trials which showed that these laparoscopic operations were oncologically the same. In addition there were benefits in terms of reduced pain , smaller scar (less likelihood of adhesions) and earlier recovery to work. Laparoscopic colonic surgery is even better suited for removing benign lesions.
A 45 year old patient underwent colonoscopy for altered bowel habit. At colonoscopy a caecal cancer was found. A laparoscopic right hemicolectomy was done.
A 41 year old lady underwent laparoscopy for suspected appendicitis. At laparoscopy the caecum looked suspicious. The appendix was normal. A limited right hemicolectomy was done laparoscopically. As laparoscopic expertise was available, a major laparotomy was avoided.Pathologic examination showed the caecum to have diverticulitis, a rare condition (see picture).
The patient made an uneventful recovery and was discharged on the third postoperative day.
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