About Laparoscopy

What is History of Laparoscopy?

It is difficult to credit one individual with the pioneering of laparoscopic approach. In 1902 Georg Kelling of Dresden performed the first laparoscopic procedure in dogs and in 1910 Hans Christian Jacobaeus of Sweden reported the first laparoscopic operation in humans. In the ensuing several decades, numerous individuals refined and popularized the approach further for laparoscopy. The introduction of computer chip television camera was a seminal event in the field of laparoscopy. This innovation in technology provided the means to project a magnified view of the operative field onto a monitor, and at the same time freed both the operating surgeon’s hands, thereby facilitating performance of complex laparoscopic procedures. Prior to its conception, laparoscopy was a surgical approach with very limited application and used mainly for purposes of diagnosis and performance of simple procedures in gynecologic applications.

What is the Procedure of Laparoscopic Surgery?

Laparoscopic cholecystectomy is the most common laparoscopic procedure performed. In this procedure, 5-10 mm diameter laparoscopic instruments can be introduced by the surgeon into the abdomen through port and a seal to keep the CO 2 from leaking. Rather than a big incision as in traditional cholecystectomy, four incisions of 0.5-1.0cm will be sufficient to perform a laparoscopic removal of a gallbladder. Since the gall bladder is a balloon like structure that stores and releases bile, it can usually be removed from the abdomen by suctioning out the bile and then deflated gallbladder can easily be removed through the 1cm incision either at the patient’s navel or epigastric region. The length of postoperative stay in the hospital is very minimal, and same-day discharges are possible in many cases of early morning procedures.

How you remove big specimen in Laparoscopic Surgery?

In many advanced laparoscopic procedures where the size of the organ being removed would be too large to pull out through a port site,  an incision larger than 10 mm must be made or surgeon can use morcellator (A device which can cut the tissue in small pieces) in those circumstances. The most common of these procedures are removal of all or part of the uterus, or removal of the kidney (nephrectomy). A good laparoscopic surgeon perform these procedures completely laparoscopically, and some making the larger incision toward the end of the procedure for specimen removal, or, in the case of a colectomy, to also prepare the remaining healthy bowel for anastomosis.

Nowadays Hand assisted laparoscopic surgery is also common. Many surgeons feel that since they have to make a larger incision for specimen removal anyway at the end of surgery, they might use this incision to have their hand in the operative field during the procedure from the begining to aid as a hand assisted instrument as retractor, dissector, and to be able to have taktile feedback, as they would in open surgery. Since they will still be working with scopes and other laparoscopic instruments, CO2 will have to be maintained in the patient’s abdomen, so a device known as a hand access port (like lap disk or Hand port or Omni Port) must be used. Surgeons that choose this hand-assist technique feel it reduces operative time significantly vs. the straight laparoscopic approach, as well as providing them more options in dealing with unexpected adverse events that may otherwise require creating a much larger incision and converting to a fully open surgical procedure.

Which procedure can be performed by Laparoscopy?

The laparoscopic surgery is intended to minimise post-operative pain and speed up recovery times, while maintaining an enhanced visual field and magnified view for surgeons. Due to improved patient recovery, in the last two decades, laparoscopic surgery has been adopted by various surgical sub-specialties including gastrointestinal surgery, Gynecological procedures and and urology. Based on numerous prospective randomized controlled trials, the approach has proven to be beneficial in reducing post-operative morbidities such as wound infections and incisional hernias (especially in morbidly obese patients), and is now deemed safe when applied to surgery for cancers such as cancer of colon.

What is the drawback of this procedure?

There are many drawback of Laparoscopic surgery also like restricted vision, the difficulty in handling of the instruments (new hand-eye coordination skills are needed), the lack of tactile perception and the limited working area are factors which add to the technical complexity of this surgical approach. For these reasons, minimal Access surgery has emerged as a highly competitive new sub-specialty within various fields of surgery. Surgical residents and junior consultant who wish to focus on this area of advanced surgery gain additional laparoscopic training after completing their basic surgical residency.

What is the advantage of Laparoscopy?

There are a number of advantages to the patient with laparoscopic surgery versus an open procedure.

  1. Reduced blood loss in experienced hand, which reduces the risk of needing a blood transfusion
  2. Smaller incision, which reduces pain and shortens recovery time.
  3. Less pain, leading to less analgesic needed.
  4. Hospital stay is less, and often with a same day discharge which leads to a faster return to everyday living.
  5. Reduced exposure of internal organs to possible external contaminants thereby reduced risk of acquiring infections.

Which hospital is good for Laparoscopic Surgery?

In India World Laparoscopy Hospital is best because it is dedicated for Laparoscopic Surgery. Address is

World Laparoscopy Hospital

Cyber City, DLF Phase II, Gurgaon, NCR Delhi, 122 002, India

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Previous experience of open surgery does not affect the outcome of developing laparoscopic skill

All over world Dr R K Mishra is considered as one of the best laparoscopic trainer who has alone trained more than 3000 surgeon and gynecologists from 108 countries. According to Dr Mishra training of laparoscopic skills during surgical training is recognized as an important aspect of surgical education. In fact, in developed country the residency review committee for surgery has now required minimum numbers for laparoscopic procedures. It is proved now that laparoscopy requires a very different set of skills compared to open surgery. Laparoscopic skills are inherently different than the open surgery due to differences in the sensory input, including loss of depth perception due to the translation of a two-dimensional video image to a three-dimensional working environment, different skilled eye-hand coordination because the field of vision is not the same as the operating field, dissimilar tactile feedback compared to open surgery, the fulcrum and liver effect of long laparoscopic instruments, varying handles of laparoscopic instruments. Laparoscopic basic skills are best trained in the nonclinical setting. The beginners are more benefited if they will perform laparoscopic surgery after developing their skill in non clinical environment. Godd quality endotrainer and virtual-reality trainers have been shown to be useful in training laparoscopic skills. At World Laparoscopy Hospital, Gurgaon, study were perform to see that previous experience of open surgery is necessary or not to develop laparoscopic skill. This study tested the hypothesis that baseline scores could be predicted in inanimate box trainers and virtual-reality trainers by non surgical skills. In this study only preclinical medical students were included so that they should not have the training of open surgery. All participating doctor were given a survey ascertaining if they played computer games or played a electronic keyboard. After calculating all the data it was found that nonsurgical skills do not predict baseline scores in either trainer.

 

Prof. Mishra performing Laparoscopic SurgeryThere are obvious differences among individuals with regard to baseline ability and skill. Certain nonsurgical skills may predict baseline laparoscopic skills. Some studies have suggested that baseline laparoscopic skills can be predicted by video game usage interestingly. Because of more require enhanced eye-hand coordination, manual dexterity, and visuospatial ability, which are traits necessary for laparoscopic proficiency. The young participants with good previous history of interest in playing video game could develop their skill in laparoscopy more quickly. The difficult aspect of defining laparoscopic skill is that it does not truly exist in a vacuum. To separate laparoscopic skill from surgical judgment is difficult. In addition, while many have developed excellent metrics for laparoscopic skills no data have yet been published to determine if these metrics correlate with patient outcome, which is the ultimate reason for learning laparoscopic skills. Ultimately, all laparoscopic skill training needs to accompany a broad-based curriculum. The conclusion of this study was it is evident that the preexistence of nonsurgical skills cannot be consistently utilized to predict baseline scores on endoscopic trainer.

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