Laparoscopic Surgery
Laparoscopy is derived from the Greek word (lapar) = abdomen and (oscopy)=to inspect or look at. In simple terms it describes a technique of inspecting the abdominal cavity with the assistance of an instrument, the laparoscope, without the need to make large and painful incisions. This technology has been available for many decades, but had not been utilized beyond the inspection stage until the late 1980's. By 1990, new instruments had evolved and operations now could be performed in the abdomen without large incisions. A parallel analogy in orthopedic procedures is called arthroscopy.
In many cases, the operation, or specific intent of the procedure has not been altered, and the great advantages of the laparoscopic approach are.
- Reduction in pain and discomfort
- Reduction in the length of hospital stay and reduced cost
- Earlier return to normal activities and return to work.
- Less visible scarring and less risk for future incisional hernias.
- On occasion, increased safety in very ill patients.
Laparoscopic surgery is not a stand-alone specialty. It is one more tool in the surgeon's armamentarium, complimenting their experience and training in the diagnosis and open surgical correction of disease.
NWSS recognized the value and potential of laparoscopic surgery in 1990 and we were in the forefront of introducing this technology to the Puget Sound community. The initial efforts, and at this time, the most universal application in general surgery, is the laparoscopic assistance in removal of the gall bladder, or in medical parlance, laparoscopic chlolecystectomy. The benefit to the patient, combined with the 98% success rate in completing the operation successfully, has made it the absolute first choice for all patients. Due to the high incidence of gallstones in our country, this operation is performed between 300,000 and 400,000 times a year. It is often said, when there are many ways to cut the pie, they must all be good, or no one way is best. When it comes to removing the gall-bladder, there is one best way for most patients, with the assistance of the laparoscope. The wide application and acceptance by surgeons and patients serves as testimony.
It was natural to adapt a new and beneficial tool to other surgical conditions. The greatest advantage is to treat common problems, that is, those that occur frequently. Repair of inguinal hernias with laparoscopic assistance is now well established. The decreased pain and faster recovery with laparoscopy verses open repair of hernias is the major benefit, and when applied to the appropriate patient, is safe and effective. The treatment of patients with recurrent hernias or with simultaneous hernias on both sides are especially favorable candidates for the laparoscopic approach.
A more recent procedure with demonstrated value for laparoscopic repair is the correction of abnormal reflex of gastric acid into the esophagus. This is a common medical disease that is very responsive to surgical correction, a major undertaking when done as an open procedure, but now widely done with laparoscopic assistance. All the benefits of a minimally invasive procedure accrue combined with successful results and quicker relief of symptoms.
Other common ailments which lend themselves to laparoscopy are the diagnosis and treatment of acute appendicitis, diverticulitis, and many disorders of the pelvis and female organs of reproduction. Laparoscopy can also be used to remove the spleen or adrenal gland, divide adhesions, look for metastatic cancer etc.
It is stated, that essentially any abdominal operation can be done with laparoscopic assistance, yet many of them are infrequent, technically challenging, and of some doubt as to the advantage over the open surgical approach. NWSS recommends weighing the complexity of the procedure with the skill and experience of the surgeon in evaluating your choice in such instances.
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