The field of surgery has seen remarkable advances through the years. One result of those advances is that today surgeons can operate in far less invasive ways than in the past. This is important for many reasons, but most of all because the less invasive a procedure is, the safer it is for the patient.
One of the most common methods of minimally invasive surgery is laparoscopic surgery. This type of surgery came into wide use in the late 1980s and is now utilized for many of the most commonly performed surgeries.
The advantages of laparoscopic surgery are numerous. Instead of making a large incision of several inches in length, the surgeon is able to perform the surgery by making three or four small incisions and then inserting small tools and a thin, flexible tube with a video camera on the end. The images from the camera are displayed on a television monitor that the surgeon utilizes to see inside the patient’s body and guide the surgical instruments accordingly. This process results in less cutting on the patient and therefore, minimal scarring.
Laparoscopic surgery also provides the advantage of reduced blood loss and decreased risk of infection. Recovery time is faster and hospital stays are shorter. In some cases, the patient may not need to remain in the hospital overnight at all. While there is always some risk associated with all surgeries, laparoscopic surgeries have a decreased overall risk when compared to traditional, open surgery.
Surgical robotics provide for another minimally invasive surgical method. With robotics-assisted surgery, the surgical instruments and camera are inserted in the patient in a manner similar to laparoscopic surgery. The surgeon controls the surgical instruments through a sophisticated series of controls while viewing a 3-D image on the screen.
“With surgical robotics, the surgeon is always in complete control of the operation and the robotic surgical tool does not make any movements on its own,” explains Dr. Andrea Palmer, an obstetrician and gynecologist. “The advantage of robotics is that we can guide the instruments to make very precise movements that are sometimes difficult for human hands to make. The robotics also enable us to guide the camera into places we could not otherwise see.”
Both laparoscopic surgery and robotics-assisted surgery require the surgeon to undergo specialized training. Privia Medical Group North Texas has several surgeons who are highly trained on laparoscopic surgery and robotics-assisted surgery. Here is a look at some of the more common surgeries that are often performed utilizing minimally invasive techniques.
There are several procedures involving the female reproductive system that are commonly conducted on a minimally invasive basis. Some of the most common are hysterectomy, removal of ovaries and tubal ligation.
“Hysterectomy, the removal of the uterus, is one of the most common gynecological surgeries,” says Dr. Palmer. “Some of the reasons a hysterectomy may be necessary include uterine fibroids, endometriosis, abnormal uterine bleeding and gynecologic cancer.”
Uterine fibroids, the most common reason for a hysterectomy, are noncancerous growths in the uterus that can cause excessive menstrual bleeding, pelvic pressure and pain, urination problems and constipation. Endometriosis is a painful condition in which tissue similar to the uterine lining grows outside of the uterus.
“If removal of the uterus is necessary, a minimally invasive hysterectomy is generally preferable when feasible,” explains Dr. Jennifer McLeland, an obstetrician and gynecologist. “There will be less pain for the patient, a shorter hospital stay and quicker recovery than with an open surgery.”
Surgery to remove the ovaries may also be performed laparoscopically. This procedure may be necessary in the event of ovarian cancer or painful ovarian cysts.
Tubal ligation or “getting tubes tied,” is the most common form of female sterilization and is usually performed laparoscopically. “With the tubal ligation procedure, we surgically block, cut or even completely remove the fallopian tubes, blocking eggs from descending from the ovaries and preventing sperm from traveling up to the eggs,” explains obstetrician and gynecologist, Dr. Kathleen Cammack. “For women who wish to never become pregnant in the future, this is a highly effective form of birth control.”
The appendix is a finger-shaped pouch located on the lower right side of the abdomen. If the appendix becomes infected (appendicitis), surgery is usually necessary to remove it before it bursts. Appendicitis can affect people of any age but is most common between the ages of 10 and 30.
Appendicitis can be very dangerous. It is characterized by a sudden sharp, intense pain in the lower right part of the abdomen and may be accompanied by a low-grade fever and nausea. Anyone who experiences these symptoms or has unexplained and severe stomach pain should get to the emergency room immediately to be checked out.
Appendicitis can be quickly diagnosed – or ruled out – through a blood test, physical exam and/or imaging. If untreated, appendicitis can cause the appendix to rupture, which results in the release of toxins into the abdomen, a dangerous and potentially lethal condition. Removal of an infected appendix before it bursts can be a life-saving surgery.
“Prior to the advent of laparoscopic surgery, an appendectomy required a four-inch incision to open the patient up and remove the appendix,” explains Dr. Annette Elbert, a general surgeon. “In most cases today, we can remove the appendix laparoscopically, through three small incisions. This results in a shorter and less painful recovery period for the patient and prevents a long scar on the patient’s abdomen.”
Gallbladder removal surgery (cholecystectomy) is one of the more common surgeries performed in the United States and is often done laparoscopically. The gallbladder is a pear-shaped organ that sits just below the liver on the right side of the abdomen. The gallbladder and the bile ducts comprise the biliary tract, a part of the body’s digestive system. The liver produces bile, a substance that carries waste products and toxins out of the body. The purpose of the gallbladder is to store the bile and then release it when we eat. The gallbladder releases bile through the bile ducts, which then mixes with food in the small intestine.
Problems may arise if gallstones develop. Gallstones are hard particles that can vary greatly in size; some are as small as a grain of sand while others can be as large as a golf ball. It is possible to just have one gallstone or several of varying sizes. Sometimes gallstones cause no noticeable symptoms. However, when a gallstone blocks the bile ducts, a “gallbladder attack” results, causing a sharp and sudden pain in the abdomen.
“While the gallbladder serves a purpose, it is not an essential organ,” says Dr. David Rutledge, a general surgeon. “When the gallbladder causes problems, such as painful gallstones, the best solution is usually to simply remove the gallbladder – and the best way to conduct this surgery is usually laparoscopically.”
Most laparoscopic gallbladder surgeries do not even require an overnight hospital stay. In contrast, when an open cholecystectomy is performed, patients usually remain in the hospital for a few days.
Colon Cancer Surgery
For people age 50 and older, periodic colonoscopies are necessary to detect signs of colon cancer. If colon cancer is detected at an early stage, the physician is often able to remove the cancerous cells through surgery. Laparoscopic surgery is commonly used to remove colon cancers and to collect cells from the lymph nodes at the same time in order to determine if the cancer has spread.
Many orthopedic surgeries are now performed utilizing minimally invasive techniques. For example, if a patient has a torn anterior cruciate ligament (ACL) in the knee, the surgeon may be able to repair the injury arthroscopically through two tiny incisions rather than a larger incision. This will result in a faster recovery time and less pain for the patient. Open surgery requires a longer incision and may disturb more muscle tissue to get to the torn ligament.
The Less Invasive, the Better
There are numerous other conditions that may be treated through minimally invasive surgery. Examples include hernia repair, various cancer surgeries, urologic procedures, some heart procedures, gastrointestinal surgery and more.
While laparoscopic or robotics assisted surgery is not feasible in every circumstance, it’s the preferred option when possible – it’s safer and easier on the patient in terms of recovery time and pain.
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