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Laparoscopy Surgery Treatment

Laparscopic Surgery in India'Going under the scissors' has always been a fear lived by practically every human. Whenever we talk about an operation, the first thing that comes to mind is - "Oh God! They are going to cut me open…." Well, not anymore! Reducing the size of incisions has been a dream of surgeons for thousands of years and with Laparoscopy, they have been able to achieve just that.

Laparoscopy is a surgical procedure performed through very small incisions in the abdomen, using specialized instruments. This type of surgery is also called 'minimally invasive surgery' or 'keyhole surgery' because of the very small incisions used. Yet major procedures can now be performed using this technique. In this procedure, a pencil-thin instrument called a laparoscope is used. A laparoscope has lenses like a telescope to magnify body structures, a powerful light to illuminate them, and a miniature video camera. The camera sends a magnified image from inside the body to a video monitor, giving the surgeon a close-up view of the organs and tissues. Specialized surgical instruments can be inserted through the laparoscope, and through small incisions nearby. These instruments serve as tiny hands within the abdomen and assist the surgeon. Laparoscopy is used either to treat the problem (laparoscopic surgery) or to diagnose it (diagnostic laparoscopy). With laparoscopy, the doctor can identify diseased organs, take tissue samples for biopsy, and remove abnormal growths.

Laparoscopic Hernioplasty
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A hernia is an abnormal protrusion, or bulging out, of part of an organ through the tissues that normally contain it. A hernia may develop in almost any part of the body; however, the muscles of the abdominal wall are most commonly affected. In this condition, a weak spot or opening in a body wall, often due to laxity of the muscles, allows part of the organ to protrude. Hernias by themselves usually are harmless, but nearly all have a potential risk of having their blood supply cut off (becoming strangulated). If the hernia sac contents have their blood supply cut off at the hernia opening in the abdominal wall, it becomes a medical and surgical emergency. There are many different types of abdominal wall hernias. They are:

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Latest Methods
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Laparoscopic Cholecystectomy is now the gold standard treatment and is the commonest operation performed laparoscopically worldwide. Gynaecologists have long used this technique to tie the Fallopian tubes and to inspect the female reproductive organs. Now the use of laparoscopy has been expanded to include removing a diseased gallbladder. The first documented laparoscopic Cholecystectomy was performed by Erich Mühe in Germany in 1985. Currently, over 90% of cholecystectomies are performed laparoscopically; making it the most common procedure performed in general surgery practice.
 
It is a minimally invasive approach that involves specialized video equipment and instruments that allow a surgeon to remove the gallbladder through four tiny incisions, most of which are less than a half-centimetre in size.

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Conventional method
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Conventional method

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The more traditional method is an open hernia surgery. In this technique, surgery is done from the outside of the body. A cut is made through the skin over the hernia. This involves making a four- to six-inch incision and identifying the gap by looking through the layers of tissue. After this the protruding tissue is either removed or pushed back into the abdomen and the abdominal wall is repaired and strengthened. The abdominal wall can be strengthened by sewing surrounding muscle over it, or it can be strengthened with a special type of mesh.

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Laparoscopic Inguinal Hernia Repair
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Inguinal hernias are repaired with a 1cm incision for the camera and two 5mm ports. The preperitoneal repair, developed 40 years ago by Dr. Stoppa as an open operation and recently translated into a laparoscopic approach, is used to recreate the pelvic floor. The peritoneum is mobilized to the level of the umbilicus to create a large space behind the rectus abdominal muscle. A 6-by-6-inch piece of mesh is introduced into the concavity of the pelvis, which covers the origin of the defect from the inside, rather than the more traditional one that lay on top of the hernia. Currently, the two most popular laparoscopic techniques are :

    TAPP (Trans abdominal preperitoneal)
    TEP (total extra peritoneal)

The most ardent critique of the TAPP procedure is that it is an intra-abdominal procedure with significant potential morbidity. On the other hand, the TEP procedure avoids intra-abdominal access. A major advantage of laparoscopic inguinal hernia repair is that bilateral hernias, which are not uncommon, can be repaired during the same operation. The laparoscopic procedure also allows the physician to see and repair small hernias not detected by a physical examination. Patients who cannot have laparoscopic inguinal hernia repair are those who have had bladder surgery, open prostate surgery, radiation for prostate cancer, or other prior invasion of the preperitoneal space.

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Minimal Invasive Procedure For Varicose Veins (seps) Treatme
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The veins of the legs are divided into two systems - the deep veins (which run deep to the leathery layer of fascia surrounding the muscles) and the superficial veins (which run in the layer of fat just beneath the skin). The superficial veins are the ones that you can see (for example, on your foot or around the ankle) and they are the ones that can become varicose. It is essential to keep in mind these two different systems - deep and superficial - in order to understand varicose veins and their treatment. In a number of places in the leg, the superficial and deep veins are linked by perforating veins (or 'perforators'). They are called perforators because they perforate the leathery fascial layer surrounding the muscles of the legs. Normally their valves should allow blood to flow only inwards - from the superficial veins to the deep veins. If the valves stop working properly, then blood is pushed out into the superficial veins when the muscles contract: this is one reason for high pressure in the superficial veins, and can be a cause of varicose veins.

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The Long Saphenous Vein (lSV)
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This vein and its tributaries are the ones that most often form varicose veins. The long saphenous vein is formed from tributaries in the foot, and is visible in many people when they stand, as the vein just in front of the bone on the inner side of the ankle. It runs up the inner side of the calf and the thigh, and at the groin dives to join the main deep vein (the femoral vein).

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Sclerotherapy
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Sclerotherapy

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Laparoscopic Surgery Treatment for Varicose VeinsThis form of treatment is a non-surgical procedure in which a solution is injected into the problem varicose veins or spider veins in order to cause its disappearance.

A chemical irritant can be injected into veins, although large veins are difficult to treat using this method, as the chemical has to physically come in contact with the lining of the target vein for long enough to destroy it. Sclerotherapy works by burning the lining of the vein, which causes the vessel to spasm and block off with clot. The idea is to make the vein shrivel away by scarring. Unfortunately, the clot often clears away, allowing the scarred vessel to open up again.

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Standard surgical method
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Standard surgical method

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Surgical Treatment for Varicose VeinsThe most common operation performed for varicose veins is high long saphenous ligation and stripping involving a groin crease incision.

To perform vein stripping, your physician disconnects and ties off all major varicose vein branches associated with the saphenous vein, the main superficial vein in your leg. Your physician then removes the saphenous vein from your leg. A procedure, called small incision avulsion, can be done alone or together with vein stripping. Small incision avulsion allows your physician to remove varicose veins from your leg.

In a similar procedure called TIPP (Transilluminated Powered Phlebectomy), your physician shines an intense light on your leg to show your veins. Once your physician locates a varicose vein, he or she passes a suction device through a tiny incision and suctions out the vein. Although these procedures sound painful, they cause relatively little pain and are generally well tolerated. Your vascular surgeon will advise you regarding which procedure is the best for your particular situation..

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Laparoscopic Intestinal Surgery Treatment
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The introduction of laparoscopic removal of the gall bladder (Laparoscopic Cholecystectomy) in the late 1980s revolutionized the surgical management of many abdominal operations. It offered less discomfort to the patient and faster recovery. But it was only the delay in the development of proper instruments that prevented Colon and Rectal Surgeons from performing laparoscopic intestinal surgery until 1991.

Laparoscopic Intestinal Surgery in India

Today, laparoscopic surgery is an increasingly popular option for people with intestinal conditions, who may need sections of the bowel repaired or removed. Laparoscopy is a minimally invasive procedure in which the surgeons operate through very tiny holes (approximately 1/2-inch wide) instead of large incisions (8- to 12-inch wide). While recovery from open surgery for intestinal disease, takes an average of six weeks, people who have undergone laparoscopic surgery tend to feel back to normal in just three weeks.

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Laparoscopic Cholecystectomy Treatment
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Cholecystitis is an inflammation of the gallbladder wall and nearby abdominal lining. Cholecystitis can occur suddenly or gradually over many years. Acute cholecystitis is the sudden onset of inflammation of the gallbladder, resulting in severe, steady upper abdominal pain (biliary colic), which may occur repeatedly. Chronic cholecystitis is long-standing inflammation of the gallbladder characterized by repeated attacks of pain (gallbladder attacks) over a prolonged period.

At least 95% of people with acute cholecystitis have gallstones. Gallstones are stones which are formed in the gallbladder. The Gall Bladder stores and concentrates bile. Sometimes the substances contained in bile crystallize in the gall bladder, forming stones. These small, hard concretions are more common in persons over 40, especially in women and the obese. Rarely, acute cholecystitis occurs in a person without gallstones (acalculous cholecystitis). In these cases the cause can be any major injury, operation or burn, bacterial infection in the bile duct system, tumor of the pancreas or liver.

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During the procedure
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During the procedure

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Process of Laparoscopic Surgery The anesthesiologist and nurses keep using monitors to check the heart rate and breathing rate during the procedure. These may include EKG leads, a blood pressure cuff and an oxygen mask. The patient is operated in the supine position with a steep head-up tilt. A nasogastric tube is inserted and the stomach aspirated. The tube is kept in the stomach during the operation but removed at the end of the procedure.

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Laparoscopic Ventral Hernia Repair
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Incisional, Ventral, Epigastric, or Umbilical hernias are defects of the anterior abdominal wall. They may be congenital (umbilical hernia) or acquired (incisional). Incisional hernias form after surgery through the incision site or previous drain sites, or laparoscopic trocar insertion sites. About 95% of ventral hernias can be repaired laparoscopically. It is recommended that patients with hernias resulting from prior incisions, patients with umbilical hernias that have increased over time, patients who are substantially overweight, or patients with hernias larger than 4cm, have the hernia repaired laparoscopically with mesh. The only patients who cannot have a laparoscopic ventral repair are those who have experienced a loss of domain or those with severe adhesions that cannot be safely reduced laparoscopically.

The mesh has a smooth surface that faces the small bowel and prevents it from adhering to the mesh, while a rougher surface on the side facing the abdominal wall allows for rapid tissue ingrowth. Because the mesh is placed inside the abdomen, behind the defect, any strain tends to push it more tightly against the abdominal wall and distributes the pressure throughout the mesh. In comparison, traditional mesh repair uses an incision extending beyond the length of the hernia on either side to gain access to the hernia. Mesh is placed on the outside of the defect,

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Procedure
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Procedure

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Laparoscopic Surgery for Varicose VeinsSubfacial Endoscopic Perforator Surgery (SEPS) is a minimally invasive surgical procedure which the doctors use to treat the underlying condition that causes venous ulcers. During the procedure they disconnect the abnormal perforator veins, which cause ulceration because of improperly functioning valves. By disconnecting these veins, they redirect the blood flow to healthy veins. Circulation in the leg is improved, and the ulcer is healed.

SEPS is usually performed with two ports of entry into the leg. A special instrument is inserted deep to the fascia of the leg and a large balloon is inflated with water to create a working space. The balloon is then emptied and the space is insufflated with air. The camera is inserted and the perforator veins can be seen in the space passing from superficial to deep layers. Another small incision is made in the calf for passage of another instrument. The perforator veins are carefully dissected, clips are applied and the veins are divided if necessary. Perforating veins are then divided with endoscopic scissors. Metal clips are placed on the cut ends of the vein to avoid bleeding. Another option to interrupt the vein is to use a harmonic scalpel, an instrument that uses ultrasonic waves to seal the cut end of the veins to avoid bleeding. All trocars are then removed and the wounds are closed. The leg is dressed with an ACE wrap.

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Laparoscopic Splenectomy Treatment
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Splenectomy means surgical removal of spleen. The spleen is a blood filled organ located in the upper left abdominal cavity. It is a storage organ for red blood cells and contains many specialized white blood cells called "macrophages" (disease fighting cells) which act to filter blood. The spleen is part of the immune system and also removes old and damaged blood particles from your system. The spleen helps the body identify and kill bacteria.

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Laparoscopic Adrenalectomy Treatment
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Adrenal glands are a part of our endocrine system. They are two small organs, located one above each kidney. They are triangular in shape and about the size of a thumb. These glands produce hormones which are involved in control of blood pressure, chemical levels in the blood, water use in the body, glucose usage, and the "fight or flight" reaction during times of stress. These adrenal-produced hormones include cortisol, aldosterone, the adrenaline hormones and a small fraction of the body's hormones (oestrogen and androgens).

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A hernia is an abnormal protrusion, or bulging out, of part of an organ through the tissues that normally contain it. A hernia may develop in almost any part of the body; however, the muscles of the abdominal wall are most commonly affected. In this condition, a weak spot or opening in a body wall, often due to laxity of the muscles, allows part of the organ to protrude. Hernias by themselves usually are harmless, but nearly all have a potential risk of having their blood supply cut off (becoming strangulated). If the hernia sac contents have their blood supply cut off at the hernia opening in the abdominal wall, it becomes a medical and surgical emergency. There are many different types of abdominal wall hernias. They are:

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  • Diagnostic Laparoscopy for Acute Abdominal Pain.
  • Laparoscopy for Abdominal Trauma (Blunt and Penetrating) .
  • Laparoscopic Management of Intestinal Obstruction.
  • Laparoscopic Management of Diverticulitis.
  • Laparoscopy for Acute Appendicitis.
  • Complicated ovarian cysts.
  • Pelvic inflammatory diseases.
  • Acute salpingitis.
  • Intestinal adhesions.
  • Mesenteric adenitis.
  • Ectopic pregnancy.
  • Endometriosis.
  • Complicated Meckel's diverticulum.
  • Omental necrosis.
  • Intestinal infarction.
  • Acute diverticulitis.
  • Bedside Laparoscopy in the ICU.
  • Laparoscopic Management of Perforated Ulcer.
  • Laparoscopy for Intestinal Ischemia.
  • Laparoscopic Re-operations for Postoperative Complications.
  • Emergency laparoscopic orchidectomy for torsion of intra-abdominal testis.

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