Patient Information Regarding Minimal Access Surgery (FAQs)

Patient Information regarding Minimal Access Surgery (FAQs)

For laparoscopy, the patient is usually given a general anaesthesia and is unconscious during the operation. General anaesthesia relaxes muscles and makes it easier for the doctor to perform the surgery.

Some procedures, however, are done with a local aesthetic to numb the immediate area of the body where the incisions will be made. The patient is awake during the operation, but usually is given medication to help stay calm and relaxed.

  • Damage to the bile duct can lead to leakage or even obstruction of bile flow. Laparotomy to drain or repair the bile duct may be necessary if this occurs. This is a serious problem but is rare with an incidence of less than 2%.
  • Bleeding from blood vessels feeding the gall bladder or liver. This is usually controllable at the laparoscopy but may require further laparotomy to stop the bleeding. If the bleeding starts after the surgery has been completed, the patient may have to return to the operating theatre to stop the haemorrhage. Again this is a very rare complication.
  • Damage to other organs or blood vessels. This is extremely rare and the incidence is minimised by using a special blunt tipped instrument to enter the abdominal cavity through the incision beneath the umbilicus.
  • Gas embolism. This can occur when the CO2 which is being used to keep the abdomen inflated enters an open blood vessel and passes to the heart. This has never occurred in my experience.
  • Pulmonary embolism. This occurs when clots form in the deep veins of the legs and pass up the veins to the lung blocking the flow of blood to the lungs. This has never occurred in my experience and should be less likely than with open surgery, as patients are in less pain and are moving about more freely on the day of surgery. Blood thinning injections and calf compressors are used during the surgery to help prevent this complication. Other medical problems such as allergic reactions, heart attacks, pneumonia and strokes can occur but are exceedingly rare.
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  • Wound infections are not uncommon especially in the umbilical wound, which can be contaminated by the bacteria in the gall bladder as it is removed. These are usually minor and respond to antibiotics but can be painful and a nuisance in the short term.
  • Keloid scars. These are thickened scars to which some patients are prone. With the small incisions, scarring is minimal in most cases. 
  •  With laparoscopic cholecystectomy, you may return to work sooner, have less pain after surgery, and have a shorter hospital stay and a shorter recovery time. Surgery to remove the gallbladder with a laparoscope does not require that the muscles of your abdomen be cut, as they are in open surgery. The incision is much smaller, which makes recovery go quicker.
 
  • With laparoscopic cholecystectomy, you probably will only have to stay in the hospital overnight. With open cholecystectomy, you would have to stay in the hospital for about five days. Because the incisions are smaller with laparoscopic cholecystectomy, there isn't as much pain after this operation as after open cholecystectomy.
Normally after laparoscopic surgery, a heating pad should help. Your doctor will prescribe medicine to help relieve your abdominal pain. DO NOT use prescription pain medication (narcotics) for shoulder discomfort. Take acetaminophen and/or apply a heating pad.
Yes, Many times two operations are performed side by side at the same time.
Most women experience a period of emotional ups and downs following gynecological laparoscopic surgery. .Experiences with the first period after a laparoscopy can vary dramatically. If your period is more painful, longer, or heavier than usual, don't panic. Internal healing takes much longer than external healing.
‘Piles’ is a distressing condition which, at its least, causes itching discomfort around the back passage and at its worst, becomes severe condition involving pain and bleeding. You may feel an uncomfortable ‘weight’ around yours anus, or experience discomfort or pain when passing motion. You may find blood on your stool or on your underwear after opening your bowls, and, if Piles and prolapsed, yours will be able to feel them when washing after going to the toilet.
This surgery is done through one or more small incisions, using small tubes and tiny cameras and surgical instruments. Another type of minimally invasive surgery is robotic surgery. It provides a magnified, 3-D view of the surgical site and helps the surgeon operate with precision, flexibility and control.
Major advances aided by surgical robots have been remote surgeryminimally invasive surgery and unmanned surgery. Due to robotic use, the surgery is done with precision, miniaturization, smaller incisions; decreased blood loss, less pain, and quicker healing time. Articulation beyond normal manipulation and three-dimensional magnification help to result in improved ergonomics. Due to these techniques, there is a reduced duration of hospital stays, blood loss, transfusions, and use of pain medication. The existing open surgery technique has many flaws like limited access to the surgical area, long recovery time, long hours of operation, blood loss, surgical scars, and marks.
Vaginal bleeding up to 1 month after surgery is normal. Many women do not have their next normal menstrual cycle for 4 to 6 weeks after surgery. When your normal cycle returns, you might notice heavier bleeding and more discomfort than usual.
Most women go home 2-3 days after most of the simple laparoscopic surgery, but complete recovery takes from six to eight weeks. During this time, you need to rest at home. You should not be doing housework until you talk with your doctor about restrictions.
Depending on your state of health, it can be shorter or longer. An average time length that a lot of people say with an abdominal incision is about one to two months or even just six weeks to where you really want to let it heal and you try not to put too much pressure on your abdomen during that time.
In some cases, you may have to remain in the hospital overnight.

The timing of your release will vary. It depends on:

  • your overall physical condition
  • the type of anesthesia used
  • your body’s reaction to the surgery
In general, Laparoscopic surgeries have lesser recovery time after the operation
 
The incidence of shoulder pain varies from 35% to 80% and ranges from mild to severe. In some cases, it has been reported to last more than 72 hours after surgery. If a surgeon will remove the CO2 nicely after laparoscopy pain does not last long after laparoscopic surgery.
After your surgery, it is normal to feel weak and tired for several days after you return home. Your belly may be swollen. If you had laparoscopic surgery, you may also have pain in your shoulder for about 24 hours. You may have gas or need to burp a lot at first, and a few people get diarrhea.
Laxative medications can be given for smooth defecation. A laparoscopic surgeon may prescribe a stool softener for people with post-surgical constipation. These medications, which include docusate sodium (Colace), draw water from the intestines to moisten the stool. Moist stools are easier to pass

Surgery is options that doctor have historically hesitated to recommend. It is an unfortunate fact that many patients suffered some server post – surgery discomfort pain, and had to take considerable time from work.

Typically, hernias are not dangerous. Most hernias cause minor discomfort or mild pain. Emergency situations, such as the intestine getting stuck occur infrequently, but can be life-threatening. Still, because of potential problems and complications associated with hernias, anyone suspected of having a hernia should be evaluated by a primary care physician or surgeon.

The price of Laparoscopic surgery is slightly higher than general surgery but at the end it turns out to be lesser expensive as the patients stay at hospital after surgery is lesser

Yes, robotic surgery is costlier than the traditional surgeries but it is because of the well equipped robot used for higher performance during the surgery.

In every surgery there is a risk of life but in Laparoscopic surgery this risk is lesser.

 

however, every patient needs pre anaesthetic checkup before surgery to rule out any existing disease because if any preexisting disease such as diabetes , hyperthyroidism etc present then risk of any surgery increases.

Some kinds of arthoscopic surgery, such as that done on the knee, may not need general anesthesia. It still is necessary for most operations, including those on the abdomen and pelvic areas. That's because the general anesthesia does more than block the sensation of pain; it also relaxes muscles and makes it easier for the surgeon to work inside the body and complete the operation.

  • Fibroids are benign growths of the uterus. They occur in 20 to 25 percent of women. Fibroids are most common in women aged 30 to 40 but may occur at any age. Women may have one fibroid or many fibroids. The size of the fibroid also varies from the size of a small pee to more then 6 inches wide.. Some women may be entirely asymptomatic and others may complain of changes in menstruation, pain, pressure, miscarriages and infertility.
 
 
They aren’t really stones. They're pieces of solid material that form in the gallbladder, a small organ located under the liver.

You might not even know you have them until they block a bile duct, causing pain that you need to get treated right away.

Types
The two main kinds are:

Cholesterol stones. These are usually yellow-green in color. They're the most common kind, accounting for 80% of gallstones.
Pigment stones. These stones are smaller and darker. They're made up of bilirubin, which comes from bile, a fluid your liver makes and your gallbladder stores.

Laparoscopic cholecystectomy is the Gold standard for Gallstone disease. This is the more common procedure for gallstone disease. The laparoscopic surgeon passes thin long laparoscopic instruments, a laparoscopic light, and a laparoscopic digital camera through several small cuts in the belly. He views the inside of the body on a video monitor. You usually go home the same day.
‘Piles’ are swollen blood vessels in the back passage. They may occur inside your body. In the anal canal, or sometimes be felt outside your anus. In this case they are called prolapsed piles. As one in three of us will experience Piles at some stage in our lives.
Following are the benifits of Minimal Access Surgery:

1) It is more reliable 
2) It is safer
3) Least post operative discomfort
4) Faster recovery
5) Shorter stay in hospital
6) Smaller scar
The advantages of robotic surgery for the patient are significant and may include:

Shorter hospital stay
Less blood loss
Fewer complications
Less need for narcotic pain medicine
Faster recovery
Smaller incisions resulting in minimal scarring
The small incisions made to allow access for the surgical tools and camera mean less blood loss, lower risk of blood transfusion and infection, a shorter hospital stay, decreased need for pain medication and a quicker recovery and return to normal function.

Patients also benefit from the high-tech nature of the equipment. The robotic camera provides ten-fold magnification and three-dimensional vision rather than the two-dimensional vision of a laparoscope. The robotic arms move with incredible precision, moving in, out and with a wrist-like turning motion of 360 degrees. Human tremor is filtered out completely. The surgeon and surgical team work from a comfortable, ergonomic position, resulting in less fatigue during long complex cases.

During surgery if surgeon finds there is massive addition or difficult anatomy then anytime laparoscope surgery can be converted into open surgery. Average conversion rate in 1in 100 patient. it also depends on the experience of the surgeon.

These are some common surgeries done by Laparoscopy :
 
  • Appendectomy
  • Gallbladder removal
  • Bariatric or weight-loss surgery
  • Colon resection
  • Hernia repair
Activities: With a minimally invasive laparoscopic procedure you will recover much more quickly than with a standard open procedure. Your activity level should be gradually increased over the next 2 to 7 days depending on the extent of your procedure. It is normal to tire easily after surgery and you should maintain a flexible schedule and get adequate rest. When you go home you may:
- Climb stairs
- Take a shower
- Drive after 72 hours
- Have sexual intercourse when you are comfortable; wait at least 5 days; 2 weeks if a hysterectomy was performed
- Perform light housework and cooking as tolerated
- Exercise in 5 to 10 days; swim in 7 days
- Douching IS NOT recommended
- Avoid lifting anything over 20 lbs. For 2 weeks
- Take over the counter pain medications such as Tylenol, Motrin, Advil, Aleve.

If these are not sufficient, take your prescription pain medication as needed. Incision Care: Laparoscopy incisions are typically very small and rarely have complications. You may wash the incisions with soapy water, then thoroughly dry the area and keep the skin dry. Dressings or band-aids are not necessary as exposure to oxygen in the air speeds healing. You may notice one or more stitches; these will fall off on their own, usually four weeks after the surgery. Itching, bruising, a pulling sensation, and/or numbness around the incisions are all normal. If any incision becomes hot, red, swollen or increasingly painful, please call your physician. Bowels: The intestines are usually somewhat lazy for a few days after surgery causing gas, bloating and constipation. Drinking plenty of water, increasing fiber in your diet and walking are helpful. If constipated, you may try milk of magnesia, Metamucil or a Dulcolax suppository. If these methods do not result in a bowel movement within 48 hours, please call. Vaginal Bleeding: You may have slight vaginal bleeding for 3 to 5 days after surgery. The bleeding should not be heavier than a normal period. Use pads only, NO TAMPONS. If you had a supracervical hysterectomy, occasionally a small amount of bleeding can occur at the time of your period and this may be annoying, but is normal. 
The Pros:

Weight loss is quick and dramatic. People lose an average of 60% to 80% of their excess body weight.
Because weight loss is quick, weight-related health problems such as diabetes, high blood pressure, high cholesterol, arthritis, sleep apnea, and heartburn improve quickly.
Most people are able to keep at least 50% of the excess weight off long term.

Loss of stomach tissue results in a drop in the so-called "hunger hormone" (ghrelin), which helps control appetite.

The Cons:

Gastric bypass surgery is riskier and is associated with more complications.
The surgery may result in vitamin and mineral deficiencies.
The surgery may result in dumping syndrome, which occurs when food moves too quickly through the stomach and intestines. Dumping syndrome can cause shaking, sweating, dizziness, nausea, and severe diarrhea.
Gastric bypass is generally considered irreversible. The surgery permanently changes how your body digests food.
        Followings are the risks in Laparoscopic surgery
  • fevers or chills
  • abdominal pain that becomes more intense over time
  • redness, swelling, bleeding, or drainage at the incision sites
  • continuous nausea or vomiting
  • persistent cough
  • shortness of breath
  • inability to urinate
  • lightheadedness
  • complications from general anesthesia
  • inflammation of the abdominal wall
  • a blood clot, which could travel to your pelvis, legs, or lungs
  • A laparoscope is a small, thin tube that is put into your body through a tiny cut made just below your navel. Your surgeon can then see your gallbladder on a television screen and do the surgery with tools inserted in three other small cuts made in the right upper part of your abdomen. Your gallbladder is then taken out through one of the incisions.
  • Endometriosis is a condition, when the endometrium (the lining of the uterus) is found in other places than the uterine cavity. Endometriotic implants can be found on pelvic sidewall, fallopian tubes, ovaries, bowel, bladder, and less commonly outside of the pelvic cavity. Like the endometrial lining in the uterus, these implants undergo similar changes in response to the cyclic hormonal changes. The implants may swell and bleed every month causing pain. Endometriosis may also lead to cysts and adhesions.

  • This condition is found in approximately 20% of women. The most common symptoms of endometriosis are pain with your period, irregular bleeding and infertility. At the present time there is no simple test for diagnosing endometriosis. The only way to diagnose endometriosis with certainty is by laparoscopy and biopsy. Rarely large endometriotic lesions can be diagnosed by ultrasound.
 
 
The surgery to remove the gallbladder is called a cholecystectomy (chol-e-cys-tec-to-my). The gallbladder is removed through a 5 to 8 inch long incision, or cut, in your abdomen. The cut is made just below your ribs on the right side and goes to just below your waist. This is called open cholecystectomy.

A less invasive way to remove the gallbladder is called laparoscopic cholecystectomy. This surgery uses a laparoscope (an instrument used to see the inside of your body) to remove the gallbladder. It is performed through several small incisions rather than through one large incision.
Laparoscopic hernia repair is similar to other laparoscopic procedures. General anaesthesia is given, and a small cut (incision) is made in or just below the navel. The abdomen is inflated with air so that the surgeon can see the abdominal organs.

A thin, lighted scope called a laparoscope is inserted through the incision. The instruments to repair the hernia are inserted through other small incisions in the lower abdomen. Mesh is then placed over the defect to reinforce the abdominal wall.

There are many things to consider when deciding if you should have inguinal hernia repair surgery, such as whether your hernia is incarcerated or strangulated and whether you have other conditions that need to be addressed before hernia repair surgery is appropriate.

It is a modern way of performing a hysterectomy that avoids a large abdominal incision. In this procedure, instead of the normal large incision, very small incisions are made for a laparoscopic procedure, and the doctor uses the laparoscope to see and cut the tough bands of tissue that hold the uterus in place. That's the "laparoscopically-assisted" part. Then the uterus is removed through the vagina.

 
surgery carried out using mechanical arms controlled by the surgeon and bearing surgical instruments and a camera, especially to avoid the need for large incisions.
Robotic surgery is the most recent and innovative minimal access surgical technique and became available in the late 1990s. Building on the techniques for laparoscopic surgery, the surgical tools inserted into the patient through the ports are connected to robotic arms rather than held by the surgeon. The robotic arms, however, are fully controlled by the robotic surgeon. The level of surgical precision in robotic surgery is unsurpassed, and there are numerous other advantages as well. The robotic platform available at Inova hospitals is the da Vinci Surgical System.
In 2010, World Laparoscopy Hospital started the da Vinci robotic-assisted surgery in the Gurugram. Now we offer the newest da Vinci model featuring 3D vision for superior physician depth perception and visualization. Our commitment to offering the most innovative, patient-focused treatments is demonstrated by our continuously high patient satisfaction scores. Inova's experience (and expertise) creates the best possible surgical experience for you.
  • A cyst is a fluid filled cavity. Cysts can often be found in the ovaries. Ovarian cysts are usually diagnosed by pelvic exam or ultrasound. If the cyst is entirely filled with fluid it is called a 'simple cyst'. Ovarian follicles as they undergo maturation may appear on ultrasound as simple cysts or occasionally as complex cysts. These cysts usually resolve within one to two months.

  • Simple cysts are almost always benign. Removal is indicated if they are bigger than 5-6 cm in diameter or if they cause symptoms. If the cyst contains echogenic structures (shadows by ultrasound) it is categorized as a 'complex cyst'. Complex cysts can represent endometriosis, infection, benign tumors, and rarely malignancies. It is generally recommended that complex cysts be evaluated laparoscopically and possibly removed. The majority of ovarian cysts can be removed laparoscopically.

 

Individuals who have laparoscopic surgery should carefully follow their doctors' instructions after going home. The exact kind of care needed depends on the type of surgery, the individual's age and general health, and other factors. In general, people recovering from laparoscopic surgery should care for their incision as directed by the doctor, be cautious about certain activities, and watch for any of the warning signs.

Following laparoscopy on the abdomen or pelvic areas, it is most likely that one will:

  • leave the adhesive bandage or dressing on the incision for two days. During that period, keep the incision area dry. Do not take a shower.
  • not need to apply new bandages to the incisions unless clothing is rubbing against them.
  • remove the bandages after two days, following the doctor's instructions. Individuals usually can resume taking showers at this point.
  • bandages after two days, following the doctor's instructions. Individuals usually can resume taking showers at this point.
Contact your ob-gyn right away if you have any of the following signs or symptoms:
  • Fever
  • Pain that is severe or gets worse
  • Heavy vaginal bleeding
  • Redness, swelling, or discharge from the incision
  • Fainting
  • Inability to empty your bladder
Protein – Protein is essential to wound healing, so try to get plenty of foods like chicken and eggs.
Vitamin C – Some research shows that Vitamin C and zinc can help with healing, so eat the recommended amount of fruit each day.
Most people who have laparoscopic hernia repair surgery are able to go home the same day. Recovery time is about 1 to 2 weeks. Studies have found that people have less pain after laparoscopic hernia repair than after open hernia surgery.
You should contact a doctor after the surgery as soon as you experience any of the following:

•  Heavy bleeding from the incisions
•  Fever or chills
•  Problems with urination or bowel movements
•  Heavy vaginal bleeding
•  Severe or increasing abdominal pain
•  Vomiting
•  Redness or discharge from the skin incisions
•  Shortness of breath or chest pain.
Due to lack of infrastructure and knowledge in developing countries, laparoscopy is performed lesser. 
But these surgeries are developing in India with access to world class treatment.
Mainly because of the small incisions. The large incision used in many traditional operations causes more damage to layers of skin, muscle, and other body tissue. It takes a long time for the body to repair that damage - usually about six weeks. During that period, patients often have to restrict their normal activities so that the incision heals properly. The incision also causes a good deal of discomfort that makes patients want to take it easy for several weeks.
A videotape gives the most detailed possible record of the operation. Surgeons normally dictate an account of the operation and a paper record goes into the patient's file, but the amount of detail varies from surgeon to surgeon. Almost every operating room with modern laparoscopic equipment can videotape each procedure, creating a visual document of the operation. A record of the operation clearly shows what the surgeon found during the first operation, what difficulties were encountered, and what procedures were done. The record is very important for other doctors who may be involved in your care at some point, especially if complications occur after the first surgery or the disease comes back later on.

 

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