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Chapters

0:00 Introduction
1:04 Why do doctors perform laparoscopy?
2:11 How is laparoscopy performed?
3:22 Result
3:47 Risk of laparoscopy

Laparoscopy (from Ancient Greek λαπάρα (lapára) 'flank, side', and σκοπέω (skopéō) 'to see') is an operation performed in the abdomen or pelvis using small incisions (usually 0.5–1.5 cm) with the aid of a camera. The laparoscope aids diagnosis or therapeutic interventions with a few small cuts in the abdomen.[1]

Laparoscopic surgery, also called minimally invasive procedure, bandaid surgery, or keyhole surgery, is a modern surgical technique. There are a number of advantages to the patient with laparoscopic surgery versus an exploratory laparotomy. These include reduced pain due to smaller incisions, reduced hemorrhaging, and shorter recovery time. The key element is the use of a laparoscope, a long fiber optic cable system that allows viewing of the affected area by snaking the cable from a more distant, but more easily accessible location.

Laparoscopic surgery includes operations within the abdominal or pelvic cavities, whereas keyhole surgery performed on the thoracic or chest cavity is called thoracoscopic surgery. Specific surgical instruments used in laparoscopic surgery include obstetrical forceps, scissors, probes, dissectors, hooks, and retractors. Laparoscopic and thoracoscopic surgery belong to the broader field of endoscopy. The first laparoscopic procedure was performed by German surgeon Georg Kelling in 1901. There are two types of laparoscope:[2]

A telescopic rod lens system, usually connected to a video camera (single-chip or three-chip)
A digital laparoscope where a miniature digital video camera is placed at the end of the laparoscope, eliminating the rod lens system

The mechanism mentioned in the second type is mainly used to improve the image quality of flexible endoscopes, replacing conventional fiberscopes. Nevertheless, laparoscopes are rigid endoscopes. Rigidity is required in clinical practice. The rod-lens-based laparoscopes dominate overwhelmingly in practice, due to their fine optical resolution (50 µm typically, dependent on the aperture size used in the objective lens), and the image quality can be better than that of the digital camera if necessary. The second type of laparoscope is very rare in the laparoscope market and in hospitals.[citation needed]

Also attached is a fiber optic cable system connected to a "cold" light source (halogen or xenon) to illuminate the operative field, which is inserted through a 5 mm or 10 mm cannula or trocar. The abdomen is usually insufflated with carbon dioxide gas. This elevates the abdominal wall above the internal organs to create a working and viewing space. CO2 is used because it is common to the human body and can be absorbed by tissue and removed by the respiratory system. It is also non-flammable, which is important because electrosurgical devices are commonly used in laparoscopic procedures.[3]
Procedures
Surgeons perform laparoscopic stomach surgery.
Patient position

During the laparoscopic procedure, the position of the patient is either in Trendelenburg position or in reverse Trendelenburg. These positions have an effect on cardiopulmonary function. In Trendelenburg's position, there is an increased preload due to an increase in the venous return from lower extremities. This position results in cephalic shifting of the viscera, which accentuates the pressure on the diaphragm. In the case of reverse Trendelenburg position, pulmonary function tends to improve as there is a caudal shifting of viscera, which improves tidal volume by a decrease in the pressure on the diaphragm. This position also decreases the preload on the heart and causes a decrease in the venous return leading to hypotension. The pooling of blood in the lower extremities increases the stasis and predisposes the patient to develop deep vein thrombosis (DVT).[4]
Gallbladder

Rather than a minimum 20 cm incision as in traditional (open) cholecystectomy, four incisions of 0.5–1.0 cm, or more recently, a single incision of 1.5–2.0 cm,[5] will be sufficient to perform a laparoscopic removal of a gallbladder. Since the gallbladder is similar to a small balloon that stores and releases bile, it can usually be removed from the abdomen by suctioning out the bile and then removing the deflated gallbladder through the 1 cm incision at the patient's navel. The length of postoperative stay in the hospital is minimal, and same-day discharges are possible in cases of early morning procedures.[citation needed]
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This video demonstrates Laparoscopic Cholecystectomy Fully Explained Skin-to-Skin Video with Near Infrared Cholangiography performed by Dr R K Mishra at World Laparoscopy Hospital. A laparoscopic cholecystectomy is a minimally invasive surgical procedure that involves removing the gallbladder. It is typically performed using small incisions in the abdomen, through which a laparoscope (a thin tube with a camera and light) and surgical instruments are inserted. The surgeon uses the laparoscope to visualize the inside of the abdomen and to guide the instruments in removing the gallbladder.

Near-infrared cholangiography is a technique that uses a special camera and fluorescent dye to visualize the bile ducts during surgery. The dye is injected into the cystic duct (the tube that connects the gallbladder to the bile ducts) and the camera detects the fluorescence emitted by the dye, allowing the surgeon to see the bile ducts more clearly.

The combination of laparoscopic cholecystectomy and near-infrared cholangiography has become a standard of care in many hospitals and surgical centers. It allows for a more precise and efficient surgery, reducing the risk of complications such as bile duct injury.

The use of indocyanine green (ICG) with near-infrared imaging during laparoscopic cholecystectomy has several advantages. Here are some of them:

Better visualization of the biliary anatomy: ICG with near-infrared imaging allows for better visualization of the biliary anatomy during surgery. This helps the surgeon identify important structures, such as the cystic duct and the common bile duct, and avoid injuring them.

Reduced risk of bile duct injury: With better visualization of the biliary anatomy, the risk of bile duct injury during surgery is reduced. Bile duct injury is a serious complication that can occur during laparoscopic cholecystectomy and can lead to long-term health problems.

Improved surgical precision: ICG with near-infrared imaging also improves surgical precision. The surgeon can better see the tissues and structures being operated on, which can help reduce the risk of bleeding and other complications.

Shorter operating time: The use of ICG with near-infrared imaging can shorten the operating time for laparoscopic cholecystectomy. This is because the surgeon can more quickly and accurately identify the biliary anatomy, which can help streamline the surgery.

Overall, the use of ICG with near-infrared imaging is a valuable tool in laparoscopic cholecystectomy that can improve surgical outcomes and reduce the risk of complications.

Like any surgical procedure, laparoscopic cholecystectomy (gallbladder removal) has potential complications. Here are some of the most common ones:

Bleeding: Bleeding during or after the surgery is a possible complication of laparoscopic cholecystectomy. Most cases are minor and can be easily controlled, but in rare cases, significant bleeding may require a blood transfusion or even additional surgery.

Infection: Any surgical procedure carries a risk of infection. After laparoscopic cholecystectomy, there is a risk of infection at the site of the incisions or within the abdomen. Symptoms may include fever, pain, redness, or drainage from the incision sites.

Bile leakage: In some cases, a small amount of bile may leak from the bile ducts into the abdominal cavity after gallbladder removal. This can cause abdominal pain, fever, and sometimes requires further surgery or treatment.

Injury to nearby organs: During the surgery, there is a small risk of unintentional injury to nearby organs such as the liver, intestines, or bile ducts. This can cause additional complications and may require further treatment.

Adverse reactions to anesthesia: As with any surgery requiring general anesthesia, there is a small risk of adverse reactions to the anesthesia, such as an allergic reaction, respiratory problems, or heart complications.

Most patients recover without complications following a laparoscopic cholecystectomy, but it is important to discuss any concerns or questions with your surgeon beforehand.

Contact us
World Laparoscopy Hospital
Cyber City, Gurugram, NCR Delhi
INDIA : +919811416838

World Laparoscopy Training Institute
Bld.No: 27, DHCC, Dubai
UAE : +971525857874

World Laparoscopy Training Institute
8320 Inv Dr, Tallahassee, Florida
USA : +1 321 250 7653





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