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					                        LAPAROSCOPIC SURGERY

Also called Minimally Invasive Surgery or Keyhole Surgery.

What is Laparoscopic Surgery?
It is a relatively new Surgical Speciality which involves operating with special
instruments through small incisions, typically not longer than 5 or 10 mm.
Carbon Dioxide gas is used to create a working space within the abdomen.

How is it performed?
First the abdomen is punctured by a needle and inflated with the gas. Next,
through a 10 mm-incision a troicar is inserted, then a tin, telescope-like
instrument is passed. This is connected to a tiny video camera, which projects
the view onto television screens in the operating room. Through additional small
incisions of 5 or 10 mm length further troicars are inserted, then special long
instruments are passed to cut, separate, clip, seal or remove the source of the
For the removal of the gallbladder for instance we use 4 small incisions, as
shown on this drawing. The following pictures show the positioning of the
Operative Team, the application of the special instruments, the clipping of the
cystic duct and the removal of the separated gallbladder through one of the
At the end the gas is released and the incisions are closed.

Laparoscopic Surgery is most frequently used for removal of the gallbladder, i.e.
cholecystectomy, since this is the second most common abdominal surgery –
exceeded only by hernia repairs.
Today about 90% of diseased gallbladders are removed laparoscopically.
The success rate of course is lower when there is a heavy inflammation of the
gallbladder – then we have to change to Open Surgery. Therefore the
inflammation of the gallbladder caused by gallstones should be avoided, doing
cholecystectomy in time!

Surgical treatment of severe obesity is another frequent application of
laparoscopic surgery.
Obesity or Bariatric Surgery is provided for patients who suffer from severe or
morbid obesity, which means having a Body Mass Index above 40.Many of these
patients suffer from life-threatening obesity-related diseases like diabetes,
hypertension or sleep apnea.
For these patients the procedure of choice is Laparoscopic Gastric Banding, as
shown in this picture, implanting an adjustable gastric band, which creates a
partitioning of the stomach. The very small top pouch allows only a small
amount of food to be ingested at one time. The band is adjustable according to
patient needs, and the procedure is reversable.

This picture shows you the set-up in the operating room for laparoscopic
surgery. The whole surgical procedure is controled by the televison screen.

What are the benefits of laparoscopic surgery?
It decreases the size of incisions used by surgeons resulting in less pain and
scarring, the very small scars may become invisible over time, a shortened
hospital stay and a faster recovery compared to traditional surgical techniques.

What are the complications of laparoscopic surgery?
Internal bleeding, infection and the risk of general anesthesia are complications
for all types of surgery, and laparoscopic procedures are not different.

What are the disadvantages and limitations of laparoscopic surgery?
         Restricted vision of the operative field and limited working area
         Difficult handling of the instruments (i.e. hand-eye coordination)
         Laparoscopic surgery needs a lot of training and experience
         Lack of tactile perception by our hands and fingers
         Laparoscopic surgery is more expensive because of the special
          instruments required

All in all, the surgeon performing laparoscopic Operations should be fully aware
of the advantages and the disadvantages and limitations of the method, to make
the correct choice of the best suitable procedure for the individual patient.

                                                    Prof. Dr. Guenther Kieninger
                                         Cedars – Jebel Ali International Hospital