Cirugia Laparoscopica
- New Approach in laparoscopic surgery
- Umbilical scar, less pain
Single Orifice Surgery, also known as a single incision surgery, has developed quite rapidly.
In Costa Rica, Dr. Ariel Rivera Aguerri, Surgeon Director of the Center for Laparoscopic Surgery and Chief of General Surgery at the Hospital CIMA, is pioneer in the implementation of the first Single Incision Surgery for gallbladder and appendix in the Costa Rica.
These procedures' hidden scar "require a single skin incision, and is conducted entirely through the umbilicus of the patient, either with a larger trocar or several smaller ones. The goal is to reduce postoperative pain, speed recovery and improve the aesthetic results for patients.
Many single incision procedures is now performed entirely through the umbilicus, leaving no visible scar for the patient.
The potential advantages for the patient:
1. Less postoperative pain: lower abdominal pain
2. A faster recovery: less pain and fewer incisions
3. Better cosmetic results: the scar is hidden in the navel
4. Minor complications:
a. Reduce the chance of infection site
b. Reduce the incidence of ventral hernia
Benefits of this procedure via umbilical (procedure known as SIS-single-incision surgery and single port access SPA) vs. Vaginal (procedure known as NOTES, natural orifice where the best known is the vagina)
A. Reduced rate of infection,
B. Inclusion of both male and female patients,
C. No advance preparation is required orifice (vs. requirement in the vaginal procedure),
D. Less formal instruments, etc.
Colon Surgery – Colostomy, Laparoscopic Colon Resection
Understanding colon surgery or Laparoscopic colon resection and what is expected from Colostomy
What is the colon?
The colon is the big intestine; it is the lower portion of the digestive tract. The intestine is the long and tubular organ that entails the small intestine, the colon (big intestine) and rectum, or the final portion of the colon. After eating food, digestion of that food begins in the stomach to then go to the small intestine where the nutritive food is absorbed. The waste goes through the colon to the rectum and the body eliminates it. The rectum and the colon absorbed water and retain the waste until it is ready to be eliminated.
 Colon anatomy |
Currently, over 600.000 surgical procedures are done in the United States to treat colon diseases such as diverticulitis, colon cancer and polyps, among others.
What is laparoscopic colon resection surgery?
One technique known as laparoscopic colon surgery that is minimally invasive enables the surgeons to make many common colon procedures through small incisions. It is important to mention that both benign and malign pathology and colon cancer can be operated laparoscopically as safe and efficient to traditional open surgeries.
Diagnostic tests: most of the colon diseases are diagnosed through one of two tests: one colonoscopy or barium enema. A colonoscopy is a soft and flexible tube which thickness is similar to an index finger inserted in the anon a then through the big intestine.
The barrio enema is a special radiography where a white liquid like “liquid with milk” is applied in the rectum and through the use of slight pressure it goes through the big intestine. These tests let the surgeon see the inside of the colon. Sometimes it might be necessary to have a computerized tomography of the abdomen. Before the operation, it is possible to do some other tests like blood tests, electrocardiogram or chest radiography.
Preparation for the surgery:
- Pre-surgical preparation includes blood tests, medical examination, chest radiography and electrocardiogram depending on the age and medical condition of the patient
- It is recommended to take a shower the previous night or the morning of the surgery
- The rectum and colon should be totally evacuated before the surgery. Generally, the patient has to drink a special solution to clean the intestine. It is possible to have the patient follow a liquid diet and take laxative medicines and use enemas before the operation
- It is common to prescribe oral antibiotics
- Follow the instructions of the doctor. If it is not possible to take the solution or the antibiotics, let the surgeon know
- After midnight the night before the operation, the patient should not eat or drink anything, except the medications prescribed by the surgeon with a sip of water the morning of the surgery
- Drugs such as aspirin, anticoagulant drugs, anti-inflammatory drugs (arthritis drugs) and vitamin E should be temporarily suspended for several days and up to one week before the surgery
- Quit smoking and make the necessary arrangements for any assistance you might need in your house.
What can be expected after the laparoscopic colon resection surgery?
- After the operation it is important to follow the physician instructions. Although some people feel better after a few days, remember that the body needs time to heal
- You are encouraged to get up from bed the day after the surgery and walk. This will help reduce the muscular pain
- Probably you can go back to most of the normal activities after one or two weeks. Such activities include: taking showers, driving a car, climbing up the stairs, working or having sexual relations.
Call and ask for a control appointment within two weeks after the operation.
Appendix Surgery – Laparoscopic Appendicectomy
Understanding the symptoms, causes, treatment and Appendix surgery or Laparoscopic Appendicectomy
What is the appendix? The appendix produces a protein called immunoglobulin that destroys bacteria and helps fight infections in the body. However, its function is not essential. People that have undergone an appendicectomy do not have increased risks of getting infections. Other organs of the body undertake such function when the appendix is extirpated.
Causes: Appendicitis is produced when the appendix gets filled with something that causes inflammation, such as mucus, feces or parasites. The appendix is then irritated and inflamed. Blood irrigation in the appendix is interrupted as the inflammation and irritation increase. Adequate blood irrigation is necessary for that part of the body to remain healthy.
The rupture (or puncture) is produced when holes develop in the wall of the appendix letting the feces, mucus and other substances permeate through them reaching the interior of the abdomen. When the appendix is ruptured, an infection is generated inside the abdomen; this infection is known as peritonitis.
Appendicitis can occur after a viral infection in the digestive tract or when the tube connecting the big intestine and the appendix is obstructed or trapped by the feces. Due to the risk of rupture that can occur at just 48 to 72 hours after the onset of symptoms, appendicitis is considered an emergency, and any person with symptoms needs to see a doctor immediately.
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Appendix |
Symptoms: The abdominal pain that characterizes acute appendicitis can vary from patient to patient causing some difficulty at the moment of making the diagnosis. Usually, it begins near the navel to later get set at the lower right part of the abdomen and grow from there in terms of intensity.
This pain is frequently associated to the loss of appetite, nausea, vomit, mild fever usually below 38° Celsius. Sometimes there is diarrhea. In some age groups, such as children and elderly patients, and also during pregnancy, the characteristics of the disease present differently.
It is important that the people that have symptoms of appendicitis do not take laxatives or use enemas to relieve constipation because these medications and procedures can cause the rupture of the appendix. In addition, they should also avoid pain medication because these can hide other symptoms that the doctor needs to observe to make the diagnosis.
How is it diagnosed?: To assist in the correct diagnosis, it is necessary to perform several examinations in the patient: blood tests to determine whether or not there is infection, urine test, abdominal ultrasound, computerized tomography (depending on the case), among others.
Treatment: Due to the probability of appendix rupture and the increase risk of a severe life threatening infection, the doctors recommend the extirpation of the appendix via surgery.
What is laparoscopic Appendicectomy?
Appendicitis is one of the most common surgical problems. The treatment requires an operation to remove the infected appendix. The traditional approach is to remove it through an incision in the lower right abdominal wall.
In most laparoscopic appendicectomies the surgeons operate through three small incisions while looking at the enlarged image of the internal organs of the patient in a television monitor.
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Laparoscopic Appendicectomy |
Advantages of Laparoscopic Appendicectomy
The results can vary according to the general condition of the patient. The common advantages are:
- Less post-operatory pain
- Shorter stay in hospital
- Faster return of intestinal function
- Faster return to normal activity
- Better cosmetic results
Am I a candidate for laparoscopic appendicectomy? An appendicitis without rupture that is diagnosed early can generally be removed laparoscopically. Laparoscopic appendicectomy is more difficult to perform if there is severe infection or if the appendix is ruptured.
What can I expect after the appendicectomy?
- After the operation, it is important to follow the directions of the physician. Although some people feel better after a few days, remember that your body needs time to heal.
- You are encouraged to get up from bed the day after the surgery and walk. This will help reduce the muscular pain and also the risk of formation of clogs in the legs
- You can probably go back to most of your normal activities after one or two weeks. These activities include: taking showers, driving a car, climbing up the stairs, working or having sexual relations
- If your pain is prolonged or if there is no relieve from the analgesics prescribed, let the surgeon know about it.
Call and ask for a control appointment within two weeks from your operation.
Abdominal Organs Surgeries – Laparoscopic Surgery of Solid Organs
There are different types of diseases and conditions that occur in the solid intra-abdominal organs such as:
- The spleen
- The pancreas
- The liver and
- The suprarenal glands
Many of these diseases and conditions can be treated with laparoscopic or minimally invasive surgery.
1.Laparoscopic Spleen Surgery The spleen is the organ located in the upper left part of the abdomen. It participates in the immune system of the human being and serves as a blood filter for old and damage structures that move in the circulatory system. |
 Inguinal Hernial |
There are several diseases, mainly hematological, that derive mandatorily in the extirpation of the spleen. Among these diseases, we have idiopathic thrombocytopenic purpura, hemolytic anemia, hereditary conditions (spherocytosis, talasemias, falciform cells anemia) and certain malignant conditions (lymphomas or certain types of leukemia).
The size of the spleen is the most important condition to determine if the patient is a candidate for spleen extirpation (spleenectomy) through laparoscopic surgery.
2.Laparoscopic Pancreatic Surgery The pancreas is an organ located in the depth of the abdomen. It has a very important function both in digestion (production of enzymes) and in the regulation of glucose metabolism. |
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Pancreatic |
Many operatory management diseases can be intervened with laparoscopic or minimally invasive surgery, especially those located in the body and tail of the pancreas.
Many inflammatory disease and certain types of localized tumors at this level can be safely and effectively treated with the great advantages provided to the patient by laparoscopy.
In cases of severe acute pancreatitis (nechrohemorragic) where there is a need to extirpate dead tissue, this can be done laparoscopically.
Likewise, in pancreatitis complications, like pancreatic pseudo-cyst, this can be drained laparoscopically.
In tumoral conditions like pancreas cancer, which are generally presented in the head, laparoscopic surgery is not appropriate, although there are extirpations that have been made in some centers worldwide. However, the great assistance of minimally invasive surgery in this type of condition lies in the diagnosis of how advanced is the disease and if the person is a candidate for curative surgery or, otherwise, only palliative surgery. In case of the latter condition, many of the derivative procedures can be done laparoscopically.
Certain tumoral conditions that occur in the body and tail of the pancreas such as endocrine tumors type NEM, mucinose cystic adenomas, can be laparoscopically treated.