World Scenario – Who is Who?
Laparoscopic or “minimal Access Surgery” is a highly specialized technique for performing surgery of abdomen. In the past, this surgical technique was commonly used only for gynecologic surgery, for diagnostic laparoscopy in cases of infirtility and for gall bladder surgery. Over the last 10 years the use of this specialized surgical technique has expanded into intestinal surgery. In traditional “open” surgery the surgeon uses a single incision to enter into the abdomen. Laparoscopic surgery uses several 0.5-1cm incisions. Each incision is called a “port.” At each port a tubular instrument known as a trocharand cannulla is inserted. Specialized instruments and a special telescope known as a laparoscope are passed through the port during the procedure. At the beginning of the procedure, the patient’s abdomen is inflated with carbon dioxide gas to provide a working and viewing space for the laparoscopic surgeon. The laparoscope transmits images from the abdominal cavity to high-resolution video monitors through a digitall advanced camera system in the operating room. During the operation the surgeon watches detailed images of the abdomen on the high resolution monitor. This system allows the surgeon to perform the same operations as traditional surgery but with smaller multiple incisions.However recently single incision laparoscopic surgery is also evolved.
In certain situations a minimal access surgeon may choose to use a special type of port that is large enough to insert a hand known as Hand Port. When a hand port is used the surgical technique is called “hand assisted laparoscopic surgery”. The incision required for the hand port is generally 5.5 cm and hence larger than the other laparoscopic incisions, but is usually smaller than the incision required for traditional surgery.
Advantages of laparoscopic surgery?
Compared to traditional open surgery, patients often experience less pain, an earlier recovery, and less scarring with laparoscopic surgery.
Operations which can be performed using laparoscopic surgery?
Most of the abdominal advanced surgeries can be performed using the laparoscopic technique in experienced hand. These include surgery for gallbladder, dduodenal perforatio, appendicitis, Crohn’s disease, ulcerative colitis, diverticulitis, cancer, rectal prolapse and severe constipation.
In the past there had been concern raised about the safety of laparoscopic surgery for radical cancer operations. But recently several studies involving hundreds of patients have shown that laparoscopic surgery is safe for certain colorectal cancers.
How safe is laparoscopic surgery?
Laparoscopic surgery is as very safe as traditional open surgery. At the beginning of a laparoscopic operation the laparoscope is inserted through a small incision near the umbilicus, Either superior crease or inferior crease of umbilicus. The laparoscopic surgeon initially inspects the abdomen by doing diagnostic laparoscopy to determine whether laparoscopic surgery may be safely performed. If there is a large amount of inflammation or if the surgeon encounters other factors that is risky and prevent a clear view of the structures the surgeon may need to make a larger incision in order to complete the operation safely by converting laparoscopic surgery into open surgery.
Any intestinal or abdominal laparoscopic surgery is associated with certain risks such as complications related anesthesia and bleeding or infectious complications. The risk of any operation is determined in part by the nature of the specific operation and hidden risk factor within the patient itself. An individual’s general health and other medical conditions are also factors that affect the risk of any operation. Patient should discuss with your surgeon your individual risk for any operation. World Laparoscopy Hospital, Gurgaon is very reach in this concern because for poor and needy patient surgery is completely free at World Laparoscopy Hospital.
Single incision laparoscopic surgery (SILS) or Single port access (SPA) surgery, also known as laparoscopic endoscopic single-site surgery (LESS), umbilical surgery (OPUS) or single port incision less conventional equipment-utilizing surgery (SPICES) or natural orifice transumbilical surgery (NOTUS), or Embryonic Natural Orifice transumbilical surgery (E-NOTES) is an advanced minimally invasive surgical procedure in which the surgeon operates almost exclusively through a single entry point, typically the patient’s navel. SPA surgical procedures are like many laparoscopic surgeries in that the patient is under general anaesthesia, insufflated and laparoscopic visualization is utilized.The World Laparoscopy Hospital in NCR Delhi is the first hospital in Haryana and only the third in the India to perform a single-port, natural orifice gallbladder surgery through the navel for gallbladder stone disease. During the procedure, surgeons use a single opening in the umbilicus as they manipulate a camera and two laparoscopic instruments to separate the gallbladder from its attachments in the abdomen. The gallbladder is then removed through that same opening. Only a tiny bandage is required to close the navel, and there are no scars.
Single-incision laparoscopic surgery employs the same tools and techniques as conventional laparoscopic surgery and can be used in both men and women. The only difference is a specially-designed port that accommodates the tools.
World Laparoscopy Hospital surgeons have always been leaders in minimally invasive surgery,” says Dr R K Mishra, Director of the World Laparoscopy Hospital and professor of TGO University. “This procedure signals another step forward for our nationally single incision surgery and elevates our efforts to provide the best surgical care while improving patient recovery.”
Dr. Mishra says that single incision laparoscopic surgery should not only for simple surgery like cholecystectomy but should also be used for surgery like donor nephrectomy and for donor who have already decided to give the gift of life and are willing to go through surgery to help a person in need, the possibility of coming through the surgery without scars is a secondary benefit.
1929 – Heinz Kalk, a german gastroenterologist, is considered the founder of the German School of Laparoscopy. The method of laparoscopy, mainly being introduced as a diagnostic tool, has developed into an important therapeutic procedure during the last decade. This development is associated with the name of the German gastroenterologist Heinz Kalk. Born in Frankfurt in 1895 he first published about laparoscopy in 1929 and also designed a new laparoscope with a prograde optic. He realized the great value of laparoscopy in the differential diagnosis of liver diseases. During the 40’s Kalk introduced laparoscopically guided liver biopsy and was involved to a great extent in research of hepatic diseases, especially Hepatitis epidemica. The work of Kalk was of decisive influence for the development of laparoscopy in Europe. In 1949 he became chief of the Department of Internal Medicine of Kassel’s hospital “Stadtkrankenhaus”, making it one of the most interesting places to be in for hepatologists and laparoscopically working internists. Heinz Kalk died in 1973.
1934 – John C. Ruddock, M.D., F.A.C.P., pioneer in laparoscopy, an american internist described laparoscopic as a good diagnostic method, many times, superior than laparotomy. His instrument consisted of a built-in forceps with electrocoagulation capacity.
1938 – J Veress, of Hungary, developed the spring-loaded needle. It main purpose was to perform therapeutic pneumothorax to treat patients suffering from tuberculosis. It current modifications makes the “Veress” needle a perfect tool to achieve pneumoperitoneum during laparoscopic surgery.
1939 – Richard W. Telinde, tried to perform an endoscopic procedure by a culdoscopic approach, in the lithotomy position. This method was rapidly abandoned because of the presence of small intestine.
1944 – Raoul Palmer, performed gynecological examinations using laparoscopy and placing the patients in the Trendelemburg position, so air could fill the pelvis. He also stressed the importance of continuos intra-abdominal pressure monitoring during a laparoscopic procedure. Raoul Palmer born in Paris in 1904 from Swedish parents with a humanistic tradition and a non-conformist spirit obtained a scientific degree (licence ès-sciences) before starting his medical studies. Attracted by experimental surgery he was at the head of Fiessinger’s laboratory before becoming demonstrator of gynecology at the Hôpital Broca in the services of Proust, Brocq, Macquot, Funck-Brentano and Huguier. As a surgeon specialized in sterility since 1935 but conscient as to the difficulty of making a prognosis without being informed of the extent of the lesions, he invented pre-operatory exploratory coelioscopy in 1943. This new technique allowed him to go further with the sampling of ovocytes, electrocoagulation of the uterine horns, punction of cysts, adhesiolysis
1960 – Professor Kurt Semm performed the world’s first laparoscopic appendicectomy at the University of Kiel in Germany. When Semm, director of the department of obstetrics and gynaecology at Kiel University Hospital, later told a surgical meeting what he had done, the president of the German Surgical Society called for his suspension. Semm was a pioneer in minimally invasive surgery who was initially ridiculed and attacked by many of his colleagues but later was praised for his early advances in a field that went on to become highly fashionable. Nowadays minimally invasive surgery is a scientifically established standard procedure for certain operations. After qualifying in 1951, Semm made his first scientific contributions in gynaecological endocrinology under Nobel prize winner Adolf Butenandt in Munich. For the next few years his work concentrated on the treatment of infertility.
1971 – Jordan M. Phillips, founded the American Association of Gynecological Laparoscopist with its goal of providing education about this technology. Dr. Jordan M. Phillips, a doctor of obstetrics and gynecology who championed the use of laparoscopy for gynecological diagnosis and surgery when it was still a new procedure in the United States, has died. He was 85. A native of Boston, Dr. Phillips became interested in laparoscopy in the 1960s when the surgical procedure was being developed by several doctors in Europe. Minimally invasive, it allows a tiny camera to see inside the abdomen through a small incision.
Inspired by the possible applications for gynecology, Dr. Phillips founded the American Association of Gynecologic Laparoscoptics in 1971, to teach the fundamentals of the procedure to practicing doctors. He invited three other gynecologists to join him as founding members. There are now about 4,000 members.
The group’s inaugural meeting was held in Las Vegas in 1972. Doctors from nearly 50 countries attended. The featured speakers were leading laparoscopic surgeons Patrick Steptoe of England and Hans Frangenheim of Germany. Frangenheim’s demonstration of how to inspect ovaries by laparoscopy ended with a standing ovation. Most doctors in the room had never seen the procedure.
1980 – Patrick Christopher Steptoe (June 9, 1913, Oxford, England – March 21,1988, Canterbury) was a British obstetrician and gynaecologist and a pioneer of fertility treatment. Steptoe was responsible with biologist and physiologist Robert Edwards for developing in vitro fertilization. The birth of the first test-tube baby, Louise Joy Brown, occurred on July 25, 1978. Steptoe became the Director of the Centre for Human Reproduction, Oldham in 1969. Using laparoscopy, he collected the ova from volunteering infertile women who saw his place as their last hope to achieve a pregnancy. Edwards and his assistant Jean Purdy provided the laboratory expertise. During this time they had to endure criticism and hostility to their work. Finally, in 1978, the birth of Louise Brown changed everything. Although he encountered further criticism, other clinics were able to follow the lead and patients responded. To accommodate the increased patient number and train specialists, he and Edwards founded the Bourn Hall Clinic, Cambridgeshire in 1980 of which he was a Medical Director until his death.
1987 – Phillipe Mouret, performed the first video-laparoscopic cholecystectomy in Lyons, France. On June 20, 2008, Dr. Philippe Mouret died in Lyon, France at the age of 70. His death was attributed to lung cancer. He was one of the great pioneers who stunned the medical community with the introduction of laparoscopy in general surgery.
1994 – A robotic arm was designed to hold the laparoscope camera and instruments with the goal of improving safety, reducing resource utilization and improving efficiency and versatility for the surgeon.
1996 – First live broadcast of laparoscopic surgery via the Internet.
In 1985 a robot, the PUMA 560, was used to place a needle for a brain biopsy using CT guidance. In 1988, the PROBOT, developed at Imperial College London, was used to perform prostatic surgery.
The ROBODOC from Integrated Surgical Systems was introduced in 1992 to mill out precise fittings in the femur for hip replacement. Further development of robotic systems was carried out by Intuitive Surgical with the introduction of the da Vinci Surgical System and Computer Motion with the AESOP and the ZEUS robotic surgical system. (Intuitive Surgical bought Computer Motion in 2003; ZEUS is no longer being actively marketed.
The da Vinci Surgical System comprises three components: a surgeon’s console, a patient-side robotic cart with 4 arms manipulated by the surgeon (one to control the camera and three to manipulate instruments), and a high-definition 3D vision system. Articulating surgical instruments are mounted on the robotic arms which are introduced into the body through cannulas. The surgeon’s hand movements are scaled and filtered to eliminate hand tremor then translated into micro-movements of the proprietary instruments. The camera used in the system provides a true stereoscopic picture transmitted to a surgeon’s console. The da Vinci System is FDA cleared for a variety of surgical procedures including surgery for prostate cancer, hysterectomy and mitral valve repair, and is used in more than 800 hospitals in the Americas and Europe. The da Vinci System was used in 48,000 procedures in 2006 and sells for about $1.2 million.
1997 – a reconnection of the fallopian tubes operation was performed successfully in Cleveland using ZEUS.
1998 – Dr. Friedrich-Wilhelm Mohr using the Da Vinci surgical robot performed the first robotically assisted heart bypass at the Leipzig Heart Centre in Germany.
1999 – Dr. Randall Wolf and Dr. Robert Michler performed the first robotically assisted heart bypass in the USA at The Ohio State University.
In October 1999 the world’s first surgical robotics beating heart coronary artery bypass graft (CABG) was performed in Canada by Dr. Douglas Boyd and Dr. Reiza Rayman using the ZEUS surgical robot.
2001 – Prof. Marescaux used the “Zeus” robot to perform a cholecystectomy on a pig in Strasbourg, France while in New York.
In September 2001, Dr. Michel Gagner used the Zeus robotic system to perform a cholecystectomy on a woman in Strasbourg, France while in New York.
The first unmanned robotic surgery took place in May 2006 in Italy.
2009 – Dr. Todd Tillmanns reported results of the largest multi-institutional study on the use of da-Vinci robotic surgical system in gynecologic oncology and included learning curves for current and new users as a method to assess acquisition of their skills using the device.