Role of Ultrasound in Laparoscopy

October 5, 2010

Advantages of Laparoscopic Surgery

Filed under: Institute of Ultrasound Training — Ultrasound Training Institute @ 8:07 pm

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 gynaecologic surgery, for diagnostic laparoscopy in cases of infertility 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 trochar and 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 digitally 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, duodenal perforation, 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 anaesthesia 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)

Filed under: Institute of Ultrasound Training — Ultrasound Training Institute @ 6:51 pm

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.

August 11, 2009

Laparoscopic Ultrasound in Esophagogastric Cancer

Filed under: Institute of Ultrasound Training — Ultrasound Training Institute @ 2:23 pm

The Use of Laparoscopic Ultrasound

Although laparoscopic scrutiny solo names most cases of metastatic disease, such as superficial hepatic wounds and peritoneal seeding, the add on of LUS profits a subset of patients. No extra unwholesomeness has been reported for LUS when added to arranging laparoscopy. Its utilization increases the operative time by 15-20 seconds, which looks sensible for the added symptomatic benefit.

Recommendations :.

Because of the limited quality of the available evidence showing a benefit of arranging laparoscopy and the absence of clear verbal description of the extra benefit of LUS therein background, our ability to provide a strong testimonial for the routine employment of LUS in pretherapeutic theatrical production of esophageal malignant neoplastic disease is limited. Nevertheless, DECILITRE with sonography should be studied in patients with esophagogastric malignances who do not have metastatic disease on superiority scaffolding COMPUTERIZED TOMOGRAPHY read.

The primary utilization of LUS in biliary disease has been as an alternative to intraoperative cholangiography to identify choledocholithiasis during laparoscopic cholecystectomy.
Indications :.

LUS can be used routinely to identify the common bile duct, common hepatic duct, and intrahepatic common bile duct to determine dilatation or common bile duct stones. In some cases, the cystic duct general anatomy can also be made out.
Technique :.

General anesthesia is used, and larboard position is the same as for laparoscopic cholecystectomy. The arrangement of investigations will be different for affecteds role with hepatomegaly. The flexile echography investigation is placed through the umbilical port wine, while the photographic camera is placed through the midepigastric port wine .1 Commencement, the liver is scanned and the common bile duct can be got word median to the gall bladder. The gall bladder and liver are shrunk back superiorly and cephalad so that the transducer can be placed flat over the common bile duct. Sometimes the conjunction of the right and went forth hepatic ducts or the cystic duct conjunction can be picked up. The common bile duct is followed to the duodenum. A transversal position of the common bile duct can be found by acute deflexion of the transducer. If there is airwave in the duodenum, it can be constricted with the investigation or body of water can be instiled into the breadbasket for a better position of that expanse. If the common bile duct is hard to visualise, a cholangiogram catheter can be placed into the cystic duct and flushed with saline solution to distend the duct.

Hazards benefits :.

The literature reexamined does not discover any jeopardies related this procedure. The benefits are that it provides an alternative to fluoroscopy and to cholangiogram catheter placement. The cost is a bit over half that of intraoperative cholangiography and with experience can be done in less time (Level II).
Outcomes :.

The common bile duct can be amply passed judgment in 97 % of cases (Level II). For naming choledocholithiasis, the sensitiveness is 90 % -96 % and specificity 100 % (Level II). The overconfident prognostic value is 100 %, and the disconfirming prognosticative value is 98 % (Level II). In a comparative test, intraoperative cholangiography had a predisposition of 86 %, specificity of 99 %, cocksure prognosticative economic value of 98 %, and disconfirming prognosticative value of 92 % (Level II).
Conclusions :.

LUS is a good alternative to intraoperative cholangiogram (Grade B). Compared to intraoperative cholangiogram, it costs less to perform (Grade B) and takes less time (Grade C).

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