Laparoscopic surgery, also called minimally invasive surgery or keyhole surgery is a modern surgical technique in which operations in the abdomen are performed through small incisions (usually 0.5–1.5cm) as compared to larger incisions needed in traditional surgical procedures.
Open surgery typically requires an incision large enough for the surgeon's hands to enter the patient, while the term microscopic refers to various magnifying devices used during open surgery. Keyhole surgery uses images displayed on TV monitors for magnification of the surgical elements.
Laparoscopic surgery includes operations within the abdominal or pelvic cavity.
There are a number of advantages to the patient with laparoscopic surgery versus an open procedure. These include reduced pain due to smaller incisions and hemorrhaging, and shorter recovery time.
The key element in laparoscopic surgery is the use of a laparoscope. This is usually a telescopic lens system that is connected to a video camera. Also attached to the telescopic lens system is a light source to illuminate the operative field. The abdomen is usually insufflated, or essentially blown up like a balloon, with carbon dioxide gas. This elevates the abdominal wall above the internal organs like a dome 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.
Hernia surgery is to repair:
- Inguinal hernia
- Femoral hernia
- Incisional hernia
- Umbilical hernia
- Hiatus Hernia
A hernia is a lump that occurs when some of the contents of the abdomen push through a weakness in the muscles of the abdominal wall. The aim of a hernia repair operation is to push the intestine back in place and strengthen the abdominal wall.
There are several different types of hernia. A hernia at the navel (belly button) is called an umbilical hernia. Inguinal and femoral hernias are located in the groin. An incisional hernia results from a weakness in the abdominal wall caused by previous surgery.
Hernias are usually repaired under general anaesthetic. Both open and ‘laparoscopic’ (key-hole) surgical techniques can be used. The procedures take around 45 minutes and you may need to stay overnight in hospital.
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Gallbladder surgery and Gallbladder removal (cholecystectomy)
The gallbladder is a small pear-shaped pouch in the upper right part of your abdomen. It stores bile produced by the liver. Bile is a digestive fluid that helps to break down fatty food, and it is carried from the gallbladder to the intestine through a tube called the bile duct.
Gallstones can develop if the bile gets too concentrated. These small, hard stones can block the bile duct, resulting in attacks of abdominal pain, nausea and fever. If these symptoms persist, removal of the gallbladder is often required. The body can function well without a gallbladder.
A gallbladder operation is usually done using “keyhole” surgery – also known as laparoscopic cholecystectomy. This means Mr loyd can remove the organ without having to make a large cut on your abdomen. However, some people may need open surgery. Mr Lloyd will explain which method is most suitable for you.
Keyhole surgery is usually carried out as a day-case, but some patients may need to stay overnight in hospital. The operation is done under general anaesthesia. This means that you will be asleep during the procedure. Mr Lloyd will explain the benefits and risks of having your gallbladder removed, and will also discuss the alternatives to the procedure.
About the operation
Mr Lloyd will make two or three small cuts (about 5–10mm long) on the skin, above, or just below, your navel. Using a hollow needle, passed through or near your navel, carbon dioxide gas is pumped into the abdomen. This creates more room for your surgeon to work in and makes it easier to see the internal organs.
The laparoscope (a long, thin telescope with a light and camera lens at the tip) is then passed through one of the cuts. Mr Lloyd will examine the internal organs by looking directly through the laparoscope, or at pictures it sends to a video screen.
Specially adapted surgical instruments are passed through the other cuts to help move the internal structures so that your surgeon can see around them and to cut and remove the gall bladder.
X-ray pictures may be taken to look at the bile duct during the operation, so that your surgeon can find out if any gallstones are blocking the bile duct. Afterwards, the instruments are removed and the gas is allowed to escape through the laparoscope. The skin cuts are closed with dissolvable stitches and covered with a dressing.
The operation takes 60 to 90 minutes.
Following the operation, you are likely to feel some pain in the abdomen as well as “referred pain” in the tips of your shoulders - caused by the gas used to inflate the abdomen. This usually disappears within 48 hours or so.
Laparoscopic cholecystectomy is commonly performed and generally safe. For most people, the benefits in terms of improved symptoms are much greater than the disadvantages. However, all surgery carries an element of risk.
Specific complications of laparoscopic cholecystectomy are uncommon but can include accidental damage to other organs in the abdomen (such as the bile duct, bowel, bladder, liver or major blood vessels) requiring further surgery to repair the damage.
In the longer term, some people experience ongoing abdominal symptoms, such as pain, bloating, wind and diarrhoea. These may require further investigation and treatment.
The chance of complications depends on the exact type of operation you are having and other factors such as your general health. Ask Mr Lloyd to explain in more detail how any risks apply to you.
Click here for more information about gallbladder removal (cholecystectomy)
The Lloyd Release Procedure
The definitive treatment of groin pain for elite athletes.
Groin pain is extremely common and affects many athletes at some point in their sporting career. New evidence suggests that the symptoms are caused by inflammation and disruption of the attachment of the inguinal ligament to the pubis bone. Releasing this ligament and its attachments relieves the tension and relieves the pain without any functional change. This revolutionary keyhole surgery method of treating groin pain has become known as the Lloyd Release Procedure.
Most athletes have returned to their competitive sport within a few weeks of their operation.
The procedure involves general anaesthetic and 3 tiny incisions and no stitches. The incisions are made near the belly button and the procedure takes less than 30 minutes to perform.
A telescopic camera is placed into the abdomen and the ligaments in the groin are examined. Tension in the groin is released and a synthetic mesh is placed on the inside to reinforce the abdominal wall, in the same way as for routine keyhole hernia repairs.
Rehabilitation is rapid and sportsmen and women are encouraged to return to their normal activities as quickly as possible.
Benefits of the Lloyd Procedure for groin pain
- No large incisions
- Daycase surgery
- Minimal scarring, minimal pain
- Successfully performed on more than 300 athletes
- Recovery faster than conventional open groin surgery
- Most athletes start training 7-10 days after the procedure
- 90% of athletes return to competitive sport within 4 weeks
- Excellent long term results
Endoscopic retrograde cholangiopancreatography (ERCP) is a technique that combines the use of endoscopy and fluoroscopy to diagnose and treat certain problems of the biliary or pancreatic ductal systems. Through the endoscope, the physician can see the inside of the stomach and duodenum, and inject dyes into the ducts in the biliary tree and pancreas so they can be seen on x-rays.
ERCP is used primarily to diagnose and treat conditions of the bile ducts, including gallstones, inflammatory strictures (scars), leaks (from trauma and surgery), and cancer. ERCP can be performed for diagnostic and therapeutic reasons.