Laparoscopic Surgery

Called minimally invasive or bandaid surgery, laparoscopic surgery is a modern surgical technique in which operations in the abdomen are performed through small incisions.

Surgery is typically recommended as treatment for male reproductive organs and urinary tract organs, including prostate cancer, ureteropelvic junction obstruction (UPJ), bladder and kidney cancer and vesicoureteral reflux.

Laparoscopic surgery is one of Orange Coast Urology's most frequent procedures performed today. Orange Coast Urology offers the breakthrough laser treatment for benign prostate hyperplasia (BPH) that quickly and gently removes blocking known as Laser Induced Flow Enhancement (LIFETM) procedure using the EVOLVEĀ® Laser System in our office.

Specializing in the treatment of prostate symptoms, Dr. Gilbert is a leader in the fiber optic LIFETM technique.

A second leading-edge surgical treatment - the da Vinci Prostatectomy - treats localized prostate cancer. The da Vinci process offers a minimally invasive option for prostatectomy with significantly less pain, shorter hospital stays, and a faster return to normal daily activities. Dr. Yoshida recently performed his 100th da Vinci surgery case at Hoag Hospital.

More specifically, laparoscopic surgery, also called minimally invasive surgery (MIS), band aid 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.

Laparoscopic surgery includes operations within the abdominal or pelvic cavities, whereas keyhole surgery performed on the thoracic or chest cavity is called thoracoscopic surgery. Laparoscopic and thoracoscopic surgery belong to the broader field of endoscopy.

The laparoscopic surgery procedure requires the use of a laparoscope and there are two types: a telescopic rod lens system, usually connected to a video camera (single chip or three chip), or a digital laparoscope, where the charge-coupled device is placed at the end of the laparoscope, eliminating the rod lens system. Also attached is a fiber optic cable system connected to a 'cold' light source (halogen or xenon), to illuminate the operative field, inserted through a 5 mm or 10 mm cannula or trocar to view the operative field.

During the procedure, the abdomen is usually insufflated with carbon dioxide gas to create a working and viewing space. The abdomen is essentially blown up like a balloon (insufflated), which elevates the abdominal wall above the internal organs like a dome. The gas used is CO2, which is common to the human body and can be absorbed by tissue and removed by the respiratory system, and is non-flammable.

Laparoscopic cholecystectomy is the most common laparoscopic procedure performed. Rather than a minimum 20cm incision as in traditional cholecystectomy, four incisions of 0.5-1.0cm will be sufficient to perform a laparoscopic removal of a gallbladder. Since the gall bladder is similar to a small balloon that stores and releases bile, it can usually be removed from the abdomen by suctioning out the bile and then removing the deflated gallbladder through the 1cm incision at the patient's navel. The length of postoperative stay in the hospital is minimal, and same-day discharges are possible in cases of early morning procedures.

In certain advanced laparoscopic procedures where the size of the specimen being removed is too large to remove through a trocar site, as would be done with a gallbladder, an incision larger than 10mm is made. The most common of these procedures are removal of all or part of the colon (colectomy), or removal of the kidney (nephrectomy).

Advantages to the patient with laparoscopic surgery versus an open procedure:

  • Reduced hemorrhaging , which reduces the chance of needing a blood transfusion
  • Smaller incision, which reduces pain and shortens recovery time
  • Less pain, leading to less pain medication needed
  • Although procedure times are usually slightly longer, hospital stay is less, and often with a same day discharge which leads to a faster return to everyday living.
  • Reduced exposure of internal organs to possible external contaminants thereby reduced risk of acquiring infections.
  • Can be used in Gamete intrafallopian transfer (GIFT) surgery to put the eggs back into the fallopian tubes. The process of minimally invasive surgery has been augmented by specialized tools for decades. However, in recent years, electronic tools have been developed to aid surgeons. Some of the features include:
    • Visual magnification - use of a large viewing screen improves visibility
    • Stabilization - Electromechanical damping of vibrations, due to machinery or shaky human hands
    • Simulators - use of specialized virtual reality training tools to improve physicians' proficiency in surgery
    • Reduced number of incisions

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