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Laproscopic Surgery


Laparoscopic or "minimally invasive" surgery is a specialized technique for performing surgery. In the past, this technique was commonly used for gynecologic surgery and for gall bladder surgery. Over the last 10 years the use of this 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 is inserted. Specialized instruments and a special camera known as a laparoscope are passed through the trochars during the procedure. At the beginning of the procedure, the abdomen is inflated with carbon dioxide gas to provide a working and viewing space for the surgeon. The laparoscope transmits images from the abdominal cavity to high-resolution video monitors in the operating room. During the operation the surgeon watches detailed images of the abdomen on the monitor. This system allows the surgeon to perform the same operations as traditional surgery but with smaller incisions.

In certain situations a surgeon may choose to use a special type of port that is large enough to insert a hand. When a hand port is used the surgical technique is called "hand assisted" laparoscopy. The incision required for the hand port is larger than the other laparoscopic incisions, but is usually smaller than the incision required for traditional surgery.
Most intestinal surgeries can be performed using the laparoscopic technique. These include surgery for 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 cancer operations. Recently, several studies involving hundreds of patients have shown that laparoscopic surgery is safe for certain colorectal cancers.
Laparoscopic surgery is as safe as traditional open surgery. At the beginning of a laparoscopic operation the laparoscope is inserted through a small incision near the belly button (umbilicus). The surgeon initially inspects the abdomen 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 prevent a clear view of the structures, the surgeon may need to make a larger incision in order to complete the operation safely.
Any intestinal surgery is associated with ­certain risks such as complications related to anesthesia and bleeding or infectious complications. The risk of any operation is determined in part by the nature of the specific operation. An individual's general heath and other medical conditions are also factors that affect the risk of any operation. You should discuss with your surgeon your individual risk for any operation.

Types of Laproscopic Surgery

There are a number of operations that can be performed laparoscopically including removal of gallbladder (laparoscopic cholecystectomy), repair of hernia (laparoscopic hernia repair), removal of the spleen (laparoscopic splenectomy), removal of part of the liver (laparoscopic hepatectomy) or removal of part of the pancreas (laparoscopic pancreatectomy).
Laparoscopic gynecology refers to a collection of surgical procedures that are performed laparoscopically. This type of procedure is named after the tool it is performed with, which is known as a laparoscope.
There are many different types of laparoscopic surgery for women. Some of the most common procedures include:
a) Hysterectomy
b) Vault Suspension
c) Myomectomy
d) Uterine Suspension
e) Bladder Support
f) Fibroid Removal
g) Cyst Removal
h) Diagnostic Laparoscopy
This list is just a small portion of the total amount of laparoscopic procedures that can be performed for women.

Risk Factors

Risk factors include:

  • A comparative evaluation of different treatment modalities establishes the one with best benefit: risk profile as the favoured method. In light of this, I wish to critically evaluate the statement that "laparoscopic surgery is said to carry increased risk" by examining its role in present-day surgical practice. I shall also discuss how these risks can be reduced further and how to communicate the risks to our patients.
  • Diagnostic laparoscopy has a definitive role in the investigations of chronic pelvic pain, endometriosis, suspected ectopic pregnancy and infertility, as it offers the advantage of visual inspection of the abdominal and pelvic organs over imaging techniques. The notion that "laparoscopy carries increased risk" has not been proved true in the case of laparoscopic sterilisation, which is the most common laparoscopic surgery performed worldwide. A systematic review evaluating the risks and benefits of laparoscopic sterilisation compared to mini-laparotomy confirmed that the minor morbidity is significantly less following laparoscopic sterilisation and that there is no significant difference in the incidence of major morbidity associated with either method. For the surgical treatment of ectopic pregnancy,
  • The risks of surgery are proportional to its extent and complexity. There are concerns in this area as laparoscopic hysterectomy (LH) takes longer to perform and has a higher incidence of intra-operative injury to the bladder and ureter compared to vaginal hysterectomy (VH) and abdominal hysterectomy (AH) . These disadvantages of LH were identified with a more extensive laparoscopic approach for hysterectomy. In laparoscopy-assisted vaginal hysterectomy (LAVH), when the laparoscope is used only to free the adenexal structures and the rest of the procedure (including ligation of the uterine arteries) is completed through the vaginal route, there was no significant difference in either the operation time or in the incidence of urinary tract injury compared to VH. If oophorectomy is contemplated with hysterectomy, LAVH is a more appropriate method for its significant benefits over abdominal hysterectomy. In gynaecological oncology, laparoscopic pelvic lymphadenectomy and radical vaginal hysterectomy has become a standard alternative to Wertheim's procedure for early-stage cancer cervix.
  • It is evident that, in contemporary gynaecological practice, laparoscopic surgery has a firmly established role as its benefits far outweigh its risks. Historically, laparoscopic surgery was initiated by gynaecologists and was rapidly adopted by other surgical specialities. In the developed countries, open-access cholecystectomy has virtually been abandoned in favour of laparoscopic cholecystectomy. A systematic review of 54 studies comparing laparoscopic appendectomy with conventional open-access surgery for acute appendicitis led the reviewers to recommend the laparoscopic approach for the treatment of acute appendicitis when available and affordable for the significant benefits associated with it. The laparoscopic approach is adopted more and more commonly in colorectal and urological surgery for its obvious advantages.


Procedure include:

  • Three or more small (5-10 mm) incisions are made in the abdomen to allow access ports to be inserted. The laparoscope and surgical instruments are inserted through these ports. The surgeon then uses the laparoscope, which transmits a picture of the abdominal organs on a video monitor, allowing the operation to be performed.
    Laparoscopic intestinal surgery can be used to perform the following operations:
  • Proctosigmoidectomy. Surgical removal of a diseased section of the rectum and sigmoid colon. Used to treat cancers and noncancerous growths or polyps, and complications of diverticulitis. Right colectomy or Ileocolectomy. During a right colectomy, the right side of the colon is removed. During an ileocolectomy, the last segment of the small intestine - which is attached to the right side of the colon, called the ileum, is also removed. Used to remove cancers, noncancerous growths or polyps, and inflammation from Crohn's disease.
    Total abdominal colectomy. Surgical removal of the large intestine. Used to treat ulcerative colitis, Crohn's disease, familial polyposis and possibly constipation.
  • Fecal diversion. Surgical creation of either a temporary or permanent ileostomy (opening between the surface of the skin and the small intestine) or (colostomy (opening between the surface of the skin and the colon). Used to treat complex rectal and anal problems, including poor bowel control. Abdominoperineal resection. Surgical removal of the anus, rectum and sigmoid colon. Used to remove cancer in the lower rectum or in the anus, close to the sphincter (control) muscles.
    Rectopexy. A procedure in which stitches are used to secure the rectum in its proper position. Used to correct rectal prolapse.
  • Total proctocolectomy. This is the most extensive bowel operation performed and involves the removal of both the rectum and the colon. If the surgeon is able to leave the anus and it works properly, then sometimes an ileal pouch can be created so that you can go to the bathroom. An ileal pouch is a surgically created chamber made up of the lowest part of the small intestine (the ileum). However, sometimes, a permanent ileostomy (opening between the surface of the skin and the small intestine) is needed particularly if the anus must be removed, is weak, or has been damaged.

Range of Treatment Cost

Procedure Min Cost
Max Cost
Laparoscopic Adjustable Gastric Banding 76097/1050 90000/1250
Laparoscopic Rouxen Gastric Bypass 136975/1880 160000/2200
Laparoscopic Gastric Bypass 715316/9850 820000/11290
Laparoscopic removal of endometriosis 266000/3660 366000/5035
Laparoscopic removal of ovarian cysts 190000/2615 250000/3450
Laparoscopic removal of adhesions (scar tissue) 327000/4498 400000/5500
Laparoscopic removal of a tube and ovary 170000/2350 230000/3170
Laparoscopic myomectomy (removal of uterine fibroids) 125000/1750 250000/3450
Laparoscopic total hysterectomy (removal of uterus and cervix) 150000/2050 180000/2480
Laparoscopic supracervical hysterectomy (removal of uterus, preservation of cervix) 150000/2050 250000/3450
Laparoscopic uterine suspension 125000/1750 150000/2050
Hysteroscopic surgery (removal of polyps or fibroids from the inside of the uterus) 70000/950 250000/3450
Laparoscopic bladder support surgery 700000/950 100000/3450
Endometrial ablation (for heavy periods) 50000/650 500000/6890
Vaginal hysterectomy 125000/1750 375000/5250
Robotic Assisted Laparoscopic Removal of Fibroids 125000/1750 375000/5250
Abdominal myomectomy 100000/1350 250000/3450
Hysteroscopic myomectomy 150000/2060 350000/4850
Abdominal hysterectomy 125000/1750 350000/4850
Robot-assisted laparoscopic hysterectomy 150000/2060 350000/4850
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