Laparoscopic Surgery

Minimal Invasive Maximum Outcome...

Laparoscopic surgery is a technique with a widespread field of applications. In some medical fields, the laparoscopic approach is a standard, e.g., cholecystectomy. Due to the continuous surgical training and the ongoing development of instruments, imaging systems and surgical techniques, highly complex laparoscopic procedures are possible, such as laparoscopic gastrectomy. The department of Laparoscopic surgery at Ozone Superspeciality Hospital offer a variety of different laparoscopic surgeries and offer positive benefits and outcomes to the patients in benign and malignant diseases.

We have been continuously developing Our Department of Laparoscopic Surgeries over the past years, advancing from an invasive diagnostic tool to an efficient instrument for surgical treatment of benign and malignant disease. Ongoing training, experience, and development in imaging and laparoscopic

instruments have facilitated extension of the applications of laparoscopic surgery.

The overall advantage of minimizing trauma to the abdominal wall has been reproducible in many of the laparoscopic procedures compared with open surgery. Faster convalescence, reduced hospital stay, and faster return to normal activity are the most evident advantages of laparoscopic surgery. The outcome, efficiency, decreased incidence of wound infections, and reduced perioperative morbidity of minimally invasive procedures have been shown across different applications, e.g., cholecystectomy, fundoplication, and adrenalectomy. Despite the lack of randomized controlled trials to support laparoscopic applications, these procedures are accepted as the gold standard for surgical intervention. The laparoscopic surgeries are longer than the open ones. However, the duration has decreased over the years through experience and the learning curve. There has been no evidence that open surgery is superior to laparoscopic surgery in terms of oncological short- and long-term outcomes.

Laparoscopic surgery has become a state of the art technique in many fields of surgical treatment, providing better clinical outcomes than open surgery without compromising the oncological results.

Procedures Routinely Performed

Appendectomy

The systematic reviews and meta-analysis that compared the clinical outcome of laparoscopic vs open appendectomy clearly showed an advantage of the laparoscopic procedure. Laparoscopic appendectomy has been proven to be a safe and feasible procedure in the treatment of acute appendicitis and even complicated appendicitis. Research on the laparoscopic appendectomy maintain that in addition to an improved diagnostic accuracy, the procedure lowers the number of wound infections, results in less pain, faster recovery, and an earlier return to work.

Cholecystectomy

There is no significant difference in morbidity and mortality compared to those who undergo open surgery. In fact, they have faster recovery and shorter hospital stay. Although mini-laparotomy has a similar overall outcome, Research shows no difference between laparoscopic and minimally open and conventional open surgery in terms of morbidity and mortality.

Laparoscopic cholecystectomy is proven as a safe and feasible technique; concerning cardiac and respiratory complications, it shows superiority over open surgery in elderly patients.

As a result, patients experienced a lower incidence of postoperative complications, such as blood loss and bacterial contamination of ascites - an important cause of in-hospital morbidity and mortality.

Esophageal surgery

An adjustment in the surgical technique (the “Ivor Lewis approach”) led to better short-term and long-term outcomes for patients undergoing minimally invasive surgery with an acceptable lymph node harvest and a similar oncological outcome to open surgery. Patients with esophageal cancer who underwent laparoscopy experienced longer surgery time, less blood loss, shorter hospital stay, and reduced overall morbidity.

Overall, patients who undergo laparoscopic treatment have a significantly better overall survival.

Reflux surgery

The laparoscopic approach has become the gold standard for surgical management of GastroEsophageal Reflux Disease (GERD). Laparoscopic surgery in the treatment of GERD has helped in reduced hospital stay, faster recovery, faster return to normal activity, and a significant reduction of perioperative morbidity compared with open surgery. Laparoscopy has shown more effectiveness in treating symptoms, such as reduction of heartburn and regurgitation, and patients reported higher quality of life than achieved with other medical treatments such as proton-pump inhibitor drug alone.

Gastric surgery

Laparoscopic gastric surgery is a demanding procedure. Results of the surgery depend on the stage of the gastric tumor (early vs advanced), whether a partial or total gastrectomy was performed, and presence of gastrointestinal stromal tumors (GIST). Laparoscopic resections have an overall better short-term outcome with less blood loss, shorter hospital stay, faster recovery of bowel movement with shorter time to first flatus, and fewer serious perioperative complications. Wound complications and surgical site infections are very less significant in the laparoscopic group.

In advanced gastric cancer, the total laparoscopic gastrectomy consistently showed the advantages of laparoscopic surgery, having a better short-term outcome than open surgery.

Colorectal surgery

Laparoscopic colorectal surgery is well established as a safe procedure and must be differentiated between the surgical treatment of the benign and malignant disease.

There are satisfying outcome for patients undergoing Laparoscopic colorectal surgery. Colorectal cancer patients who undergo laparoscopic surgery within a multimodal rehabilitation protocol experienced the shortest hospital stay and the lowest morbidity.

The general benefits for patients undergoing laparoscopic surgery are the minimal trauma of access, reduced pain, accelerated postoperative return of bowel function, faster return to activity, and better cosmesis.

Surgical treatment of Crohn’s disease showed a trend towards lower rate of wound infections, with a lower rate of reoperation in non-disease related complications in the laparoscopic group.

A laparoscopic surgical approach to diverticular disease was associated with longer operation time and reduced postoperative pain.

Natural orifice specimen extraction after colon or sigmoid resection is feasible and seems to have an advantage in minimizing trauma to the abdominal wall by avoiding a small incision for specimen extraction.

Colon cancer

For colon cancer, the laparoscopic approach is regarded safe and feasible without compromising the oncological outcome. The short-term outcome benefits were lower blood loss, earlier recovery of bowel movement, earlier resumption of oral intake, and reduced hospital stay, as well as lower overall morbidity. The lymph node harvest and results of oncological outcome were similar to open surgery. Thus, laparoscopic surgery is considered superior to open surgery in the short-term outcome of colon cancer.

Rectal surgery

Laparoscopic rectopexy had fewer postoperative complications and a shorter hospital stay compared with open surgery.

Rectal cancer

Rectal cancer laparoscopic surgery has the benefit of minimally invasive access. In the laparoscopic group, blood loss, time to first bowel movement, intake of oral fluids and wound infection are significantly lower after the laparoscopic approach. There are no differences between the laparoscopic approach and the open surgery in terms of complications such as ureter injury, urinary retention, ileus, anastomotic leakage, or an incisional hernia. Oncological outcomes in the short-term and long-term results, such as length of specimen, circumferential resection margin, regional recurrence, port/wound metastasis and distant metastasis, also has no significant difference.

Liver surgery

Laparoscopic resection of the liver is performed mainly when treating metastasis of colorectal carcinoma or primary hepatocellular carcinoma. And other indications such as cyst resection. The minimally invasive approach is widely applied to patients with limited disease, such as those with solitary findings of 3-4 metastases in the liver. Findings in the liver segments II-IV are better suited for a laparoscopic approach than those in segments VII, VIII and IVa, which are difficult to reach. Detailed preoperative imaging and an intraoperative ultrasound are helpful.

Laparoscopic liver resection has advantages for short-term outcomes such as lower blood loss with a lower rate of transfusion, shorter postoperative hospital stay, and lower rates of positive resection margin and perioperative complications.

Surgery of the adrenal glands

Minimally invasive surgery of the adrenal glands has become the gold standard in resection of benign and malignant disease. Potential laparoscopic techniques are the lateral trans peritoneal approach and the posterior retroperitoneal approach. Regarding outcome of these approaches, compared to each other, the posterior retroperitoneal seems to be a comparable or superior approach based on the operation time, blood loss, pain score, hospital stay, and time to return to normal activity. The conversion rate and surgical complication rate are similar. Both techniques have replaced open access to the adrenal gland in tumors ≤ 8 cm. For the retroperitoneal approach, the findings support a faster convalescence compared with the lateral trans peritoneal approach.

Minimally invasive adrenalectomy is the mainstay of operative options for adrenal tumors. Laparoscopic approach can be an acceptable option for the primary neoplasm or adrenal metastasis with no evidence of local invasion.

Pancreatic surgery

Laparoscopic surgery of the pancreas is the most advanced surgical procedure. Laparoscopic left-side resection of pathologies of the distal pancreas or laparoscopic enucleation for benign lesions is safe and feasible, Left-side resection is the most common laparoscopic procedure in pancreas surgery because. The duration of surgery, surgical morbidity, rate of R1-resection and rate of major complications like pancreatic fistula are similar to the open surgery group; hospital stay and blood loss is reduced. Long-term outcomes of the left resection are equivalent even for malignant findings. For laparoscopic necrosectomy, therapeutic drainage is the best option for conservative management.

Laparoscopic pancreaticoduodenectomy is performed as a laparoscopic-assisted or total laparoscopic procedure.

Surgery of the spleen

Laparoscopic surgery has become standard for splenectomy in elective cases. The laparoscopic approach showed a reduced morbidity, especially in the pulmonary complications after surgery and wound infection compared with open surgery.

Laparoscopic hernia surgery

Groin hernia: There are two minimally invasive surgeries available for a groin hernia: A transabdominal preperitoneal repair (TAPP) and a totally extraperitoneal hernia repair (TEP). While the mesh is placed in the same position, the approach through the abdominal cavity (TAPP) or in front of the peritoneum (TEP) is different. Both techniques are described as effective treatments of a groin hernia.

Incisional hernia: Laparoscopic surgery for repair of an incisional hernia shows no difference in recurrence or length of hospital stay compared with open surgery. There were significantly fewer wound infections and complications requiring mesh removal. Laparoscopic surgery has Low Risk of bowel injury & Less post-operative pain.