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Dr. Asha Bale, FACS, director of University Hospital’s
Center for Diagnostic and Therapeutic Videosurgery,
answers some frequently asked questions about videosurgery
and specific procedures. If your question is not answered
here, Dr. Bale invites you to send it to bale@umdnj.edu
However, she is unable to respond to inquiries about
specific medical cases.
What is videosurgery?
Videosurgery involves the use of a thin, telescope-like
instrument with a camera attached and specially designed
surgical instruments. The camera and instruments enter
the body through small incisions, usually between 1/4
inch and 1 inch long. Surgeons use the camera as a guide
to performing surgery or as a diagnostic tool.
What
types of operations can be performed with videosurgery?
Many traditional "open" procedures can now
be done by videosurgery. What began with primarily abdominal
and gynecological applications has expanded to virtually
every area of the body. Coronary artery bypass, morbid
obesity surgery, achilles tendon repair, and varicose
vein treatment are but a few of the many procedures
that can be done using videosurgery today. Videosurgery
can also be used for diagnostic purposes, such as taking
a biopsy.
How
do I choose a videosurgeon?
Videosurgery is a relatively young specialty, with
new procedures constantly being developed, tested, and
refined. A key factor to choosing a videosurgeon is
training. How has this doctor been trained in videosurgery–through
fellowship training, approved Continuing Medical Education
courses, or another way? How experienced is the doctor
in the specific technique?
Why
might a laparoscopic procedure be converted to "open"
surgery?
The patient’s well being, rather than how a procedure
is done, is the most important consideration. A common
reason for conversion to "open" surgery is
bleeding that can’t be adequately controlled using laparoscopic
instruments. Some procedures, such as splenectomy, have
a higher risk of bleeding, so these are the ones that
generally have the higher conversion rate. Insufficient
visibility within the body is another reason for conversion
from videosurgery to the "open" procedure.
Are
there times when open surgery may be a better choice
than laparoscopy?
Sometimes it’s the type of anesthesia used, not the
procedure itself, that is the cause for most concern.
Take hernia repair, for example. Some surgeons will
use local anesthesia for an "open" hernia
repair, while general anesthesia is used with the laparoscopic
technique. In that case, open surgery might be the preferred
option, but primarily because of the greater risks associated
with general anesthesia.
Also, there are certain cancer operations where
laparoscopy is used. .Until further studies of these
procedures are completed, the conservative choice is
"open" surgery.
What
is hand-assisted laparoscopic surgery?
Hand-assisted laparoscopic surgery combines elements
of "open" and laparoscopic surgeries. Small
incisions are made and laparoscopic instruments are
used; however, one of the surgeon’s hands is inserted
into a port through a specially designed sleeve. One
hand operates the instruments, while the other may be
used for tactile exploration or other functions during
the operation.
Are
laparoscopic procedures completely different surgeries
than those done by "open" surgery?
Generally, the answer is no. The surgeries
are virtually identical. The difference occurs in the
way the surgeon gains access to the organ–through a
large incision with "open" surgery, or four
or five small incisions ranging from 1/4 inch to 1 inch
with videosurgery. However, there may be some slight
variations, depending on the procedure. For example,
a hernia repaired by "open" surgery may be
patched with a mesh material from the outside of the
abdominal wall; when done laparoscopically, the patch
is placed inside.
How
is microlaparoscopy different than laparoscopy?
Microlaparoscopy, or pinhole surgery, uses much smaller
surgical instruments (about 1/10th of an inch in diameter)
than are found with laparoscopic techniques (about 1/2
of an inch in diameter). The technology is very new
in the United States, and it is currently used primarily
for diagnostic procedures. While laparoscopy usually
requires general anesthesia, microlaparoscopy may be
able to be done with a local anesthetic and sedation.
And as the name implies, pinhole surgery offers even
smaller incisions than are commonly found today with
laparoscopy.
Why
is laparoscopic removal of the gallbladder the preferred
method today?
Laparoscopic cholecystectomy–removal of the gallbladder–is
one of the oldest and most frequently performed videosurgeries
today. It is the procedure that introduced many American
surgeons to the advances that had been made in videosurgery.
Laparoscopic cholecystectomy offers most patients a
shorter hospital stay, quicker recovery time, and less
pain than the "open" surgery, as well as minimal
scarring.
How
does an operation help stop sweaty hands?
Excessive perspiration can occur in the hands, the
underarms, the feet, the trunk, or the face. The condition
is called hyperhidrosis, and it is caused by a highly
overcharged sympathetic nervous system. It can be treated
with non-surgical remedies. However, these antiperspirants,
medications, and electrical treatments are all temporary
options that often are expensive and may have side effects.
A permanent minimally invasive surgery for hyperhidrosis
is called thoracoscopic sympathectomy. By removing certain
ganglion of the sympathetic nerve chain, the nerve impulses
sent to sweat glands are interrupted. The operation
successfully resolves the problem of sweaty palms 95
percent of the time.
Why
is the recovery time for hernia repair generally shorter
when done laparoscopically than with "open"
surgery?
Most laparoscopic procedures have a short recovery
time for primarily the same reason. Instead of making
a large incision and then cutting through muscle and
tissue to access an area, laparoscopic procedures use
four or five small incisions (ranging from 1/4 inch
to 1 inch). The healing period is significantly reduced,
and patients are able to resume their normal activities
in a shorter amount of time.
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