| What is emergency laparoscopy? |
| Laparoscopy was initially used for diagnostic and therapeutic purposes. But with the advancement of medical sciences, the role of laparoscopy was extended for emergency settings also. Emergency Laparoscopic treatment of acute abdomen was first proposed by Philippe Mouret in 1990 and since then it is being widely used for abdominal emergencies, especially- acute cholecystitis, appendicitis, perforated ulcers, Ectopic pregnancies,abdominal bleeding etc. Peptic ulcer perforation is the second most frequent abdominal perforation requiring surgery and accounts for 5% of abdominal emergencies. Dr. Manish Motwani, an eminent laparoscopic surgeon and founder of Aastha healthcare, comments," When patients come to the emergency room, we prefer laparoscopy as it helps us to conduct an immediate diagnosis and can initiate treatment right there." Aastha is well equipped to handle any kind of emergencies. It is well equipped with all modern facilities and is supported by qualified and experienced surgeons. Laparoscopic surgery has improved our management of surgical emergencies and in certain conditions is now an essential part of our armamentarium. What is clear is that as surgical expertise and technology both continue to improve, so the remit for laparoscopic surgery will expand, to the benefit of our patients. When emergency laparoscopy is performed, there can be two clinical scenarios :
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| What are the operations possible through emergency laparoscopy? |
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| How it is done? |
| The emergency laparoscopy is done in the same way as elective laparoscopy. The only thing is that the surgeon must be well qualified. Emergency Laparoscopy is generally performed under general anesthesia. Once the patient is under anesthesia, a urinary catheter is inserted to collect urine during the procedure. To begin the procedure, a small incision is made just below the navel and a cannula or trocar is inserted into the incision to accommodate the insertion of the laparoscope. Other incisions (one or two) may be made in other areas of the abdomen to allow for insertion of other laparoscopic instrumentation. A laparoscopic insufflation device is used to inflate the abdomen with carbon dioxide gas to create a space in which the laparoscopic surgeon can maneuver the instruments. Laparoscopes, which have integral cameras for transmitting images during the procedure, are available in various sizes depending upon the type of procedure being performed. The images from the laparoscope are transmitted to a viewing monitor, which the surgeon uses to visualize the internal anatomy and guide any surgical procedure. After laparoscopic treatment is completed, the laparoscope, cannula, and other instrumentation are removed, and the incision is sutured and bandaged. Generally the patient recovers faster than he would in an open surgery. But Ofcourse it all depends upon on the diagnosis of the patient at the time of operation and what the surgeon did to treat the disease. In most of the cases, the patients are encouraged to move about after few hrs of surgery. They can resume their normal activities after 7-12 days after surgery, depending upon the condition. |
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| Benefits of emergency laparoscopy |
| Emergency laparoscopy has a huge benefit of providing faster recovery rate. Let us see the benefits of emergency laparoscopy for patients: |
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| Contraindications of emergency laparoscopy |
| Relative contraindications to emergency laparoscopy are : |
http://www.aasthahealthcare.com/Emergency-laparoscopy-Surgical-Treatment.htm ------------------------------------ |
Monday, September 7, 2009
Emergency Laparoscopy Surgery Treatment | Laparoscopy Surgery | Aastha Healthcare | Super Speciality Center Hospital | India
Laparoscopic Intestinal Surgery Treatment | Laparoscopy Surgery | Aastha Healthcare | Super Speciality Center Hospital | India
| What is the intestine? |
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The large intestine is about 3.5 meters long. The large intestine is divided into 6 parts: caecum, ascending colon, transverse colon, descending colon, sigmoid colon, and rectum. The inner surface of large intestine is covered with mucous and is convoluted. The large intestine is responsible for absorption of water and excretion of solid waste material The small intestine is about 6 meters long. It is divided into 3 sections: duodenum, jejunum, and ileum. This part is where the most extensive part of digestion occurs. Most food products are absorbed in the small intestine. |
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| What is laparoscopic intestinal surgery? |
| The introduction of laparoscopic removal of the gall bladder (Laparoscopic Cholecystectomy) in the late 1980s revolutionized the surgical management of many abdominal operations. It offered less discomfort to the patient and faster recovery. But it was only the delay in the development of proper instruments that prevented Colon and Rectal Surgeons from performing laparoscopic intestinal surgery until 1991. Today, laparoscopic surgery is an increasingly popular option for people with intestinal conditions, who may need sections of the bowel repaired or removed. Laparoscopy is a minimally invasive procedure in which the surgeons operate through very tiny holes (approximately 1/2-inch wide) instead of large incisions (8- to 12-inch wide). While recovery from open surgery for intestinal disease, takes an average of six weeks, people who have undergone laparoscopic surgery tend to feel back to normal in just three weeks. Laparoscopic surgery is used to treat :
Open surgery and laparoscopic surgery Traditionally, abdominal surgery has been performed in an open manner and what that means is the patient has a reasonably large incision, which varies in size between four and 10 inches long. It's usually in the midline of the abdomen, so it runs from the pubis at the lower midline of the abdomen up to the navel. The length depends on the extent of surgery and the extent of bowel that one has to free up or take out. When the surgery's performed laparoscopically, three or four access ports are put, which are little plastic tubes that go into the abdomen that are positioned through incisions less than half-an-inch long. Then through these access ports we put in a camera, which is less than a half-inch in diameter, which is used to see what's going on inside the abdominal cavity. Through the other access ports we put in very fine little surgical instruments, about 5 millimeters in diameter. We use those instruments to free up the bowel and then we make an incision of four to six centimeters in size (around two inches) to remove the bowel. |
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| How are less invasive procedures performed? |
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| Laparoscopic surgery is a minimally invasive approach to common surgical problems in the abdomen. Many surgical problems that traditionally were performed through large incisions are now accomplished through small keyhole incisions that result in much less surgical trauma and postoperative pain. Aastha has its expertise in Laparoscopic procedures. Our surgeons have the experience in performing many basic and advanced procedures with the Laparoscopic approach. Laparoscopic intestinal surgery can be used to perform the following operations : |
| Proctosigmoidectomy- Surgical removal of a diseased section of the rectum and sigmoid colon. This is used to treat cancers and non-cancerous growths and complications of diverticulitis. Right colectomy or Ileocolectomy- Surgical removal of a section of the colon that is adjacent to the small intestine. This is used to remove cancers, non-cancerous growths or polyps, and inflammation from Crohn's disease. Total abdominal colectomy- this is the surgical removal of the large intestine. It is done to treat ulcerative colitis, Crohn's disease , and familial polyposis. Faecal diversion- This is surgical creation of an ileostomy (opening between the surface of the skin and the small intestine) or colostomy (opening between the surface of the skin and the colon). It is done to treat complex rectal and anal problems, including poor bowel control. Abdominoperineal resection- Surgical removal of the anus, rectum and sigmoid colon. This is 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. It is done 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. However, often a permanent ileostomy, in which the ileum is attached to the stoma, is needed particularly if the anus must be removed, is weak, or has been damaged. Before the surgery During the surgery Most minimally invasive intestinal procedures start the same way. Carbon Dioxide gas is used to distend the abdominal (peritoneal) cavity. The surgeon gains access to the abdomen using a trocar. A trocar is a narrow tube-like instrument. A laparoscope (a tiny telescope connected to a video camera) is inserted through the trocar, giving the surgeon a magnified view of the patient's internal organs on a television monitor. Up to 4 additional trocars are inserted for special instrumentation. After the surgery Although many people feel better in just a few days, remember that the body needs time to heal. Patients are encouraged to be out of bed the day after surgery and walk. This helps to diminish the soreness in muscles. Minimally invasive procedures offer faster recovery. So the patients are able to get back to their normal activities in one to two weeks time. But patients are advised to come regularly for follow ups. |
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| What are the advantages of the minimally invasive technique? |
Because surgeons operate through 3 to 5 tiny openings instead of a long incision, many patients experience less pain, less scarring and a shorter hospital stay. In most cases, a quicker return to work and other normal activities can also be expected. In addition, these patients often eat solid foods sooner and experience a quicker return of bowel function. So to enumerate all advantages once again, they are: |
http://www.aasthahealthcare.com/Laparoscopic-Intestinal-Surgery-Surgical-Treatment.htm ------------------------------------ |
The intestine is the portion of the alimentary canal extending from the stomach to the anus. The intestine is a long, tubular organ consisting of two parts:
Laparoscopy Adrenalectomy | Laparoscopy Surgery | Aastha Healthcare | Super Speciality Center Hospital | India
| What are Adrenal Glands? |
 Adrenal glands are a part of our endocrine system. They are two small organs, located one above each kidney. They are triangular in shape and about the size of a thumb. These glands produce hormones which are involved in control of blood pressure, chemical levels in the blood, water use in the body, glucose usage, and the "fight or flight" reaction during times of stress. These adrenal-produced hormones include cortisol, aldosterone, the adrenaline hormones and a small fraction of the body's sex hormones (oestrogen and androgens). |
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| What is Adrenalectomy? |
| The procedure of removal of an adrenal gland is called an Adrenalectomy. The adrenal gland may be removed on one side or both sides at the time of surgery depending on the nature of disease. An Adrenalectomy is the surgical removal and this procedure can be performed using an open incision or laparoscopic technique. The adrenal glands are fed by numerous blood vessels, so surgeons need to be alert to extensive bleeding during surgery. In addition, the adrenal glands lie close to one of the body's major blood vessels (the vena cava), and to the spleen and the pancreas. The surgeon needs to remove the gland(s) without damaging any of these important and delicate organs. |
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| What are the indications of Adrenalectomy? |
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| Diseases of the adrenal gland are relatively rare. The most common reason that a patient may need to have the adrenal gland removed is because of tumour within adrenal gland. Most of these tumours are small and not cancers. They are known as benign growths that can usually be removed with surgery. Removal of the adrenal gland may also be required for certain tumours even if they aren't producing excess hormones, such as very large tumours or if there is a suspicion that the tumour could be a cancer, or sometimes referred to as malignant. Fortunately, malignant adrenal tumours are rare. An adrenal mass or tumour is sometimes found by chance when a patient gets an X-ray study to evaluate another problem. Occasionally, Adrenalectomy may be recommended when hormones produced by the adrenal glands aggravate another condition such as breast cancer. Let us see the common indications for removal of the adrenal gland are the following: |
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| What are the symptoms? |
| Patients with adrenal gland problems may have a variety of symptoms related to excess hormone production by the abnormal gland. Adrenal tumours associated with excess hormone production include pheochromocytomas, aldosterone-producing tumours, and cortisol-producing tumours. Some of these tumours and their typical features are given below. |
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| How is it diagnosed? |
| If an adrenal tumour is suspected based on symptoms or has been identified by X-ray, the patients are advised to undergo blood and urine tests to determine if the tumour is over-producing hormones. CT scan, nuclear medicine scan, an MRI or selective venous sampling are commonly used to locate the suspected adrenal tumour. Surgical removal of the adrenal gland is the preferred treatment for patients with adrenal tumours that secrete excess hormones and for primary adrenal tutors that appear malignant. |
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| What are the treatment options? |
| Although laparoscopic Adrenal gland removal has many benefits, it may not be appropriate for some patients. One must obtain a thorough medical evaluation by a surgeon qualified in laparoscopic adrenal gland removal. Aastha is a state-of-art health centre attended by distinguished and experienced surgeons from different fields We have dedicated endocrine surgeons with a great deal of experience with adrenal surgery who are nationally recognized experts in performing and teaching laparoscopic procedures. They are among the most experienced laparoscopic surgeons in the world. |
| The surgeon may evaluate the patient and suggest either of the two options: Adrenalectomy by laparoscopy or by open incision. Let us see both the options in details: |
| Open procedure |
| It is generally accepted that for adrenal cancer and for conditions where there is a high risk of adrenal cancer, such as for large (4-7 cm) tumours or for those associated with multiple endocrine neoplasia, an "open" operation is better because both sides can be examined carefully and dealt with in the event of spread. |
| The surgeon may operate from any of four directions, depending on the exact problem and the patient's body type. Let us see how the surgeon may approach: |
| In the posterior approach, the surgeon cuts into the back, just beneath the rib cage. If both glands are to be removed, an incision is made on each side of the body. This approach is the most direct route to the adrenal glands, but it does not provide quite as clear a view of the surrounding structures as the anterior approach. |
| In the flank approach, the surgeon cuts into the patient's side. This is particularly useful in massively obese patients. If both glands need to be removed, the surgeon must remove one gland, repair the surgical wound, turn the patient onto the other side, and repeat the entire process. |
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| The last approach involves an incision into the chest cavity, either with or without part of the incision into the abdominal cavity. It is used when the surgeon anticipates a very large tumour, or if the surgeon needs to examine or remove nearby structures as well. |
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| Laparoscopic Adrenalectomy |
| Adrenal glands are two in number and are situated in the abdomen and lie just over each kidney. They produce chemicals that control several important processes in the body. Tumours of the adrenal glands are very rare, and most are non-cancerous (benign) and are treated by an operation to remove the gland called 'Adrenalectomy'. This operation used to be carried out routinely through a long incision in the loin or abdomen (open operation), but is now performed in a considerable proportion of patients through a few small 'keyhole' incisions of 0.5-1.5 cm long. Laparoscopic surgery refers to the technique in which a surgeon operates within the abdominal cavity with small telescopes and long instruments. Instead of making a large incision which allows the surgeon access to the abdominal contents where he/she operates with conventional instruments and their hands, a series of small (~ 1/4 to 3/4 inch) incisions are made and specialized instruments are used. One of these instruments fills air into the abdominal cavity to blow it up (like a balloon but only under modest pressure). This instillation of air makes it easier to work since the intestines and other organs will fall away from the tissues which are being examined. A camera is then place into the abdominal cavity which allows the surgeon to see what he/she is doing. The remainder of the small holes (ports) have long instruments (forceps, scissors, etc.) placed through them into the abdomen for the actual dissecting of tissues. The patient on the right is positioned on his side for a laparoscopic Adrenalectomy. Laparoscopic surgery has proved to be a major advancement for the management of adrenal tumours. Patients that have undergone laparoscopic surgery have much shorter hospitalization, more rapid recovery (approximately 2 weeks compared to 4 to 8 weeks after open surgery) and earlier return to work. The postoperative pain is markedly reduced after laparoscopic surgery and the general feeling of physical well being returns at a much faster rate. |
| At Aastha we offer specialized expertise in laparoscopic Adrenalectomy. We perform the procedure utilizing both standard laparoscopic techniques and with a laparoscopic hand-access device. Two new devices that allow the surgeon to insert a hand inside the abdomen during laparoscopic surgery have recently been developed. The procedure called hand-assisted laparoscopic surgery (HALS) allows better retraction and easier dissection of abdominal organs since the advantages of using the human hand that is present during open surgery is now also available during laparoscopic surgery. We have pioneered HALS techniques for laparoscopic Adrenalectomy and offer this procedure for large tumours in the adrenal gland that otherwise would require an open surgical procedure. We have found the use of the hand assist-device to be advantageous during laparoscopic surgery since the operative time is markedly reduced. Furthermore manipulation of the tumour with surgical instruments is reduced thus decreasing the risk of fracturing the tumour or having an incomplete excision of the tumour. In larger tumours, standard laparoscopic procedures are less desirable, due to the risk of cancer. With hand-assisted laparoscopic surgery large adrenal tumours can be safely removed intact and with a rim of surrounding normal tissue to obtain clean microscopic-free margins around the tumour tissue. Furthermore the ability to intraoperatively palpate the tumour allows the surgeon to make an early assessment as to whether the lesion is benign (non-cancerous) or malignant (cancer) and therefore convert to an open procedure if cancer of the adrenal gland is suspected. |
| Patient is positioned on the inflatable "bean bag" in the modified flank position (60-70°). We prefer to flex the operative table. The umbilicus can be used as an entrance point, and the camera can be placed in this trocar.· CO2 is insuflated up to a pressure of 18mm/Hg to create pneumoperitoneum. Under laparoscopic guidance, two or three additional working ports are inserted below the rib cage. |
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| Identification of landmarks and trocar insertion. |
| In a small number of patients the laparoscopic method cannot be performed. In that situation, the operation is converted to an open procedure. Factors that may increase the possibility of choosing or converting to the "open" procedure may include: |
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| The decision to perform the open procedure is a judgment decision made by your surgeon either before or during the actual operation. When the surgeon feels that it is safest to convert the laparoscopic procedure to an open one, these are not a complication, but rather sound surgical judgment. The decision to convert to an open procedure is strictly based on patient safety. |
| Before the surgery |
| Most aspects of preparation are the same as in other major operations. In addition, hormone imbalances are often a major challenge. Whenever possible, physicians will try to correct hormone imbalances through medication in the days or weeks before surgery. Adrenal tumours may cause other problems such as hypertension or inadequate potassium in the blood, and these problems also should be resolved if possible before surgery is performed. Therefore, a patient may take specific medicines for days or weeks before surgery. |
| Most adrenal tumours can be imaged very well with a CT scan or MRI, and benign tumours tend to look different on these tests than do cancerous tumours. Surgeons may order a CT scan, MRI, or scintigraphy (viewing of the location of a tiny amount of radioactive agent) to help locate exactly where the tumour is. The day before surgery, patients will probably have an enema to clear the bowels. In patients with lung problems or clotting problems, physicians may advise special preparations. Some patients may need medications to control the symptoms of the tumour, such as high blood pressure. Drugs such as aspirin, blood thinners, anti-inflammatory medications (arthritis medications) and large doses of Vitamin E will need to be stopped temporarily for several days to a week prior to surgery. |
| After the surgery |
| Once the surgery is completed, you will be taken to a post-operative or recovery unit where a nurse will monitor your progress. You will be scheduled for a follow-up appointment two weeks after the procedure. It is important that your bandages be kept clean and dry. Mild discomfort may occur at the incision site so your surgeon may prescribe pain medication. The laparoscopic method results in less pain than the open-procedure method. After the operation, it is important to follow your doctor's instructions. Although many people feel better in just a few days, remember that your body needs time to heal. Post-operative pain is generally mild and patients may require a pain pill or pain medication. |
| Recovery |
| Patients are encouraged to engage in light activity while at home after surgery. Patients can remove any dressings and shower the day after the operation. Most patients can resume normal activities within one week, including driving, walking up stairs, light lifting, and work. You should call and schedule a follow-up appointment within 2 weeks after your operation. |
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| Benefits and drawbacks |
| In the past, making a large 6 to 12 inch incision in the abdomen, flank, or back was necessary for removal of an adrenal gland tumour. Today, with the technique known as minimally invasive surgery, removal of the adrenal gland (also known as "laparoscopic Adrenalectomy") can be performed through three or four 1/4-1/2 inch incisions. Patients may leave the hospital in one or two days and return to work more quickly than patients recovering from open surgery. |
| Laparoscopic Adrenalectomy can de performed safely in a cost-effective manner. Given the benefits of this minimally invasive technique, the laparoscopic approach is quickly gaining popularity as the treatment of choice for Adrenalectomy. Results of surgery may vary depending on the type of procedure and the patients overall condition. Common advantages are: |
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| Complications and risks |
| As with any operation, there is a risk of a complication. Complications during the operation may include: |
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| For those carefully selected patients who are well-suited for the procedure, people who undergo laparoscopic Adrenalectomy have done much better than those receiving the standard, "open" operations, with a much quicker return to normal activity, a shorter hospital stay, less need for pain medication, and a markedly lower incidence of complications. For more information, kindly visit : http://www.aasthahealthcare.com/Laparoscopic-Adrenalectomy-Treatment.htm ------------------------------------ |
Laparoscopic Splenectomy Surgical Treatment| Laparoscopic Surgery | Aastha Healthcare | Super Speciality Center Hospital | India
| What is Splenectomy? | ||||||||||||||
 Splenectomy means surgical removal of spleen. The spleen is a blood filled organ located in the upper left abdominal cavity. It is a storage organ for red blood cells and contains many specialized white blood cells called "macrophages" (disease fighting cells) which act to filter blood. The spleen is part of the immune system and also removes old and damaged blood particles from your system. The spleen helps the body identify and kill bacteria. | ||||||||||||||
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| What are the Indications for Splenectomy? | ||||||||||||||
| There are several reasons why a spleen might need to be removed, and the following list, though not all inclusive, includes the most common reasons. The most common conditions that warrant Splenectomy in an adult are: | ||||||||||||||
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| How are these problems diagnosed? | ||||||||||||||
| An evaluation typically includes a complete blood count (CBC), a visual look at the blood cells placed on a glass slide called a 'smear', and often a bone marrow examination. Sometimes an ultrasound examination of your spleen, a computerized tomography (CT scan), magnetic resonance imaging (MRI) or nuclear scan is needed. | ||||||||||||||
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| How is it done? | ||||||||||||||
| There are two ways to perform Splenectomy: open or laparoscopic. But not all patients are candidate for open method. Certain conditions like in cases of trauma where intra-abdominal bleeding interferes with the surgeon's ability to visualize the blood vessels, requires open surgery. Spleens which are massively enlarged may also pose a problem for the surgeon because the size of the spleen restricts the visualization and manipulation of the spleen. | ||||||||||||||
| Sometimes the surgeon may decide to convert the laparoscopic surgery to an open procedure in certain situations and for patient safety. Though very infrequent, when conversion to an open technique occurs, it should not be considered a failure of the procedure. In other situations, one of the small incisions may be enlarged some for better handling of the spleen. This is called 'laparoscopically assisted' or 'hand assisted laparoscopic splenectomy' and is particularly helpful in the very large spleens. | ||||||||||||||
| Conventional method or open method | ||||||||||||||
| Traditionally, removal of the spleen has been accomplished using one larger incision. Since the cut is big, it takes more time to heal compared to laparoscopic incision. Open Splenectomy would require hospitalization for 3-7 days and 2-6 weeks for a full recovery. | ||||||||||||||
| Laparoscopic method | ||||||||||||||
| Laparoscopic or minimally invasive approach involves specialized video equipment and instruments that allow a surgeon to remove the spleen through several tiny incisions, versus a traditional large midline incision for an open approach. | ||||||||||||||
| Before the surgery | ||||||||||||||
| After your surgeon reviews with you the potential risks and benefits of the operation, you will need to provide written consent for surgery. Your surgeon may request that you completely empty your colon and cleanse your intestines prior to surgery. You may be requested to drink clear liquids, only, for one or several days prior to surgery. | ||||||||||||||
| The laparoscopic Splenectomy is usually performed with general anesthesia. An IV line will be placed in your arm for fluids and you will be brought into the operating room. The anesthesiologist and nurses will use monitors to check your heart rate and breathing during the procedure. These may include EKG leads, a blood pressure cuff, an oxygen mask and sleeves on your legs to prevent clots from forming. | ||||||||||||||
| During the surgery | ||||||||||||||
| The patient will be placed under general anesthesia. A cannula (hollow tube) is placed into the abdomen by the surgeon and the abdomen will be inflated with carbon dioxide gas to create a space to operate. A laparoscope (a tiny telescope connected to a video camera) is put through one of the cannulas which project a video picture of the internal organs and spleen on a television monitor. Several cannulas are placed in different locations on the abdomen to allow the surgeon to place instruments inside your belly to work and remove the spleen. After the spleen is cut from all that it is connected to, it is placed inside a special bag. The bag with the spleen inside is pulled up into one of the small, but largest incisions on your abdomen. The spleen is broken up into small pieces (morcelated) within the special bag and completely removed. Laparoscopic splenectomy requires three or four small incisions ranging from 1/4 to 1/2 inch. Additionally there is a small incision usually 4-5 cm in length that is used to extract the spleen | ||||||||||||||
| In a small number of patients the laparoscopic method cannot be performed. Factors that may increase the possibility of choosing or converting to the "open" procedure may include obesity, a history of prior abdominal surgery causing dense scar tissue, inability to visualize organs or bleeding problems during the operation. The decision to perform the open procedure is a judgment decision made by your surgeon either before or during the actual operation. When the surgeon feels that it is safest to convert the laparoscopic procedure to an open one, this is not a complication, but rather sound surgical judgment. | ||||||||||||||
| After the surgery | ||||||||||||||
| After surgery you will be given intravenous fluids (IV's) in your arm. You may have a stomach tube coming up out your nose to prevent vomiting or stomach bleeding because your stomach can fill up with stomach juices and not empty properly after this surgery. Not every surgeon uses this tube. You will be given pain medication to relieve the discomfort you may experience from the small incisions. You will need to let your nurse and surgeon know what your pain medication needs are since everyone has a different pain threshold. | ||||||||||||||
| The surgery is done as an overnight stay in most patients. The remaining patients typically go home the following day. Patients can resume light daily activity immediately. Most patients after laparoscopic surgery will experience a sharp shoulder pain that resolves after 2-4 hours. It is important that patients get out of bed and go for a walk as soon as possible (the night of surgery), to improve lung function and decrease the risk of abnormal blood clots. The average patient will require 1-2 weeks recovery before resuming more vigorous activity. There is no forced limitation of activity, instead patients are asked to advance their activity as tolerated. This applies to the resumption of work, sports, and sexual activity. | ||||||||||||||
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| Benefits and drawbacks | ||||||||||||||
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| Results may vary depending on your overall condition and health. Usually laparoscopic method has added benefits. They are: | ||||||||||||||
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| The table given below compares the laparoscopic and open surgery. | ||||||||||||||
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| Splenectomy, either open or laparoscopic, is a safe procedure. But as with any other surgical procedure however, complications may occur. The risk of surgery is also related to the disease process for which the Splenectomy is being performed. As with any other operation involving the abdomen, injury to abdominal organs and tissues is a potential risk. | ||||||||||||||
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| Complications | ||||||||||||||
| Complications following laparoscopic Splenectomy are infrequent, but you should consult your doctor regarding possible complications based on your specific case. Possible complications may include: | ||||||||||||||
http://www.aasthahealthcare.com/Laparoscopic-Splenectomy-Treatment.htm ------------------------------------ | ||||||||||||||
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Minimal Invasive Procedure For Varicose Veins (SEPS) | Laparoscopy Surgery | Aastha Healthcare | Super Speciality Center Hospital | India
| What are varicose veins? |
| The word "varicose" comes from the Latin root "varix," which means "twisted." Any vein may become varicose, but the veins most commonly affected are those in your legs and feet. That's because standing and walking upright increases the pressure in the veins in your lower body. |
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| The veins of the legs are divided into two systems - the deep veins (which run deep to the leathery layer of fascia surrounding the muscles) and the superficial veins (which run in the layer of fat just beneath the skin). The superficial veins are the ones that you can see (for example, on your foot or around the ankle) and they are the ones that can become varicose. It is essential to keep in mind these two different systems - deep and superficial - in order to understand varicose veins and their treatment. In a number of places in the leg, the superficial and deep veins are linked by perforating veins (or 'perforators'). They are called perforators because they perforate the leathery fascial layer surrounding the muscles of the legs. Normally their valves should allow blood to flow only inwards - from the superficial veins to the deep veins. If the valves stop working properly, then blood is pushed out into the superficial veins when the muscles contract: this is one reason for high pressure in the superficial veins, and can be a cause of varicose veins. |
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| The blood in your leg veins must work against gravity to return to your heart. To help move blood back to your heart, your leg muscles squeeze the deep veins of your legs and feet. One-way flaps called valves in your veins keep blood flowing in the right direction. When your leg muscles contract, the valves inside your veins open. When your legs relax, the valves close. This prevents blood from flowing backward. However, when these valves do not function properly, the blood pools, pressure builds up, and the veins become weakened, enlarged, and twisted. This causes varicose veins to develop. Varicose veins develop when one has faulty valves in the veins and weakened vein walls. These veins are twisted, enlarged veins close to the surface of the skin. They usually develop in the legs and ankles. |
| Varicose veins are a common condition, affecting up to 15 percent of men and up to 25 percent of women. Treatment may involve self-help measures or procedures by your doctor to close or remove veins. |
| Which veins become varicose? |
| The long saphenous vein (LSV) |
| This vein and its tributaries are the ones that most often form varicose veins. The long saphenous vein is formed from tributaries in the foot, and is visible in many people when they stand, as the vein just in front of the bone on the inner side of the ankle. It runs up the inner side of the calf and the thigh, and at the groin dives to join the main deep vein (the femoral vein). |
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| The short saphenous vein (SSV) |
| This is the other main vein under the skin of the leg, the tributaries of which can become varicose, but it is affected much less often than the LSV. The SSV starts just behind the bone on the outer side of the ankle, and runs up the middle of the back of the calf. It usually dives to join the main deep vein just above and behind the knee (the popliteal vein), but this varies and before any operation on the SSV it needs to be checked by a scan. |
| Perforating veins |
| In almost any part of the leg, a perforating vein can develop incompetent valves. This allows blood to be pumped outwards under pressure into superficial veins, causing them to become stretched and varicose. |
| Any vein |
| Any vein under the skin, in any part of the leg, can become varicose, without valve problems in the LSV, SSV or perforating veins. These varicose veins are usually quite small and cause few symptoms. |
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| What causes it? |
| Some people may be more likely than others to develop varicose veins and spider veins because of inherited characteristics (genetics), the aging process, or hormone changes. Varicose veins may also result from conditions that increase pressure on the leg veins, for example being overweight or pregnant. Though, the most contributing factor is Hereditary. Women are more likely to suffer from abnormal leg veins. Hormonal factors can affect the disease. It is very common for pregnant women to develop varicose veins during the first trimester. Pregnancy causes increases in hormone levels and blood volume, which in turn cause veins to enlarge. In addition, the enlarged uterus causes increased pressure on the veins. Varicose veins due to pregnancy often improve within 3 months after delivery. However, with successive pregnancies, abnormal veins are more likely to remain. Other predisposing factors include aging, standing occupations, obesity and leg injury. Varicose veins are present in 20-25% of adult females and 10-15% of men. This common condition represents a considerable surgical workload. |
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| What are the symptoms? |
| In varicose veins, symptoms are often worse at the end of the day because more pooling has occurred. Other things which increase pooling and therefore symptoms also include prolonged standing and sitting, exposure to heat (summertime, hot baths) and hormonal factors (pregnancy, around the time of the menses). |
| Varicose veins may be associated with a sensation of heaviness and itching and, in the presence of deep and superficial reflux, cramps and aching. However, all too often generalised aches and pains in the leg may be attributed to visible varicosed veins. Left unchecked, they tend to increase in size and often lead to progressive skin and tissue damage resulting in eczema, lipodermatosclerosis and, in advanced cases, venous ulcers. Lipodermatosclerosis is the medical term that describes damage both to the skin and to the fatty layer beneath it ' |
| Ulcers, when they occur, most often afflict the elderly, blighting their lives with frequent visits to their local surgeries or hospital out-patient departments. Many sufferers complain of aching of the legs, skin itching, ankle swelling, restless legs, night cramps and sleep disturbance. |
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| How is it diagnosed? |
| Varicose veins are arguably the most frequently referred general surgical malady presenting to hospitals. Varicose veins are often caused by an underlying problem in leg vein. |
| General examination |
| First your physician asks you questions about your general health, medical history, and symptoms. In addition, your physician conducts a physical exam. Together these are known as a patient history and exam. Your physician will examine the texture and color of any prominent veins. He or she may apply a tourniquet or direct hand pressure to observe how your veins fill with blood. So the diagnosis is based primarily on the characteristic appearance of the legs when the patient is standing or is seated with the legs dangling. |
| Duplex ultrasound exam |
| At times a physician may order a duplex ultrasound exam of extremity to see blood flow and characterize the vessels, and to rule out other disorders of the legs. Duplex ultrasound uses high-frequency waves higher than human hearing can detect. Your physician uses duplex ultrasound to measure the speed of blood flow and to see the structure of your leg veins. The test can take approximately 20 minutes for each leg. |
| Angiography |
| Rarely, an angiography of the legs may be performed to rule out other disorders. |
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| What are the treatment options? |
| The surgeon first assesses the patient, with a detailed history and physical examination, and confirms the diagnosis and extent by relevant investigations. Not every person with a varicose needs surgery. One needs to discuss the reasons for operating and understand the risks involved. |
| A large proportion of patients may wish surgery for cosmetic reasons or due to anxiety that their disease may progress to chronic venous insufficiency and ulceration. It should be emphasized that varicose vein surgery is not curative, and early surgery in uncomplicated veins will not prevent development of future varicosities. However, it has been shown, that quality of life is reduced in patients with varicose veins compared with the general population, and that this is improved by surgery. |
| Non-surgical methods |
| Varicose veins may sometimes worsen without treatment. Your physician will first try methods that don't require surgery to relieve your symptoms. If you have mild to moderate varicose veins, elevating your legs can help reduce leg swelling and relieve other symptoms. Your physician may instruct you to prop your feet up above the level of your heart 3 or 4 times a day for about 15 minutes at a time. When you need to stand for a long period of time, you can flex your legs occasionally to allow the venous pump to keep blood moving toward your heart. Besides these treatments like compression stockings, sclerotherapy, laser treatments are offered which are non-surgical and the first line of action. |
| Compression Stockings |
| For more severe varicose veins, your physician may prescribe compression stockings. Compression stockings are elastic stockings that squeeze your veins and stop excess blood from flowing backward. Compression stockings also can help heal skin sores and prevent them from returning. |
| Sclerotherapy |
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A chemical irritant can be injected into veins, although large veins are difficult to treat using this method, as the chemical has to physically come in contact with the lining of the target vein for long enough to destroy it. Sclerotherapy works by burning the lining of the vein, which causes the vessel to spasm and block off with clot. The idea is to make the vein shrivel away by scarring. Unfortunately, the clot often clears away, allowing the scarred vessel to open up again. Endovenous Laser Treatment (EVLT) EVLT works by heating the inside of the vein, which causes it to seal shut and disappear. This treatment requires that a very thin laser fiber be inserted into the damaged underlying vein. Tiny electrodes at the tip of the catheter heat the walls of your varicose vein and destroy the vein tissue. As with chemical sclerotherapy, your vein is then no longer able to carry blood, breaks up naturally, and is absorbed by your body. |
| Radiofrequency Occlusion |
| This method treats the vein by heating them, causing the vein to contract and then close. |
| Laser and Pulsed Light Treatments |
| This form of vein therapy involves a light beam that is pulsed onto the veins in order to seal them off, causing them to dissolve. Successful light-based treatment requires adequate heating of the veins. Several treatments are usually needed for optimal results. |
| Ambulatory Phlebectomy |
| This procedure involves making tiny punctures or incisions through which the varicose veins are removed. The incisions are so small no stitches are required. |
| Standard surgical method |
 The most common operation performed for varicose veins is high long saphenous ligation and stripping involving a groin crease incision.To perform vein stripping, your physician disconnects and ties off all major varicose vein branches associated with the saphenous vein, the main superficial vein in your leg. Your physician then removes the saphenous vein from your leg. A procedure, called small incision avulsion, can be done alone or together with vein stripping. Small incision avulsion allows your physician to remove varicose veins from your leg. In a similar procedure called TIPP (Transilluminated Powered Phlebectomy), your physician shines an intense light on your leg to show your veins. Once your physician locates a varicose vein, he or she passes a suction device through a tiny incision and suctions out the vein. Although these procedures sound painful, they cause relatively little pain and are generally well tolerated. Your vascular surgeon will advise you regarding which procedure is the best for your particular situation.. |
| Minimally invasive procedures like SEPS |
| Introduction |
| A few years ago, long incisions had to be made in the calf to gain access to these difficult veins. The dissection was extensive, the complication rates high and recovery prolonged, which may go a long way to explaining the continued reluctance of many surgeons to treat perforators at all. Perforators can now be treated using a camera. These are exciting refinements that have yielded excellent results in this series. SEPS stands for Subfascial Endoscopic Perforator Surgery. SEPS was introduced more than 15 years ago as a minimally invasive alternative to open perforator ligature. This is a specialized minimally invasive procedure performed on patients who suffer with leg ulcers due to incompetent perforator veins. Using tiny incisions and an operating scope, perforator veins are tied off. This results in ulcer healing in the vast majority of patients. |
| SEPS provides excellent visualization of the anatomy of the subfascial plane. Subfascial means under the fibrous tissue beneath the skin, and endoscopic refers to the narrow instrument used to examine the inside of a cavity in the body. It enables introduction of the instruments through skin incisions that are distant from the site of skin changes and carries a low rate of complications. Hence, SEPS is the procedure of choice in the treatment of patients with chronic venous insufficiency. |
| Procedure |
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SEPS is usually performed with two ports of entry into the leg. A special instrument is inserted deep to the fascia of the leg and a large balloon is inflated with water to create a working space. The balloon is then emptied and the space is insufflated with air. The camera is inserted and the perforator veins can be seen in the space passing from superficial to deep layers. Another small incision is made in the calf for passage of another instrument. The perforator veins are carefully dissected, clips are applied and the veins are divided if necessary. Perforating veins are then divided with endoscopic scissors. Metal clips are placed on the cut ends of the vein to avoid bleeding. Another option to interrupt the vein is to use a harmonic scalpel, an instrument that uses ultrasonic waves to seal the cut end of the veins to avoid bleeding. All trocars are then removed and the wounds are closed. The leg is dressed with an ACE wrap. |
| After surgery |
| After surgery, the limb is elevated at 30 degrees for 3 hours, after which walking is allowed. Patients are discharged from the hospital either the same day or the morning after the procedure. After 10 days to 2 weeks, patients may return to work. |
| Recovery |
| The patient is generally sent home the same day of surgery and the ACE wrap can be removed in 48 hours. Recovery from this procedure is rapid with a return to normal function within a week. Walking is permitted throughout this recovery period and pain associated with this procedure is minimal. For those patients who present with leg ulcers, healing of these ulcers is markedly accelerated with the reduction of venous pressure subjected to the skin and ulcer area. |
| Benefits and drawbacks |
| Subfascial endoscopic perforating vein surgery (SEPS) is the treatment of choice. The healing time with SEPS is substantially decreased when compared with conventional treatment and carries low complication and recurrence rates. Conventional surgery of perforating veins requires long skin incisions in order to ligate incompetent perforating veins. As the overlying skin is often atrophic, poorly nourished and frequently affected with skin necrosis, impaired wound healing and wound infection pose considerable problem. |
| Ulcer healing is rapid, and half of the ulcers can be expected to heal within 8 weeks. The wound complication rate is only 5%. At 2 years, 80% of the ulcers stay healed in patients who never had blood clots in the leg but only 54% of those who had blood clots in the leg veins before surgery have no ulcers. And above all minimal hospital stay is required following SEPS. For more information, kindly visit : http://www.aasthahealthcare.com/Minimal-Invasive-Procedure-For-Varicose-Veins-SEPS-Treatment.htm ------------------------------------ |
This form of treatment is a non-surgical procedure in which a solution is injected into the problem varicose veins or spider veins in order to cause its disappearance.
Subfacial Endoscopic Perforator Surgery (SEPS) is a minimally invasive surgical procedure which the doctors use to treat the underlying condition that causes venous ulcers. During the procedure they disconnect the abnormal perforator veins, which cause ulceration because of improperly functioning valves. By disconnecting these veins, they redirect the blood flow to healthy veins. Circulation in the leg is improved, and the ulcer is healed.