Laparoscopic or “minimal Access Surgery” is a highly specialized technique for performing surgery of abdomen. In the past, this surgical technique was commonly used only for gynaecologic surgery, for diagnostic laparoscopy in cases of infertility and for gall bladder surgery. Over the last 10 years the use of this specialized surgical 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 and cannulla is inserted.  Specialized instruments and a special telescope known as a laparoscope are passed through the port during the procedure. At the beginning of the procedure, the patient’s abdomen is inflated with carbon dioxide gas to provide a working and viewing space for the laparoscopic surgeon. The laparoscope transmits images from the abdominal cavity to high-resolution video monitors through a digitally advanced camera system in the operating room. During the operation the surgeon watches detailed images of the abdomen on the high resolution monitor. This system allows the surgeon to perform the same operations as traditional surgery but with smaller multiple incisions.However recently single incision laparoscopic surgery is also evolved.

In certain situations a minimal access surgeon may choose to use a special type of port that is large enough to insert a hand known as Hand Port. When a hand port is used the surgical technique is called “hand assisted laparoscopic surgery". The incision required for the hand port is generally 5.5 cm and hence larger than the other laparoscopic incisions, but is usually smaller than the incision required for traditional surgery.

Advantages of laparoscopic surgery?

Compared to traditional open surgery, patients often experience less pain, an earlier recovery, and less scarring with laparoscopic surgery.

Operations which can be performed using laparoscopic surgery?

Most of the abdominal advanced surgeries can be performed using the laparoscopic technique in experienced hand. These include surgery for gallbladder, duodenal perforation, appendicitis, 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 radical cancer operations. But recently several studies involving hundreds of patients have shown that laparoscopic surgery is safe for certain ­colorectal cancers.

How safe is laparoscopic surgery?

Laparoscopic surgery is as very safe as traditional open surgery. At the beginning of a laparoscopic operation the laparoscope is inserted through a small incision near the umbilicus, Either superior crease or inferior crease of umbilicus. The laparoscopic surgeon initially inspects the abdomen by doing diagnostic laparoscopy 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 is risky and prevent a clear view of the structures the surgeon may need to make a larger incision in order to complete the operation safely by converting laparoscopic surgery into open surgery.

Any intestinal or abdominal laparoscopic surgery is associated with certain risks such as complications related anaesthesia and bleeding or infectious complications. The risk of any operation is determined in part by the nature of the specific operation and hidden risk factor within the patient itself. An individual’s general health and other medical conditions are also factors that affect the risk of any operation. Patient should discuss with your surgeon your individual risk for any operation. World Laparoscopy Hospital, Gurgaon is very reach in this concern because for poor and needy patient surgery is completely free at World Laparoscopy Hospital.

Single incision laparoscopic surgery (SILS) or Single port access (SPA) surgery, also known as laparoscopic endoscopic single-site surgery (LESS), umbilical surgery (OPUS) or single port incision less conventional equipment-utilizing surgery (SPICES) or natural orifice transumbilical surgery (NOTUS), or Embryonic Natural Orifice transumbilical surgery (E-NOTES) is an advanced minimally invasive surgical procedure in which the surgeon operates almost exclusively through a single entry point, typically the patient’s navel. SPA surgical procedures are like many laparoscopic surgeries in that the patient is under general anaesthesia, insufflated and laparoscopic visualization is utilized.The World Laparoscopy Hospital in NCR Delhi is the first hospital in Haryana and only the third in the India to perform a single-port, natural orifice gallbladder surgery through the navel for gallbladder stone disease. During the procedure, surgeons use a single opening in the umbilicus as they manipulate a camera and two laparoscopic instruments to separate the gallbladder from its attachments in the abdomen. The gallbladder is then removed through that same opening. Only a tiny bandage is required to close the navel, and there are no scars.

Single-incision laparoscopic surgery employs the same tools and techniques as conventional laparoscopic surgery and can be used in both men and women. The only difference is a specially-designed port that accommodates the tools.

World Laparoscopy Hospital surgeons have always been leaders in minimally invasive surgery,” says Dr R K Mishra, Director of the World Laparoscopy Hospital and professor of TGO University. “This procedure signals another step forward for our nationally single incision surgery and elevates our efforts to provide the best surgical care while improving patient recovery.”

Dr. Mishra says that single incision laparoscopic surgery should not only for simple surgery like cholecystectomy but should also be used for surgery like donor nephrectomy and for donor who have already decided to give the gift of life and are willing to go through surgery to help a person in need, the possibility of coming through the surgery without scars is a secondary benefit.

The introduction of sophisticated laparoscopic technical equipment in minimally invasive surgery has created new ergonomically and technical problems in the domain of man-machine interaction during laparoscopic operations. Much study has revealed a high incidence of problems with technical problems. The advantage of checklist of laparoscopic instrument in operation theatre is very much and a list has not been studied much before. It is important to determine the effect of a checklist to prevent incidents with technical equipment problems during a routine laparoscopic procedure.

Study was performed to make one effective checklist it was developed and tested during 25 laparoscopic cholecystectomies at Laparoscopy Hospital, New Delhi. A digital video capturing system Sony DV direct was used, consisting of 3 camera images inputs and a microphone. The image of the endoscope, an overview of the operation theatre, and an image of the hands of the surgeon were recorded. The microphone was placed near the laparoscopic equipment and the operation table. After the laparoscopic procedure the videos were thoroughly analysed. Problems with ergonomics and technical equipment such as the CO2 insufflators, electrosurgical apparatus, Video monitors, Xenon light source, Telescope or instruments were registered and compared to the results of 50 laparoscopic cholecystectomies without checklist which was used as control procedures.

Prof. R.K. Mishra performing Laparoscopy

It is very important for every laparoscopic surgeon to make a preoperative checklist. The pre-operative checklist is very easy to make and reduces problem with laparoscopic instruments in the operation theatre.

Laparoscopy.biz is one of the leaders and pioneers in the field of Endoscopic Instrumentation and Equipment. Laparoscopy.biz instruments have been developed in close cooperation with leading surgeons. The entire line of our instruments is completely reusable, uncompromising in quality and durability, simple in operation and maintenance. Our up-to-date manufacturing process, combined with a long tradition in premium workmanship, yields instruments and equipment of the highest quality at the most competitive prices. 

Abdominal laparoscopic surgery gained popularity in the late 1980’s, when benefits of laparoscopic removal of the gallbladder over traditional (open) operation became evident. Reduced postoperative recovery time, markedly decreased post-operative pain and wound infection, and improved cosmetic outcome are well established benefits of laparoscopic surgery, derived mainly from the ability of laparoscopic surgeons to perform an operation utilizing smaller incisions of the body cavity wall.

Laparoscopic procedures generally involve insufflation of the abdominal cavity with CO2 gas to a pressure of around 12 mm Hg. The abdominal wall is pierced and a 5-10 mm in diameter straight tubular cannula or trocar sleeve is then inserted into the abdominal cavity. A laparoscopic telescope connected to an operating room monitor is used to visualize the operative field, and is placed through (one of) the trocar sleeve(s). Laparoscopic instruments (graspers, dissectors, scissors, retractors, etc.) are placed through two or more additional trocar sleeves for the manipulations by the surgeon and surgical assistant(s).

Recently, so-called “mini-laparoscopy” has been introduced utilizing 2-3 mm diameter straight trocar sleeves and laparoscopic instruments. When successful, mini-laparoscopy allows further reduction of abdominal wall trauma and improved cosmesis. However, instruments used for mini-laparoscopic procedures are generally more expensive and fragile. Because of their performance limitations, due to their smaller diameter (weak suction-irrigation system, poor durability, decreased video quality), mini-laparoscopic instruments can generally be used only on selected patients with favorable anatomy (thin cavity wall, few adhesions, minimal inflammation, etc.). These patients represent a small percentage of patients requiring laparoscopic procedure. In addition, smaller, 2-3 mm, incisions may still cause undesirable cosmetic outcomes and wound complications (bleeding, infection, pain, keloid formation, etc.).

Since the benefits of smaller and fewer body cavity incisions are proven, it would be attractive to perform an operation utilizing only a single incision in the navel. An umbilicus is the thinnest and least vascularized, and a well-hidden, area of the abdominal wall. The umbilicus is generally a preferred choice of abdominal cavity entry in laparoscopic procedures. An umbilical incision can be easily enlarged (in order to eviscerate a larger specimen) without significantly compromising cosmesis and without increasing the chances of wound complications. The placement of two or more standard (straight) cannulas and laparoscopic instruments in the umbilicus, next to each other, creates a so-called “chopstick” effect, which describes interference between the surgeon’s hands, between the surgeon’s hands and the instruments, and between the instruments. This interference greatly reduces the surgeon’s ability to perform a described procedure.

Thus, there is a need for instruments and trocar systems, which allow laparoscopic procedures to be performed entirely through the umbilicus while at the same time reducing or eliminating the “chopstick effect”. A laparoscopic procedure performed entirely through the umbilicus, using the laparoscopic instruments and trocar system according to an embodiment of the present invention, allows one to accomplish the necessary diagnostic and therapeutic tasks while further minimizing abdominal wall trauma and improving cosmesis.

Laparoscopy.biz is one of the leaders and pioneers in the field of Endoscopic Instrumentation and Equipment. Laparoscopy.biz instruments have been developed in close cooperation with leading surgeons. The entire line of our instruments is completely reusable, uncompromising in quality and durability, simple in operation and maintenance. Our up-to-date manufacturing process, combined with a long tradition in premium workmanship, yields instruments and equipment of the highest quality at the most competitive prices.

Laparoscopic surgery is particularly known for its technically complex minimal access technique, which calls for operative analysis of laparoscopic instruments for its quality and durability. Many study has been done to investigates the opinion of experts about clinical problems with instruments occurring during laparoscopic surgery.

In one study a questionnaire was used to obtain the opinions of expert laparoscopic surgeons about difficulties experienced operatively using laparoscopic instruments.
 
The laparoscopic surgeons indicated that laparoscopic coagulators were especially prone to cause complications of the gastro-intestinal tract, vascular injuries, and bile duct injuries if they were not of good quality. Dissectors were considered to play a role in the occurrence of solid organ and bile duct injuries, especially if there jaws were not of good quality and retractors are responcible to cause solid organ injuries during splenectomy or nephrectomy. Insufficient functionality of the laparoscopic instruments and insufficient quality of the image produced by defective camera and light source were indicated to contribute to the instrument’s risks.

In one study the questionnaire were uses to asses the effectiveness of instrument and it was identified that technological deficiencies are prone to cause operative complications in laparoscopic surgery. The results provide a basis for the interaction between surgeons and engineers, and serve as pilot information on which to base an in-depth object evaluation of instrument problems can be faound.

For effective and profound analysis of instrumental problem there is a need to develop quality control in minimal access surgery. The govenment should establish the department just like drug and food adminitration so that they can control over the quality of laparoscopic instrument.

All the instrument of Laparoscopy.biz are test for quality and durability by expert laparoscopic surgeons and they are manufactured in state of art setup under quality control of Delhi Laparoscopy Hospital, Pvt. Ltd. Laparoscopy.Biz instruments are regularlu used in laparoscopic surgery and all the surgeons who are using this instrument are very much satisfied with the laparoscopic instruments.