Laparoscopic surgery

Laparoscopic surgery ( from Ancient Greek λαπάρη lapare the course, σκοπεΐν skopein consider ) is a subspecialty of surgery, the surgery within the abdominal cavity are made with the help of an optical instrument. It is associated with the complex minimally invasive surgery (MIS ).

Methods

Laparoscopy, also called laparoscopy refers to a method in which the abdominal cavity and the organs lying therein are made with special rod-lens optics ( rigid endoscopes ) visible through small openings created by the surgeon in the abdominal wall. About a 0.3-2 cm long incision, a trocar is inserted into the abdomen, the abdomen can be viewed by the then using a special endoscope ( laparoscope ) that is connected to a video camera and a light source. In a diagnostic laparoscopy after the inspection of the abdominal cavity, the instrument is again removed and the abdominal wound with stitches. In a surgical procedure also 0.3-2 cm skin incisions are further introduced additional tools with which the operation can be performed.

In the conventional method, first the abdomen is filled with gas until a pneumoperitoneum is created. This can be done by different methods. One of them is that with a surgical scalpel, a small skin incision is made around the navel ( in part because there the abdominal wall is thinnest and the distance to the abdominal organs largest). After that is pierced only so far with a special insufflation ( Veres needle or Veres needle ) the abdominal wall that eventually their blunt point at which the insufflation is freely located in the abdomen. Now, connected to the Veress needle insufflation of the hose and the abdomen with carbon dioxide (CO2) are so far "pumped " that a kind of " work and study space " is created. The insufflation cannula is removed and a trocar is inserted "blind". About this trocar, the laparoscope is then introduced. Thus the Intraabdominalraum can be considered.

This space ( Intraabdominalraum ) must be made ​​available for an endoscopic surgical now still. For this purpose, depending on the nature of the planned intervention, as already described above, made ​​more small incisions in the abdominal wall, are introduced through which gas-tight seal trocar sleeves and securely anchored. With this in technical jargon " Trokarzugänge " called " keyhole openings " may the endoscope and surgical specialties instruments by the surgeon or the assistant be operated manually. In this method, side effects may like shoulder pain due to irritation of the phrenic nerve can occur.

In an alternative, less widely used method of gasless laparoscopy, the abdomen is lifted mechanically by means of a lift- system. Here, the patient should have a variety of advantages over the CO2 method: The pain after surgery should be much shorter (especially the manner customary for the gaseous laparoscopy shoulder pain ), and recovery after surgery reduced in time. In addition, the cost of treatment to be reduced.

Laparoscopic surgery

The following procedures can be performed laparoscopically:

• General surgery Emergency laparoscopy for abdominal trauma
• Findings are ambiguous
• Studies in cancer patients
• Liver resection
• Further diagnosis of various diseases of all the organs of the abdominal cavity
• Vagotomy
• Gallbladder removal ( cholecystectomy)
• Appendectomy ( appendectomy ) Laparoscopic appendectomy
• Part of the intestine distances: sigmoid
• Rectal resection
• Rectopexy
• Ileocecal resection
• Colostomy

• Treatment of hiatal hernia
• Suturing with perforated gastric ulcer
• Gastrectomy
• Fundoplication ( anti- reflux surgery)
• Gastroenterostomy
• Interventions for morbid obesity: gastric banding

• TAPP - transabdominal preperitoneal
• TEP - Total extraperitoneal

• Gynecology Laparoscopic Hysterectomy Laparoscopic myomectomy Removal of fallopian tube and ovary
• Treatment of endometriosis
• Treatment of ectopic pregnancy
• Fimbrioplastik
• Treatment of hydrosalpinx
• Hysterectomy
• Retroperitoneal lymph node dissection
• Treatment of fibroids, myomectomy
• Ovariectomy
• Sterilization
• Clarification of sterility by chromopertubation
• Treatment of stress incontinence
• Removal of ovarian cysts

• Pediatric Surgery ( In addition to the above procedures ): pyloromyotomy

• Radical prostatectomy
• Nephrectomy
• Pyeloplasty
• Harnleiterplastik
• Adrenalectomy
• Retroperitoneal lymphadenectomy
• Varicocele surgery

Even laparoscopic tumor operations are performed by default now in Germany. (Sources: see for example, the website of the Charité Berlin). For example, a study in laparoscopic resection of colorectal cancer results equivalent to the open procedure in gentler OP for the patient.

History

The first laparoscopy in humans - a diagnostic laparoscopy - was founded in 1910 by the Swede Hans Christian Jacobaeus ( 1879-1937 ) performed after the Dresden Georg Kelling ( 1866-1945 ) had in 1901 carried out a laparoscopy in a dog. In the 1930s, for the first time were also therapeutic laparoscopies, performed primarily by gynecologists. The first laparoscopic appendectomy was held at the University Hospital Kiel in 1980 by the gynecologist Kurt Semm ( 1927-2003 ). The first laparoscopic gallbladder removal via a Galloskop ( one-pipe technology) in 1985 conducted by the Böblingen surgeon Erich Mühe, who, however, with his technique in the literature found no appreciation. The first laparoscopic Gallenblasenentferung several additions, as it is common today, taken in 1987 by the French surgeon Phillipe Mouret ( born 1937 ), 1989, the first hernia operation by D. Bogojavlensky, 1991, the first colon surgery by John Monson. In 1998 came the introduction of Lift-Laparoscopy with the Abdo - lift ( new concept of gasless laparoscopy) by Daniel Kruschinski.