Next.
1. Which hopsital to go ?
2. Which surgeon for laparoscopic surgery ?
3. What to ask ?
4. What to expect ?
5. Where to do some research to see for yourself ?
6. How to recover from a laparoscopic surgery ?
7. When to start walking, running, swimming, biking, sexual activity etc ?
Wednesday, October 31, 2007
C. Hospital Facility Factors
1. Lack of adequate operating facility and instruments
The set up of an operating room for laparoscopic surgery can be costly. Basic laparoscopic equipment allows basic laparoscopic surgery. Therefore for more advance laparoscopic cases, the hospital must be willing to invest on good laparoscopic equipment for patient safety.
2. Lack of training supportive personnel.
This is especially truth when caring for patient with morbid obesity.
The set up of an operating room for laparoscopic surgery can be costly. Basic laparoscopic equipment allows basic laparoscopic surgery. Therefore for more advance laparoscopic cases, the hospital must be willing to invest on good laparoscopic equipment for patient safety.
2. Lack of training supportive personnel.
This is especially truth when caring for patient with morbid obesity.
Monday, October 29, 2007
Pictures of Incisions used for traditional open versus laparoscopic surgery
The incisions here are represented by th red dotted lines.
The picture of the left represent a classical midline incision and a left subcostal insicion.
The picture on the right represent a incisions used by laparoscopic approach. Usually it has three or more small ( less than 10 to 12 mm each) incision.
Some argue that the combination of these small incisions in lenght may be approximate the a large open incisions. Therefore, outcome should be quite similar. This statement is NOT TRUTH. As mentioned, post operative pain is less, complications is less, patients ambulate earlier, start oral intake ealier and likely to be dismissed from the hospital earlier.
The picture of the left represent a classical midline incision and a left subcostal insicion.
The picture on the right represent a incisions used by laparoscopic approach. Usually it has three or more small ( less than 10 to 12 mm each) incision.
Some argue that the combination of these small incisions in lenght may be approximate the a large open incisions. Therefore, outcome should be quite similar. This statement is NOT TRUTH. As mentioned, post operative pain is less, complications is less, patients ambulate earlier, start oral intake ealier and likely to be dismissed from the hospital earlier.
Sunday, October 28, 2007
B. Physician Factors
1. Lack of Adequate Training
The minimally invasive surgical technique started in 1991-1992 with laparoscopic gallbladder removal. Since the success of that operation, more than 90% of the gallbladder is now removed via minimally invasive technique. A more structural training for general surgery resident was not available until very recently. In fact for more advanced laparoscopic surgery (i.e laparoscopic esophageal surgery, laparoscopic liver and pancreas surgery etc), many general surgery resident has undertake an extra 1 or 2 years of training or so called the “ fellowship”. During the fellowship, they are properly supervised and taught by the respective authority in the field.
Therefore, it is possible that some of the general surgeons may not have the exposure to the minimally invasive surgery to allow to them to gain experience. Certain general surgeons, however, do engage in active learning and has acquired the necessary skill to perform these operations.
2. Lack of data to support the outcome of minimally invasive surgery.
This statement could have been truth 4 or 5 years ago. Many excellent surgical centers who had engaged in clinical study have subsequently answered the safety questions. Studies showed not only this minimally invasive technique are safe but is in fact more beneficial to the patients (as mentioned in previous page).
Laparoscopic surgery or minimally invasive surgery is SAFE in experienced hand.
3. Do not have the time.
No doubt that laparoscopic operation can be very time consuming, especially when they are at their learning curve. An open colectomy that usually take 1 to 2 hours to perform can takes up to 3 to 4 hours to perform. Despite the longer operating time, the recovery time for patient after the operation is certain much shorter and the risk of post operative complications is equally lowered as well
The minimally invasive surgical technique started in 1991-1992 with laparoscopic gallbladder removal. Since the success of that operation, more than 90% of the gallbladder is now removed via minimally invasive technique. A more structural training for general surgery resident was not available until very recently. In fact for more advanced laparoscopic surgery (i.e laparoscopic esophageal surgery, laparoscopic liver and pancreas surgery etc), many general surgery resident has undertake an extra 1 or 2 years of training or so called the “ fellowship”. During the fellowship, they are properly supervised and taught by the respective authority in the field.
Therefore, it is possible that some of the general surgeons may not have the exposure to the minimally invasive surgery to allow to them to gain experience. Certain general surgeons, however, do engage in active learning and has acquired the necessary skill to perform these operations.
2. Lack of data to support the outcome of minimally invasive surgery.
This statement could have been truth 4 or 5 years ago. Many excellent surgical centers who had engaged in clinical study have subsequently answered the safety questions. Studies showed not only this minimally invasive technique are safe but is in fact more beneficial to the patients (as mentioned in previous page).
Laparoscopic surgery or minimally invasive surgery is SAFE in experienced hand.
3. Do not have the time.
No doubt that laparoscopic operation can be very time consuming, especially when they are at their learning curve. An open colectomy that usually take 1 to 2 hours to perform can takes up to 3 to 4 hours to perform. Despite the longer operating time, the recovery time for patient after the operation is certain much shorter and the risk of post operative complications is equally lowered as well
A. Patients Factors
1. Patient can not tolerate general anesthesia
It is essential that a patient is under general anesthesia for laparoscopic operations.
2. Patient body habitus
In many cases, patients that is has morbid obesity, laparoscopic operation is quite technically challenging to perform. Except when the laparoscopic operation is performed for weight lost. For example: Laparoscopic insertion of adjustable gastric banding system, laparoscopic sleeve Gastrectomy and laparoscopic RNY gastric by pass)
3. Patient had many previous abdominal operations
Many previous operations may have generated significant amount of scarring or so called adhesions. These increase the challenge of creating a “working space” within the abdominal cavity. These certainly will make the operation longer and perhaps increase the risk of iatrogenic injury to the internal organ. Some experience laparoscopic training surgeons are still willing to offer the minimally invasive approach to the patient knowing that should he/she encounter difficulty, the conduct of the operation will be changed to a traditional open approach.
It is essential that a patient is under general anesthesia for laparoscopic operations.
2. Patient body habitus
In many cases, patients that is has morbid obesity, laparoscopic operation is quite technically challenging to perform. Except when the laparoscopic operation is performed for weight lost. For example: Laparoscopic insertion of adjustable gastric banding system, laparoscopic sleeve Gastrectomy and laparoscopic RNY gastric by pass)
3. Patient had many previous abdominal operations
Many previous operations may have generated significant amount of scarring or so called adhesions. These increase the challenge of creating a “working space” within the abdominal cavity. These certainly will make the operation longer and perhaps increase the risk of iatrogenic injury to the internal organ. Some experience laparoscopic training surgeons are still willing to offer the minimally invasive approach to the patient knowing that should he/she encounter difficulty, the conduct of the operation will be changed to a traditional open approach.
Why a patient is not offer the laparoscopic surgery ?
Once the disease process dictate an operation for a cure, there are usually a number of reasons why these laparoscopic or minimally invasive surgery is not offer to patients. This can be divided into patients, physician and hospital facility factors. However, by far the commonest reason reported is physician factors.
The main reason for laparoscopic surgery not beening offer in Eugene, Oregon is Physician Factor !
The main reason for laparoscopic surgery not beening offer in Eugene, Oregon is Physician Factor !
Type of Minimally Invasive Surgery or Laparoscopic Surgery, Eugene, Oregon
Type of Minimally Invasive Surgery or Laparoscopic Surgery in Eugene, OR
The common question should be asked by every patient that may need abdominal operation is “Doctor! Can my operation be done laparoscopically?”
The lists of laparoscopic surgery that can be performed in the United States are as below. Of note, all these laparoscopic operation are available in Eugene, Oregon! Further details and pictures for each operation will be described in detail in the subsequent pages
A. Gastrointestinal System
1. Laparoscopic Esophageal Resection (Esophagectomy), Fundoplication, Myotomy
2. Laparoscopic Stomach Resection (Gastrectomy), Banding, G-tube insertion
3. Laparoscopic Small Intestine Resection, J-tube insertion
4. Laparoscopic Liver Resection (Hepatectomy), radiofrequency ablation (RFA)
5. Laparoscopic Pancreatic Resection (Pancreatectomy)
6. Laparoscopic Large Bowel Resection (Colectomy)
7. Laparoscopic Ilea-anal Pouch Reconstruction.
8. Laparoscopic Appendix Removal (Appendectomy)
9. Laparoscopic Gallbladder Removal (Cholecystectomy)
10. Laparoscopic weight lost surgery (Laparoscopic insertion of adjustable gastric banding system, laparoscopic sleeve Gastrectomy and laparoscopic RNY gastric by pass)
B. Endocrine System
1. Laparoscopic Adrenal Gland Removal (Adrenalectomy)
C. Urological System
1. Laparoscopic Nepherectomy
2. Laparoscopic Prostatectomy
D. Gynaeocology
1. Laparoscopic Removal of Uterus (Hysterectomy)
2. Laparoscopic Removal of Ovary (Oophorectomy)
Laparoscopic Surgery or Minimally Invasive Surgery in Eugene
It is true that minimally invasive surgery or so called laparoscopic surgery is currently available in Eugene Oregon.
Definition:
Instead of a traditional large incision surgeon used to make to operate in the abdominal and chest cavity. Surgeons now can use much smaller incisions to operate in the same cavity and achieving similar results. That is why it is called minimally invasive surgery.
Other terms:
Laparoscopic surgery applied to minimally invasive surgery in the abdomen cavity.
Thoracoscopic surgery applied to minimally invasive surgery in the chest (also called thoracic) cavity
Advantages of Minimally Invasive Surgery or laparoscopic surgery:
1. Smaller incisions mean less postoperative pain and wound complications (i.e.: infection and dehiscence)
2. Shorter hospital stays
3. Earlier recommence of oral intake
4. Cosmetically excellent
5. Less long terms side effect (less chances of adhesions, bowel obstruction and ventral hernia)
Disadvantages of Minimally Invasive Surgery or Laparoscopic Surgery:
1. Surgeon needs extra years of proper training in order to minimize complications due to technical error. These complications can be significant and therefore, it is essential that the surgeon is comfortable with this new technique and know their limits.
Definition:
Instead of a traditional large incision surgeon used to make to operate in the abdominal and chest cavity. Surgeons now can use much smaller incisions to operate in the same cavity and achieving similar results. That is why it is called minimally invasive surgery.
Other terms:
Laparoscopic surgery applied to minimally invasive surgery in the abdomen cavity.
Thoracoscopic surgery applied to minimally invasive surgery in the chest (also called thoracic) cavity
Advantages of Minimally Invasive Surgery or laparoscopic surgery:
1. Smaller incisions mean less postoperative pain and wound complications (i.e.: infection and dehiscence)
2. Shorter hospital stays
3. Earlier recommence of oral intake
4. Cosmetically excellent
5. Less long terms side effect (less chances of adhesions, bowel obstruction and ventral hernia)
Disadvantages of Minimally Invasive Surgery or Laparoscopic Surgery:
1. Surgeon needs extra years of proper training in order to minimize complications due to technical error. These complications can be significant and therefore, it is essential that the surgeon is comfortable with this new technique and know their limits.
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