Minimally Invasive Surgery, Department of Surgery

General Information - Disease and Procedures

inimally Invasive Surgery represents nothing less than a revolution in surgical practice and technology. Compared with traditional open surgery, minimally invasive procedures result in less tissue trauma, less scarring, and faster postoperative recovery time. Although the techniques vary from procedure to procedure and among different surgical subspecialities, all minimally invasive surgical procedures employ video cameras and lens systems to provide anatomic visualization within a region of the body.

Achieving such visualization requires the creation and maintenance of an optical cavity, most commonly created with carbon dioxide insufflation. Using short incisions in the skin, narrow tubes are inserted through the abdominal wall so that instruments can be slid through them to perform the maneuvers necessary for the operation. All this is viewed directly on a video monitor which receives its picture from a video camera attached to the laparoscope. Video cameras and specialized surgical instruments can be inserted through small access incisions in the skin and utilized within the optical cavity for the removal or repair of an organ system.

Using these cutting-edge techniques and with the advent of specialized state-of-the-art instruments, surgery to the gallbladder, stomach, and intestines has become commonplace.

Benefits
The advantages of laparoscopic surgery come from minimizing the trauma of access to internal organs. By avoiding a long incision through the muscles, many postoperative problems are eliminated, and pain is markedly reduced. This enables you to breath and cough better. Use of strong pain medications is drastically reduced so the drowsiness, fatigue, and unsteadiness they cause is minimized.

Risks
All surgery carries some risk. Those risks that are the most important for you to know about are mentioned here.

Most of the complicated laparoscopic procedures that we perform require full general anesthesia to allow enough relaxation of the muscles of the abdominal wall so that the operative space to work in is large enough. Modern anesthesia is very safe, and the anesthesiologists at Mount Sinai are all highly-skilled board certified physicians. Naturally they will need to be fully informed of any medical disorders that you may have or problems with anesthesia in the past. It is especially important that if you have any heart problems your regular physician send copies of old EKGs and information about any other tests that you may have had.

Any operation can be complicated by bleeding and infection. If an operation has been performed through a large incision, a hernia (or muscle defect) can develop in the wound days, months, or years later. Thrombosis and pulmonary embolus (clots to the lungs) are an ever present risks. It has been our experience that these complications are much less frequent after laparoscopic than conventional surgery.

Even in traditional surgery, each operation has a specific complication that every surgeon strives to avoid. These potential pitfalls are still present when the operation is performed laparoscopically and will be outlined to you, depending on the type of procedure you require.

Occasionally, difficulties are encountered during surgery that cannot be safely managed laparoscopically. This may be suspected before the operation and confirmed with the laparoscope. If so, conversion to a conventional procedure is for your safety.

Alternatives
Most patients come to us for laparoscopic surgery, although we have an extensive background in traditional surgery. Much of the discussion of alternative forms of treatment will have taken place before you come to see us. If we feel that your best interests will not be served by laparoscopic surgery, we will tell you so and suggest an appropriate alternative.

What to expect after your surgery
As early as the evening following surgery, you should be able to sit in a chair or even walk around your bed. You will be expected to go to the bathroom and back to bed with minimal assistance. After many types of surgery, you will be drinking clear liquids immediately, and you will advance to a light regular diet the next day.

The need for pain medication varies a lot from person to person, but usually after a few doses of a strong agent like Percocet, it will be possible to control discomfort with Tylenol or equivalent. Prolonged use of narcotic analgesics (such as Percocet or Tylenol with codeine) should be avoided, as they cause severe constipation, which may be more distressing than the discomfort being treated.

Avoid driving a car if there is any abdominal soreness that may prevent you from reacting quickly in an emergency, or if you are still taking strong painkillers.

You will return home with adhesive tape on your wounds. It is quite safe to shower with the adhesive tape. Leave it be till you are seen in the office again. Dissolving stitches are usually used, so there is nothing to remove except the tape. It is normal for a painless, firm bump to develop under each scar. These bumps just indicate sound healing and disappear in about two months.

You are encouraged to return to normal activities as soon as possible. It is vital that you get as much reasonable exercise as you can tolerate in the early postoperative period to stimulate the circulation and breathing. It is very difficult to disrupt any of the surgery, so do not be afraid that you will do yourself harm.

Diseases and Procedures