Minimally invasive surgery takes advantage of fiberoptic technology which allows the introduction of tiny cameras into the abdomen or other body cavities so that surgeries can be performed with minimal trauma to the abdominal wall, thus providing faster recovery, less pain, shorter hospital stay and lower risk of infection and hernias. Gynecologists frequently use this for examination of the uterus and ovaries. Orthopedic surgeons use these instruments for inspecting cartilage damage in joints. General surgeons and thoracic surgeons have now developed the technology for surgery in the abdomen and chest. The laparoscope, which has a camera attached, is inserted through a small incision to send images to the video screen from which the surgeon works. Small surgical instruments that are thinner than a straw and approximately 1 1/2 feet long, are inserted through other incisions as working ports. The abdomen is inflated with carbon dioxide, which is removed at the completion of the operation. (These operations historically involved lasers, hence the name "Laser Surgery". However, the risk of injury using lasers was found to be too high, without added benefit to the patient. Therefore, conventional cautery and state-of-the-art ultrasonic coagulators are now utilized.) The use of several small incisions instead of a single long one has resulted in much higher patient satisfaction, comfort and better cosmetic result. All of the below stated procedures are successfully performed at Kishwaukee Community Hospital under the care of the DeKalb Clinic surgeons.
In the United States, approximately 20% of the population has gallstones. Only 20% of those individuals have symptoms. Once an attack has occurred, it is highly recommended that the patient have the gallbladder removed in order to prevent subsequent problems such as pancreatitis, yellow jaundice, or infection. Gallbladder surgery is done using laparoscopic equipment by placing a small camera through the bellybutton and three other holes, called "ports". The gallbladder can be removed this way over 95% of the time. The DeKalb Clinic surgeons have been able to maintain this national average. (For more information, please see the "GI file". This will cover gallbladder attacks in more detail.) Many patients after gallbladder surgery are able to return home the same day and return back to work in 7-10 days, although infrequently two weeks is required.
This is the newest use of this equipment. The large and small intestine as well as small portions of stomach can be removed using this approach with excellent results. Dr. Jack Wagoner and Dr. Roger Maillefer have accomplished training in this area and have successfully performed these procedures locally. The end result requires a 2-inch incision in the left lower quadrant to remove the specimen. These patients do very well and again, return to work in approximately two weeks (compared to the average of six). They are also in the hospital for only 3-4 days (versus 7-10). This approach is ideal for diverticulitis, polyps in which malignancy cannot be ruled out, and even some cancers can be removed this way.
Appendicitis occurs secondary to inflammation of the appendix, which is located in the right lower quadrant. This can be removed using the laparoscope with a camera through the bellybutton and a small one down by the pubis and one other small hole in the right flank. The indications for this procedure are typically in females in which ovarian pain versus appendicitis cannot be ruled out. At the time of the operation, appendicitis in encountered and can therefore be removed in this fashion. Recovery is approximately the same versus the open technique.
Hernias develop in several places. The most frequent are inguinal (groin) hernias followed by umbilical (bellybutton) hernias, and then incisional hernias. All of these have been repaired locally using state-of-the-art techniques and equipment. With umbilical and incisional hernias, the recurrence rate after laparoscopic repair is reported to be less than 5% versus, in some studies, as high as 25-40%. Inguinal surgery is performed using three small incisions to introduce a mesh behind the defect in the groin. (The recurrence rate of inguinal hernias is approximately the same when comparing laparoscopic to open techniques). Our experience at the DeKalb Clinic would suggest that this is less painful than a traditional open repair. Return to work is as fast, if not faster, than a traditional repair.
A patient who has failed to improve their reflux symptoms on medicine, can undergo laparoscopic surgical repair of their reflux disease. This is performed after appropriate screening and requires an overnight stay in the hospital. The operation lasts 1-2 hours. This can be completed laparoscopically over 95% of the time. The stomach is wrapped around the esophagus and securely tied to itself with permanent sutures. In addition, the diaphragm is tightened to close off any chance of an hiatal hernia. Symptom relief is immediate and successful in 100% of the patients. The long-term results suggest a 90% symptom-free relief at 10 years. Because small holes are used, the chance of incisional hernias is rare. The DeKalb Clinic surgery department has successfully completed over 100 cases.
Occasionally, individuals with sick spleens, usually from a form of leukemia, can have their spleens removed laparoscopically. The benefits of this technique are the same as those mentioned above with regards to less pain, faster recovery, faster return to work.
Individuals who have had a spontaneous hole in the lung which fails to seal on its own or if there is a question of a mass in need of biopsy, 3 small holes can be made in the chest wall to allow for a small camera. Then, the area of concern can be stapled off. This usually requires 3 days in the hospital to recuperate and to monitor the lung for healing. Return to work is generally in 1 week (versus the old-fashioned approach of a 1 foot incision which requires 5-7 days in the hospital and 4-6 weeks off of work). A chest tube is left in the chest cavitiy after surgery for 2-3 days to assist the lung in re-expanding. Often, a night in the Intensive Care Unit is required.