In 1987, the world’s first laparoscopic surgery was successfully performed, ushering in a new era of minimally invasive surgery. Because of the advantages of laparoscopic surgery, such as small trauma, fast recovery, beautiful wound and low incidence of postoperative intestinal adhesions, laparoscopic surgery was rapidly accepted by surgeons and patients, and has rapidly emerged around the world in less than 10 years. At present, laparoscopic surgery has gradually developed from gallbladder removal to radical resection of gastric and intestinal tumors and even pancreatic tumors, gradually replacing traditional open surgery.
Laparoscopic repair of adult hernia – reducing the recurrence rate of hernia
Hernia, commonly known as “small intestine pneumonia”, is a common disease whose main cause is a weak or defective abdominal wall. When the pressure in the abdominal cavity increases, the organs in the abdominal cavity protrude outward from the weak or defective area to form a hernia, and repairing the weak or defective abdominal wall becomes the fundamental treatment.
Traditional inguinal hernia repair uses its own tendon tissue to repair the defect, but the incision is large, the long-term postoperative pain rate is high, and there is a suspicion of “tearing down the east wall to repair the west wall”, so the recurrence rate is high. The common tension-free hernia repair, which uses artificial material (patch), has reduced the recurrence rate, but the problems of large incision and postoperative pain remain unresolved, and some patients also experience foreign body sensation under the incision. Laparoscopic tension-free hernia repair has the advantages of less trauma, less pain, faster recovery, shorter hospital stay, no restriction of physical activity after surgery, and lower recurrence rate, which completely solves the drawbacks of traditional surgery.
Surgery fact 1: 40-year-old Ms. Huang had found a left inguinal mass for half a year, which protruded after exercise but disappeared after lying down. It was only 10 days before the Chinese New Year, but the pain at the mass suddenly started, which made Ms. Huang feel anxious. After the consultation with Director Xie Song, Ms. Huang was relieved to learn that minimally invasive surgery could be done for her hernia.
On February 3, 10 days before New Year’s Eve, Director Xie Song performed laparoscopic hernia repair surgery on Ms. Huang. After three small 0.5-1 cm incisions were made in her abdomen, the location of the protruding hernia was clearly revealed through the laparoscope, and the hernia sac was skillfully peeled off with laparoscopic instruments, the abdominal wall defect was repaired with artificial materials, and the surgery was quickly completed with peritoneal coverage. The operation was quickly completed after covering with peritoneum. Ms. Huang was able to get out of bed on the day of surgery and was discharged from the hospital 4 days after surgery, and was able to fully perform her “housewife’s role” during the Spring Festival. Three months after the surgery, if you don’t check carefully, the three small incisions on the belly are almost invisible.
The surgery was performed on both sides, leaving a centipede-like scar about 12 cm long on both sides of the lower abdomen, and the scar was still painful 3 months after the surgery, and he did not dare to move around. Unfortunately, the left side recurred more than half a year after the surgery, and the hernia came out as soon as I got up and walked, so I had to lie down and press it back with my hands. In March this year, the helpless Uncle He was referred to Xie Song, the director of hospitalization.
After he was hospitalized, Director Xie Song decided to use laparoscopic surgery in order to reduce the possibility of recurrence. During the operation, it was found that the original surgery on the left inguinal region of Uncle He had only repaired a hiatal hernia, but now the protrusion was a straight hernia. After the cause of recurrence was clarified, Director Xie used a large patch and repaired the defect laparoscopically. Five days after the operation, Uncle He was discharged from the hospital and said that the pain of this operation was negligible compared with the last one, and that there was no need to remove stitches and almost no restriction on postoperative activities.
Surgery fact 3: 65-year-old Uncle Miao had a right inguinal hernia for more than 5 years. At first, he only felt a cramp in his right groin, but afterwards the hernia mass came out and the cramping feeling became heavier and heavier, and the prolapsed object was as big as a child’s fist. He was diagnosed with a right inguinal hernia at several hospitals, and surgery was recommended, but Miao had second thoughts about surgery.
At the beginning of May, Mr. Miao found Director Xie Song, and after examination, it was found that Mr. Miao might also have a hernia in his left inguinal area, and considering that laparoscopic surgery could repair both hernias at the same time, laparoscopic surgery was recommended. During the operation, it was confirmed that both sides of Mr. Miao had hernias, and in addition to the straight hernia, there were also two occult hernias – hiatal hernia and femoral hernia – on the right side, so the bilateral repair of four hernias was completed simultaneously under laparoscopy. When he was discharged from the hospital, Mr. Miao repeatedly thanked Director Xie Song for his excellent technique and his “wise eye” in detecting multiple hernias on both sides and avoiding the pain of reoperation.
Director Xie Song said: For adult hernia repair, many patients always think that traditional open surgery is more intuitive than laparoscopic surgery and the repair results will be better. In fact, this is not true. The three cases mentioned above reflect the advantages of minimally invasive treatment from different aspects, which can be summarized as the following four points.
First, the recurrence rate is low. In clinical practice, it is often found that some patients have two or more abdominal wall defects in the inguinal region at the same time. If conventional surgery is performed, an incision of about 8 cm has to be made in the inguinal region, and then the abdominal wall is incised layer by layer to look for the hernia sac, so the field of vision is blurred and it is difficult to find out how many abdominal wall defects there are, and it is easy to miss the repair. In contrast, laparoscopic surgery not only has less bleeding, but also has the function of magnifying the field of view, which can clearly understand the abdominal wall defects for repair. Therefore, the recurrence rate after surgery will be significantly reduced.
Second, bilateral hernia can be repaired at the same time. For bilateral hernia repair, if the abdominal wall defect is large, the traditional surgery needs to be done in two separate operations, which is more traumatic for the patient. In addition, 10-20% of hernia patients also have contralateral “occult” hernia, as in the case of Uncle Miao, which cannot be detected by traditional surgery, and when one side is repaired the hernia protrudes to the other side of the weakness and forms another contralateral hernia, often requiring another operation. In contrast, laparoscopic surgery can clearly detect a hidden hernia on the opposite side that is usually missed without an attack, and it can solve bilateral hernias at the same time in one operation.
Third, there is no obvious scar after surgery, which is safe and aesthetically pleasing and does not disrupt the normal inguinal canal anatomy. At the same time, because of the deep placement of the patch, there is almost no postoperative discomfort, whereas traditional tension-free hernia mesh repair often produces discomfort in the groin.
Fourth, the minimally invasive procedure is safe and recovery is rapid. Normal movement can be resumed the day after surgery, and there is no need to remove stitches, and the patient can be discharged from the hospital in about 5 days.
Laparoscopic appendectomy–reducing the incidence of postoperative complications
Although appendicitis has a high incidence and is considered a minor operation in abdominal surgery, it is characterized by a high rate of misdiagnosis and complications such as wound infection, which often leads to “big problems from small operations” in clinical practice. The use of laparoscopic surgery for the appendix can greatly reduce the incidence of postoperative complications.
The surgery: Last summer, 21-year-old Xiaojun had completed the surgery to study abroad, but just 10 days before she left the country, she suddenly developed pain in her lower abdomen, and the doctor diagnosed acute appendicitis and recommended surgery. When they heard about the surgery, Xiaojun’s parents were worried. If they opted for surgery, they were afraid that their trip would be delayed. If they took the risk of conservative treatment, surgery would definitely delay their trip if the treatment failed, and there was a possibility of recurrence in the future.
When he was indecisive about whether or not to operate, the doctor suggested laparoscopic surgery to shorten the recovery period, so he immediately contacted Dr. Xie Song, a specialist in minimally invasive general surgery. On the second day after admission, Director Xie Song operated on Xiaojun. After making a small incision of about 1cm at the umbilicus and a small hole in the abdominal wall, the appendix was successfully removed laparoscopically in only half an hour. Four days after the operation, Xiaojun was discharged from the hospital. When he was discharged, Xiaojun kept “showing off” his luck in front of his classmates that he did not leave a long “centipede-like” scar on the abdominal wall like other appendicitis surgeries, and did not delay his trip abroad.
Director Xie Song said: Traditional appendectomy can also make the incision small, but when it comes to obesity, unclear diagnosis or difficulty in finding the appendix, due to limited exposure of the surgical field, it is not possible to conduct a comprehensive investigation to make a clear diagnosis, and during the operation, it is necessary to pull and separate, thus increasing the possibility of intestinal adhesions. Laparoscopic surgery overcomes the drawbacks of traditional appendectomy and allows comprehensive exploration of the abdominal and pelvic cavities and timely treatment of lesions found, greatly improving the diagnosis and cure rate of acute abdominal disease, with small incisions and low infection rates.
Laparoscopic “three-hole” method of gallbladder removal–reducing trauma and pain
When one thinks of laparoscopic surgery for gallbladder stones, one immediately thinks of a “hole” (usually four “holes” are made in hospitals) surgery. However, Director Xie Song performs laparoscopic cholecystectomy, which requires only 3 small “holes” in the abdomen, with the same treatment effect and significantly less pain and trauma.
The surgery was performed on 79-year-old Mrs. Shou, who had been suffering from “gallstones” for many years and had been hospitalized in some large hospitals in Hangzhou and Shanghai 3 years ago. Although Shou old lady has a heart of reluctance, but can do nothing but continue to endure the torture of gallstones.
In the second half of last year, Mrs. Shou suddenly had severe pain in her abdomen and was rushed to the general surgery hospital for treatment. After Director Xie Song carefully treated Mrs. Shou, the pancreatitis was controlled and she passed the dangerous period, so Director Xie successfully performed a laparoscopic cholecystectomy for Mrs. Shou using the “three-hole” method. When she was discharged from the hospital, her family said happily, “Several people in our village had gallbladder removal surgery, and they all had four holes in their stomachs, but you could do the surgery with only three holes.
The operation fact 2: Although Xiaomin is only 12 years and 7 months old, he has been suffering from repeated “stomach pains” for two or three years, and as soon as he was admitted to the hospital, he was diagnosed with “gallstones”. At that time, Xiaomin’s parents did not believe that such a small child could have gallstone disease, but finally when they saw the child’s expression of severe pain repeatedly, the parents made up their mind to have the surgery.
After Xiao Min was hospitalized, Director Xie Song performed a successful laparoscopic cystectomy for Xiao Min. When Xiao Min was discharged 4 days after the operation, his parents said, “My hands were shaking when I signed the operation order. Now it seems that I made the right choice.”
Director Xie Song said: for laparoscopic gallbladder surgery, general hospitals need to open 4 small holes, while we only need to open 3 small holes, which seems to be a simple comparison of quantity, but in fact is a reflection of technical connotation. Since one hole is occupied by the laparoscopic lens during the surgery, and the surgeon must have two holes to complete the operation, the “three-hole” method of laparoscopic surgery becomes a one-man operation for the surgeon, which increases the technical difficulty exponentially. The reason why we choose the “three-hole” method is, on the one hand, because of our own laparoscopic skills and, on the other hand, from the patient’s point of view, because after all, one less hole will result in one less scar and one less pain.
Laparoscopic choledochotomy for stone extraction – fine work in the “key” hole
Laparoscopic cholecystectomy can be carried out in almost all regular hospitals. However, when it comes to patients with gallbladder stones combined with common bile duct stones, most doctors will choose traditional open surgery because of the difficulty of laparoscopic common bile duct surgery. If laparoscopic cholecystectomy and common bile duct extraction are done at the same time, the patient’s pain will be greatly reduced.
After a checkup at the hospital, the doctor said that the stones had caused biliary obstruction and abnormal liver function, and that surgery was needed to remove the gallbladder and bile duct stones to relieve the symptoms, but because the stones in the bile duct were too large, they could no longer be removed endoscopically, and the only option was to perform open surgery. The only option is to undergo open-heart surgery. When she heard that she would be left with a 20cm-long surgical scar on her stomach, she said she couldn’t make up her mind about surgery.
In late April, Wu found Xie Song, director of general surgery, who carefully studied the imaging data and concluded that minimally invasive surgery was feasible for treatment, so with the help of laparoscopic instruments, she first removed the enlarged, inflamed gallbladder, then carefully dissected out the common bile duct and carefully cut it open, removed the stone with a fiberoptic choledochoscope, placed a “T-shaped” tube and then sutured it closed. The operation was successfully completed after the intraoperative imaging confirmed that the stones had been removed. After surgery, Wu’s abdomen was left with only four 0.5-1.0cm “holes”, abdominal pain completely disappeared, jaundice faded quickly, liver function gradually returned to normal, and when discharged from the hospital Wu was glad she had escaped a disaster.
The main reason for this is that the bile ducts are not only dilated but also have a diameter of about 1.5cm, which requires accurate incision under the laparoscope; the bile duct stones are difficult to remove even in open surgery, which is difficult to accomplish under the laparoscope; and the final suturing of the common bile ducts can lead to bile leakage into the abdominal cavity if they are not tightened. The final suturing of the common bile duct can lead to leakage of bile into the abdominal cavity. Therefore, laparoscopic choledochotomy and lithotripsy is a difficult “delicate work”, and none of the steps can be completed without excellent laparoscopic techniques.
Laparoscopic splenectomy – a difficult operation in minimally invasive surgery
The spleen is deep in the abdominal cavity, brittle and prone to rupture, and rich in blood flow and blood storage, making it difficult to operate when a lesion needs to be removed and life-threatening if there is hemorrhage. For such a high-risk operation, it can be completed successfully under laparoscopy.
In early June, Xiaoyu, who was just 20 years old, had sudden abdominal pain and distension. After examination, he was diagnosed with a ruptured spleen cyst causing a large amount of cystic fluid to flow into the abdominal cavity, which was located in the center of the spleen and required immediate splenectomy and abdominal drainage. Director Xie Song decided to perform laparoscopic splenectomy in an emergency, considering that Xiao Yu was busy with his exams.
After Xiao Yu was admitted to the operating room, Chief Xie Song and attending physician Wu Xiaoqing made four small 0.5-1.0 cm incisions in the patient’s abdomen and aspirated about 1000 ml of cystic fluid from Xiao Yu’s abdomen through the lumpectomy instrument, and saw that the spleen was about 20 × 10 × 5 cm in size, with a cyst of about 8 × 6 × 6 cm inside. The diseased spleen was then removed in pieces after being cut up through an incision about 2 cm in size. The surgery went very well, with minimal bleeding, and he was discharged from the hospital a week later and soon returned to school.
Director Xie Song said: The incision for open spleen removal is at least 20 cm, and the huge trauma can easily cause intestinal adhesions, and the patient has a long recovery time after the surgery, and has to rest at home for at least several months after discharge. Although laparoscopic splenectomy requires high lumpectomy skills of the surgeon and also requires extensive experience in open splenectomy, it is less invasive and faster recovery for the patient. As one of the most difficult surgeries in minimally invasive surgery, this type of surgery is currently limited to a few large hospitals above the provincial level.
Laparoscopic radical treatment of intestinal tumor–let patients no longer suffer from the pain of giant trauma
At present, laparoscopic surgery for colon (rectal) tumors has become a routine operation in some foreign hospitals. Studies have confirmed that the survival time and recurrence rate of laparoscopic treatment of colorectal tumors are not significantly different from those of open surgery.
Surgery fact: 65-year-old Zhang Da Ma went to several hospitals for 2 months because of increased frequency of stool and blood in the stool, but doctors treated her as hemorrhoids, but her symptoms did not improve. In the middle of November last year, Zhang was referred to the hospital for treatment. After examination, Director Xie Song found that the problem was not so simple, as there was a tumor slightly larger than a dollar coin on the anterior wall of the rectum 8cm from the anus. -The tumor was deep at the bottom of the pelvic cavity, the base was wide and the nature was unknown.
On November 23 last year, Director Xie Song performed laparoscopic rectal tumor eradication for Zhang’s mother and invited the director of gastroenterology to localize the tumor with colonoscopy to ensure the integrity of tumor removal. During the operation, Director Xie made four small 0.5-1 cm holes in Zhang’s abdomen, separated the middle and upper rectum with ultrasonic knife, removed most of the rectum including the tumor and cleared the corresponding lymphatic fatty tissue, then laparoscopically anastomosed the lower end of the sigmoid colon and rectum, and removed the resected intestine through a small 3 cm incision before the end of the operation. After the surgery, the pathology report indicated that the tumor was not completely cancerous, and 1 week later, Zhang was discharged from the hospital with a normal diet and free movement.
Director Xie Song said: laparoscopic radical intestinal tumor surgery is 15-20cm shorter than the incision of traditional open surgery, and the microscopic anatomy is clear, which can preserve the abdominal nerve plexus and help ensure the sexual function and urinary function of the patient after surgery, so the postoperative complications will be significantly reduced and the body will recover quickly. However, due to the large scope and complex surrounding structures involved in radical intestinal tumor surgery, especially the need to do intestinal anastomosis to reconstruct the digestive tract after removing the tumor, all must be done under laparoscopy, which is more difficult and requires a doctor with formal training to complete the surgery.
Combined laparoscopic multiple organ resection – fully reflects the superiority of minimally invasive
When two or more abdominal organs have lesions at the same time, combined organ resection is usually required at the same time. However, when the lesions are far apart, conventional surgery only extends the incision as much as possible, thus causing great trauma to the patient. In contrast, laparoscopy has the superiority of wide field of view, and the long operating instruments of laparoscopy make the operation flexible and convenient, and only 1-2 additional perforations are needed to complete the operation when the lesions in the upper and lower abdomen are far apart. Therefore, the development of laparoscopic surgery has created “minimally invasive” conditions for the combined removal of multiple organs.
The 50-year-old Ms. Yang was admitted to the Department of General Surgery for 3 days because of pain in the right side of her abdomen, and was diagnosed with both acute calculous cholecystitis and acute appendicitis. The gallbladder and appendix were first removed through three small 0.5-1.0 cm holes in the upper abdomen, and then a small 0.5 cm hole was made in the lower abdomen to remove the appendix. There was almost no bleeding throughout the operation, and Ms. Yang was able to get out of bed on the first day after the operation and was discharged from the hospital in 6 days.
Surgery fact sheet 2: 59-year-old Ms. Shi was hospitalized for chronic calculous cholecystitis, and a 10×6cm cyst was found in the center of her spleen after examination. Director Xie considered that the gallbladder was in the upper right abdomen and the spleen was in the upper left abdomen, so if open surgery was performed, the abdominal cavity would need to be cut from left to right, so after discussing with the family, the two diseased organs were removed in one operation using laparoscopy, leaving only five “key” hole-sized surgical scars on Ms. Shi’s abdominal wall, and she was soon discharged from the hospital.
Director Xie Song introduced: laparoscopic surgery is a surgical procedure that combines modern technology with traditional surgical techniques, and is favored by patients for its minimally invasive and convenient nature. With the wide application of newer technologies such as “surgical robots”, minimally invasive surgery will definitely bring more benefits to patients.