I. What is laparoscopic surgery all about?
Laparoscopic surgery is a new technology that has emerged in the field of medical surgery in recent years, commonly known as minimally invasive surgery, which will represent the direction of surgical development. Minimally invasive surgery, as the name implies, means that the patient no longer undergoes surgery in the traditional sense, but only makes 2 to 4 incisions of about 0.5 to 1.0 cm in size on the abdomen with a puncture needle, and inserts a laparoscope connected to a television camera system and three trocar needles. The surgeon performs the procedure through a screen monitor. For this reason, laparoscopic surgery is also known as televised laparoscopic surgery and may also be referred to as keyhole surgery. Laparoscopic surgery is an extension of the surgeon’s vision and hand, without the need for opening the abdomen, but can obtain the same results as open surgery. Chen Yonghui, Department of Urology, Shanghai Renji Hospital
Second, what are the advantages of laparoscopic surgery?
Television laparoscopic surgery has advantages that are incomparable with ordinary open surgery.
(1) Laparoscopic surgery does not need to open the abdomen, and the abdominal wall is less traumatic, so the postoperative pain is mild and generally does not require pain relief treatment. The chances of postoperative incision bleeding, infection and splitting are very small.
(2) The postoperative hospitalization time of laparoscopic surgery is significantly shortened, generally 3~5 days after surgery can be discharged, and about 1 week can resume normal life.
(3) laparoscopic surgery is performed inside the body, in a completely closed state, so the chance of causing abdominal infection is much smaller than that of open surgery, and the postoperative antibiotic time is also short, so the side effects caused by antibiotics are also reduced; (4) laparoscopic surgery is performed in a completely closed state, so the chance of causing abdominal infection is much smaller than that of open surgery.
(4) The gastrointestinal function of the patient recovers quickly after laparoscopic surgery. (4) The patient’s gastrointestinal function recovers quickly after laparoscopic surgery. He can resume eating and get out of bed the day after surgery, which effectively reduces the amount and duration of postoperative infusion. Prevention of postoperative intestinal adhesions, intestinal obstruction and pulmonary infection, deep vein thrombosis, urinary retention and other complications.
(5) Good postoperative abdominal cosmetic effect of laparoscopic surgery. The size of the abdominal wall incision is generally 0.5-1.0 cm and is scattered with 2-4, with minimal post-healing scars.
(6) Laparoscopic surgery displays the whole procedure on a TV screen through an electronic video recording system, which can be observed by all members of the operation, and the disease and the surgical method can be discussed at any time.
(7) The hospital stay is short, and the cost is not substantially increased compared with traditional surgery, and in some cases, the cost is even reduced.
Third, what urological surgery can be done by TV laparoscopy? And what urological diseases can be treated?
(1) adrenal surgery.
It is mainly suitable for benign adrenal tumors, including primary aldosterone adenoma, cortisol adenoma, Cushing’s syndrome, pheochromocytoma and so on. Adrenal surgery has now become the gold standard for urological laparoscopic surgery.
(2) Nephrectomy.
Suitable for all types of renal tumors less than 6 cm, atrophic kidney, non-functioning kidney with huge hydronephrosis and living kidney donor for renal transplantation.
(3) Partial nephrectomy.
Suitable for early renal cancer (less than 4 cm), benign renal tumors, etc.
(4) total nephrectomy and ureterectomy.
Suitable for renal pelvis tumor and ureteral tumor, etc.
(5) Renal cyst opening and drainage.
Suitable for renal giant cysts and polycystic kidney, etc.
(6) renal suspension fixation.
Suitable for severe renal prolapse, etc.
(7) renal pelvic ureteroplasty.
Suitable for congenital pelvic ureteral junction stenosis (PUJ stenosis) with hydronephrosis, etc.
(8) radical resection of prostate cancer.
Suitable for early stage prostate cancer.
(9) Total cystectomy.
Suitable for invasive bladder tumors, etc.
(10) Spermatic vein ligation.
Suitable for male infertility caused by varicocele (especially for bilateral varicocele).
(11) Other procedures.
Ureterotomy and lithotomy, pelvic lymph node biopsy and dissection, bladder diverticulectomy, diagnosis and treatment of abdominal cryptorchidism, etc.
Fourth, which patients are not suitable for laparoscopic surgery
(1) systemic bleeding disorders.
(2) Patients with acute inflammation of the abdomen.
(3) those with systemic conditions that make it difficult for them to undergo surgery
(4) those with poor pulmonary function, as artificial pneumoperitoneum can cause the diaphragm to move upward, further affecting pulmonary function.
(5) Patients with a history of surgery in the region of onset and intra-abdominal adhesions
(6) patients are too obese, which can cause difficulties in surgery.
V. What should I pay attention to after laparoscopic surgery?
(1) post-laparoscopic diet: laparoscopy will have the problem of abdominal flatulence, so the first day after the opening of indigestion, greasy, easily flatulent (such as beans, eggs, milk) things temporarily do not eat, wait until the second day you can start eating what you normally eat, extra-large surgery can be properly extended eating time.
(2) Postoperative laparoscopic wound problems: the wound will be taken care of by nursing staff and physicians, in principle, do not need to touch it for the time being, and do not get wet, until a week after discharge when you return to the clinic, the attending physician can see the wound for you. Since the laparoscopic incision is only 1 cm, the abdominal dressing can be removed after one week and you can take a shower, and then you can gradually resume your normal activities. It is still important to pay attention to appropriate and light activities before one week to make the body recover as soon as possible.
(3) The question of when to remove the catheter after laparoscopy: in general, most laparoscopic surgeries that are not bladder surgery have the catheter removed 2-3 days after surgery and can urinate on their own.
(4) The question of how long to recuperate after laparoscopic surgery: It mainly depends on the nature of your work and physical condition to decide. The time to return to work can be extended for extra-large surgeries.
VI. Misconceptions about laparoscopic surgery
(1) Laparoscopic surgery is not complete for tumor removal: laparoscopic surgery is to display the magnified image on the TV screen, which shows the boundary between tumor and normal tissue very clearly. Some operations are even more thorough than open surgery.
(2) Laparoscopic surgery is expensive: laparoscopic surgery may be slightly more expensive than open surgery in terms of surgical cost, but because of less bleeding, few blood transfusions, faster patient recovery, shorter hospital stay and significantly shorter time of using antibiotics, the cost paid at discharge for some diseases is rather less than open surgery. Indirect economic benefits arising from your ability to return to normal work earlier are even more incalculable.
(3) Immaturity of laparoscopic technology: laparoscopic surgery has been applied to the clinic for decades and has accumulated a lot of surgical experience, especially with the rapid development of laparoscopic instruments in recent years, laparoscopic technology has become quite mature and some surgeries have completely replaced open surgery. In our hospital, more than 1000 cases of difficult laparoscopic surgery have been performed by specialized doctors, and the technology is not a problem at all for doctors who specialize in laparoscopic surgery. Of course, patients should be reminded that they should not easily choose primary hospitals without laparoscopic experience to perform difficult laparoscopic surgery, but should also go to tertiary hospitals with rich laparoscopic experience.
(4) Isn’t the sum of the length of 2-4 poked holes in laparoscopic surgery the same as the length of the incision in open surgery? From an arithmetic point of view alone, the sum of laparoscopic poke holes is also smaller than any abdominal incision, and this is not the main difference between the two. The main difference between the two is: 1, laparoscopic surgery poke hole is to expand into the abdominal cavity with instruments, the integrity of the abdominal wall is basically preserved. The open incision is by way of incision, there is abdominal wall muscle and corresponding vascular nerve damage, the skin around the incision will be numb after surgery, the abdominal wall muscle scarring and thus become weak, there is a risk of abdominal wall incision hernia; 2, laparoscopic abdominal wall poke holes are small (ranging from 3-10mm), scattered and hidden, and do not affect the aesthetics after healing. And we often see that the surgical incision forms a centipede-like proliferative scar; 3, the incision of traditional open incision is often cracked, which is sometimes an unavoidable problem. Whereas laparoscopic surgery is the best solution to this problem
(5) Conversion to open surgery in the middle of laparoscopic surgery is a surgical failure: laparoscopic surgery is sometimes encountered halfway through the surgery to find that it cannot be performed safely and effectively, and we will promptly convert to open surgery, which is not only a reflection of laparoscopic safety, but also the best reflection of the patient’s interests. We should not do laparoscopy just for the sake of doing laparoscopy. It is very wise to change to open surgery in time when problems are found intraoperatively. A surgeon who cannot determine when to switch to open surgery is never a good surgeon.