(1) Can laparoscopic surgery achieve the therapeutic effect of traditional open surgery?
Traditional open surgery requires a large incision in the abdominal wall to expose the surgical field and a pull hook to expose it during the operation in order to complete the operation, so the trauma and disturbance to the patient’s internal organs can be considerable, the patient’s postoperative recovery time is longer and slower, and the patient has significant postoperative pain. Longer hospitalization time increases the cost of treatment. Minimally invasive laparoscopic surgery, on the other hand, can be performed by the laparoscopic surgeon through a monitor (TV), with the main surgeon and assistant working closely together, as the images of the surgical field are transmitted through a very small surgical channel combined with a high-definition camera system. The laparoscope has a magnifying effect to clearly visualize the surgical site and allows complex and delicate surgeries to be performed as long as the surgeon has a solid foundation in surgical anatomy and skills and a good surgical team. Such complex surgeries as common bile duct exploration, lobectomy or even hemihepatectomy, resection and radical treatment of gastrointestinal tumors, splenectomy, dissection of portal hypertension, resection of pancreatic tumors or resection of pancreaticoduodenum, and anastomosis of common bile duct jejunum can also be completed successfully. The effect of surgery performed by skilled and experienced laparoscopic surgeons can not only achieve the effect required by traditional surgery, but can even surpass the therapeutic effect of traditional surgery, such as lymphatic clearance of malignant tumors to the effect of radical cure, Hou Dongsheng, Minimally Invasive General Surgery Department, The First Hospital of Guangzhou Medical University
(2) Can all surgical diseases be performed under laparoscopic surgery?
Each patient’s condition is different, and there are large individual differences, so patients must seek consultation and surgery with an experienced laparoscopic surgeon to be safer and more accurate. Laparoscopic surgery should only be performed if the patient is suitable for laparoscopic surgery. Patients who are not suitable for laparoscopic surgery should undergo traditional open surgery. The patient’s safety and interests should come first. Surgeons should choose to develop the best surgical plan for the patient’s surgical condition. Each procedure has indications and contraindications for surgery, as is the case with traditional open surgery and as is the case with laparoscopic surgery.
(3) Which diseases are suitable for laparoscopic surgery?
1. cholecystitis, gallbladder stones, gallbladder polyps, common bile duct stones, intrahepatic bile duct stones
2. Liver cysts, liver abscesses, hepatic hemangiomas and some liver cancers
3. Spleen surgical diseases
4. Pancreatic surgical diseases
5. Acute and chronic appendicitis
6. Gastroduodenal ulcer and perforation, gastric tumor
7. Colon tumor, rectal tumor, small intestine tumor
8. Intestinal adhesions and intestinal obstruction
9. Thyroid tumor, hyperthyroidism
10. Inguinal hernia
11. various difficult abdominal diseases requiring laparoscopic surgery to confirm the diagnosis
(4) Are there any risks associated with laparoscopic surgery?
There are risks associated with any surgery. There are risks associated with traditional open surgery and there are also risks associated with laparoscopic surgery. However, an experienced laparoscopic surgeon will have fewer risks than a traditional open surgery. In other words, laparoscopic surgery is safe and reliable, as long as the surgeon has the experience and laparoscopic skills to handle any specific situation accurately.
(5) Are there any disadvantages to laparoscopic surgery?
In the past, during traditional open surgery, the surgeon’s hand was very important when performing the surgery. The surgeon uses his or her hand to detect and judge the condition and then perform the surgery. But nowadays, laparoscopic surgery with the aid of a hand or the use of ultrasound for direct observation and positioning during surgery can also be used to determine the patient’s condition. Currently, most laparoscopic procedures are performed under pneumoperitoneum, so there is a certain impact on the patient’s cardiopulmonary function, so usually the patient needs to undergo laparoscopic surgery under general anesthesia, but the development of pneumoperitoneum-free laparoscopic surgery can be improved in this regard.
Many of the equipment, instruments and materials used in laparoscopic surgery need to be imported from abroad, and the cost of surgery can be more expensive than traditional open surgery. However, with the continuous research and development of domestic equipment and instruments, the production level has been improved and some of them have reached the international level, which can significantly reduce the cost of surgery. With the maturity and standardization of laparoscopic technology and the reform of medical treatment, the cost will become lower and lower.
(6) Do I need to be hospitalized before laparoscopic surgery?
Yes, as with traditional open surgery. In addition to understanding the patient’s lesion, the patient’s heart, lung, liver, kidney, coagulation, blood biochemistry and other conditions should be understood in order to have an accurate and comprehensive understanding of the patient’s whole body condition before surgery, i.e. preoperative evaluation. Only in this way can the patient’s surgical safety be fully guaranteed.
(7) What should I pay attention to after laparoscopic surgery?
Laparoscopic surgery patients should be operated under pure CO2 (99.99%) gas pneumoperitoneum. This is so that the surgical field can be clearly revealed. Patients are usually on oxygen for 2 to 4 hours after returning to the ward. Older patients or patients undergoing complex laparoscopic surgery may be on oxygen for a longer period of time. After the patient is fully awake, he or she can turn around and move around and move his or her feet. About 60-70% of female patients will have vomiting after surgery, which will be treated accordingly by the surgeon and is not a concern for patients. In addition, some patients may experience soreness in both shoulders, which is caused by the stimulation of the diaphragmatic nerve after pneumoperitoneum, and usually disappears automatically after 1~2 days. If not, it can be treated with painkillers. Patients usually fast for one day after surgery, and then they can eat a small amount of low residue liquid or semi-liquid food, and eat less and more often. However, each person has differences and should not eat too much at one time. Complex laparoscopic surgery must be eaten under the guidance of the surgeon. The same goes for getting out of bed. Although patients recover faster and have a short hospital stay, they should rest properly after going home and should not do strenuous and heavy work so as not to affect the complete recovery of their body.
(8) Do I need to take “big supplements” after laparoscopic surgery?
No, it is generally not advisable for patients to take a lot of supplements after discharge from the hospital. You can eat soft rice and noodles with low fat, low cholesterol, high vitamin and other easily digestible foods. 3~4 weeks later, it is fine to follow the same diet as usual. Fruits can be eaten more often. You can eat protein-rich foods such as pork, fish, chicken and milk. It is best to seek the advice of the doctor in charge if you do not understand. (9) What should I do when I have my first post-operative follow-up and situation?
Generally, if there is no special condition after surgery, you should return to the hospital for a follow-up examination after one month. This includes an ultrasound examination. If there are any special circumstances or needs, feel free to contact the supervising doctor for appropriate treatment. (10) When can I return to work after laparoscopic surgery?
A few days of rest after surgery is usually fine for light work and daily life. Heavy and busy work should be done only after 3-4 weeks postoperatively, as instructed by the doctor.
(11) Is there any effect on the body after gallbladder removal?
The main function of the gallbladder is to store and concentrate bile, not to secrete it. There is no major effect on the body after gallbladder removal. If the patient’s bile contraction function is poor, the removal of the diseased gallbladder not only does not show poor digestion, but also better digestion, which has been clinically proven for more than 100 years.
(12) What are the indications for laparoscopic cholecystectomy?
1. gallbladder stone induced acute cholecystitis, acute pancreatitis or other serious complications
2. atrophic cholecystitis
3. Porcelain gallbladder
4. Diabetes mellitus combined with gallbladder stones (when diabetes mellitus is under control)
5. Gallbladder adenomyoma and adenoma, or combined with stones
6. gallbladder stones embedded in the neck of the gallbladder, resulting in incompetence of the gallbladder duct.
7. Non-stone cholecystitis with gallbladder dysfunction
8. Gallbladder polyps >1CM in diameter, or increase significantly in size within a short period of time, or combined with symptoms of cholecystitis, or pathology suggesting active hyperplasia or severe hyperplasia
9. Elderly people or those with cardiopulmonary dysfunction combined with stones, still able to tolerate surgery.
(13) What preparations should be made before laparoscopic cholecystectomy?
According to the health condition of the patient, some necessary preoperative tests and examinations should be performed, such as blood routine, blood type, liver and kidney function, coagulation function, electrolytes, electrocardiogram, chest X-ray, hepatobiliary ultrasound, etc. The patient should not eat or drink for 8 hours before the operation. If the patient is constipated, he should be given a general enema or oral cathartic drugs. If the patient is taking aspirin, blood viscosity lowering or arthritis treatment medications, the above medications must be discontinued at an appropriate time before surgery under the guidance of the physician.
(14) What is meant by single-port laparoscopic surgery?
The umbilicus is a scar left by human congenital. We can make an incision through the umbilicus and place a laparoscope and operating channel to perform a considerable part of abdominal laparoscopic surgery, such as gallbladder removal, opening of liver cysts, ablation of liver tumors, repair of benign gastroduodenal ulcer perforation, loosening of intestinal adhesions, repair of adult hernia, etc., so that the rest of the abdominal wall does not leave a surgical scar of laparoscopic channel, so that patients can better enjoy the results brought by minimally invasive surgery and more cosmetic .
(15) Which gallbladder diseases can be operated laparoscopically to preserve gallbladder? 1.Benign gallbladder diseases 2.Patients are young 3.Patients have clear requirements for gallbladder preservation 4.Good gallbladder contraction function 5.No obvious abnormalities in gallbladder structure 6.Gallbladder function can still be recovered after biliary surgery 7.Patients whose gallbladder function cannot be recovered after biliary surgery and whose primary gallbladder disease can easily recur are not suitable for biliary surgery.
Prof. Hou Dongsheng Specialist Clinic
Every Tuesday afternoon at the surgery clinic in the main hospital of Guangzhou Medical Center. Address: No. 151 Yanjiang West Road, Yuexiu District, Guangzhou City, and on Monday morning and Thursday afternoon in the outpatient clinic at the Haiyin Campus of Guangzhou Medical First Hospital. Address: No.1 Kangda Road, Haizhu District, Guangzhou City.
Specialized Outpatient Clinic From Monday to Friday at the Minimally Invasive Surgery Center of Guangzhou Medical First Hospital Haiyin Campus. Attended by Professor Hou’s surgical team
Tel: 13802953608 (Prof. Hou)
13719002160 (Dr. Ye)
13631499650 (Dr. Zhang)
18998397218 (Dr. Li)
15999947735 (Dr. Du)