Laparocopic Duodenal Switch – Ileal Transposition
The duodenal Switch (DS) surgery or ileal transposition is a modification of the BPD designed to prevent the ulcers, increase the amount of gastric restriction, minimize the incidence of dumping syndrome and reduce the severity of the protein-calcium malnutrition. However, the dumping syndrome is believed to be a benefit rather than a detriment which helps the patient to avoid eating sugary and high fat foods that would adversely affect the weight loss. These operations are some of the most complex in the bariatric surgery.
It causes restriction by reducing the amount of food you consume and also causes malabsorption by reducing the amount of calories that get absorbed by your body. Duodenal switch surgery is one of the major weight loss surgeries and it is also irreversible.
If your BMI is greater than 60, you may not be a good candidate for this approach.
If you are pregnant, you should not consider DS. If you are planning to get this procedure done, you should wait for a total of 18 months after the surgery before you get pregnant.
If you have had an abdominal operation before, you may have developed come scars as well as adhesions that can make DS more difficult and take a lot of time.
What to Expect with Duodenal Switch (DS)?
During this procedure, your surgeon will remove a large portion of your stomach and reroute your small intestine. Following this procedure, you’ll eat less and will absorb fewer calories that you eat. The duodenal switch surgery leads to rapid weight loss within 12 to 18 months following surgery.
Pre-Surgery Preparation: Before undergoing this surgery, your doctor will ask you to prepare in a number of ways. You’ll be asked to quit smoking 30 days prior to the procedure. You may need to take the vitamin supplements to prevent post-operative nutritional deficiency. Your doctor will want you to lose about 5 to 10% of your body weight before this surgery, in order to facilitate recovery and post-op weight loss. You’ll be asked to avoid alcohol for about 48 hours before the surgery.
The Surgery Itself: During this procedure, you’ll be given general anaesthesia and the surgeon will remove about 75 to 85% of your stomach along with the greater curvature. He will reroute the small intestine, leave the pyloric valve and part of the duodenum intact. Finally, you’ll have only 18 to 24 inches of small intestine left for the absorption of the nutrients from the food. The surgery can take up to 3 to 4 hours for completion. Your surgeon may elect to perform this procedure in two parts. You can expect to spend up to 4 weeks recovering from this procedure.
Postoperative Recovery: Immediately following this procedure, you’ll be able to eat liquid foods. You’ll gradually begin eating purees and then the solid foods as you begin to recover.
LAPAROSCOPIC BILIOPANCREATIC DIVERSION (BPD) SURGERY
The laparoscopic biliopancreatic diversion (BPD) surgery restricts both the food intake and the amount of calories and nutrients absorbed by your body.
Indications :
Patients with BMI over 50
Redo Surgery after other metabolic operations in patients with high compliance
Treatment of:
Arterial Hypertension
Diabetes Mellitus Type II
Hyperlipoproteinemia
Other related diseases
Sweets Eaters
Stress Eaters
Binge Eaters
Accepts obligatory supplementation of vitamins and minerals
Patients with heartburn
Open vs. laparoscopic BPD/DS :
BPD/DS is done as either laparoscopic or traditional open surgery. In open surgery, the healthcare provider makes a cut in your belly area. Laparoscopic BPD/DS requires much smaller cuts and it uses small instruments with a lighted camera to perform the surgery. Laparoscopic surgery can help you recover more quickly and may reduce the risk for complications, such as infections and hernias. Some bariatric surgeons use a laparoscopic surgical robot to help do part of the operation.
Benefits of the procedure :
The BPD/DS can produce a large weight loss, more than 150 pounds, because it restricts how much food you can eat and also reduces how many calories you can absorb. It helps to maintain this weight loss over many years, probably better than either the gastric bypass or the sleeve gastrectomy. It reduces the amount of fat that your body will absorb. It also helps you lose weight. If you do eat fatty meals, you may have stomach cramping and loose stools. It also helps to control diabetes over the long term, even better than the gastric bypass or the sleeve gastrectomy.
Risks of the procedure :
BPD/DS reduces the absorption of essential vitamins and minerals and can result in serious, long-term complications. People who have BPD/DS may develop anemia, osteoporosis, or kidney stones.
In addition, people who have undergone BPD/DS are at high risk for calcium and iron deficiencies. These people are also at high risk for deficiencies in vitamins A, D, E, and K, the fat-soluble vitamins.
Although rare, a thiamine deficiency can happen after BPD/DS surgery. This can damage the nervous system if untreated.
Up to 18% of people with a BPD/DS surgery also develop some element of protein-energy malnutrition. When severe, this condition is known as kwashiorkor, a severe and potentially life-threatening form of malnutrition.
If you have BPD/DS surgery, you will need to take vitamin and mineral supplements and have regular blood testing for the rest of your life. This is done to prevent severe vitamin deficiencies and related complications. Even if you take the supplements as prescribed, you still may develop nutritional problems and need treatment.
Top Hospitals for Biliopancreatic diversion (BPD) Surgery in India :
The top hospitals for biliopancreatic diversion (BPD) Surgery in India are at par with the international standards. Our best hospitals have trained and experienced surgeons offering the best medical treatments, care and services to our international patients. Our pool of trained doctors, nurses and hospitals offers the international standard treatments at the most affordable prices.
The top hospitals for biliopancreatic diversion (BPD) surgery in India are: Global Hospitals, Mumbai, Fortis Healthcare Hospital, Chennai, Hyderabad, Gurgaon and Max Healthcare Hospital, New Delhi
Single Incision Laparoscopic Surgery (SILS):
Single Incision Laparoscopic Surgery (SILS) or Single Port Laparoscopy (SPL) is a recently developed technique in laparoscopic surgery. It is a minimally invasive surgical procedure in which the surgeon operates almost exclusively through a single entry point, a patient’s navel.
Physicians and patients prefer the laparoscopic surgery due to the benefits it offers when compared to the traditional surgery. SILS is the latest and most widely used laparoscopy surgery development since the introduction of the laparoscopic cholecystectomy more than 20 years ago. As a laparoscopic procedure, the SILS further minimizes the discomfort and reduces the recovery time associated with the surgery.
SILS surgery can be technically challenging and often performed by the surgeons already having experience in laparoscopy.
Methods and Procedures:
Under the approval of the Ethics Committee, a retrospective review of SILS cholecystectomies was conducted at the Department of Surgery of the University of Buenos Aires. The procedure began with an incision in the umbilical region approximately 2 cms length, and then the abdominal cavity is insufflated using a Veress needle followed by a dissection of the surrounded subcutaneous tissue, 10mm trocar placement and two 5mm trocars, one flexible on the right and one rigid on the left (Mickey Mouse Technique), having the freedom to have the 10mm trocar either in the upper or lower vertex. After this, the scope is introduced through the 5mm trocar based on the better visualization and comfort with the external manipulation of the instruments. Pulling the gallbladder fundus with 3-0 nylon suture using a percutaneous straight needle and neck retraction with articulated grasping forceps, introduced by trocar flexible. Cholecystectomy similar to that made by conventional laparoscopy, with the search for the “critical view of safety” and performing cholangiography selectively. Using forceps 10 mm clipper reusable. Extraction with ad hoc clamp 10 mm trocar.
Results:
Two hundred-fifty cholecystectomies were performed between January 2009 and December 2011, the mean patient age was 35 years (range 20-56), and an average BMI of 24 (range 18-28). 242 (96.8 %) completed successfully with the proposed technique, the remaining cases were converted to laparoscopic approach due to adhesions. One case required a laparotomy through a previous kocher incision looking for bleeding of the liver. Systematic assessments prove adequate healing of the umbilical access with no local complications. Follow-up averaged 6 months (range 1-12).
Conclusions:
This study demonstrates the feasibility, safety and reproducibility of an standardized technique for the performance of a single umbilical incision cholecystectomy. Our initial experience found that complications are similar to the previous reported in conventional cholecystectomy technique with 4 trocars.
Paediatric Laparoscopy – Definition, History & Advantages
What is Paediatric Laparoscopy?
Paediatric laparoscopy is the art of performing the minimally invasive surgery in children ranging from the newborn to adolescent age group. This involves performing the basic procedures like diagnostic laparoscopy, undescended testis and other diaphragmatic hernia in the newborn to pull through for anorectal malformation and the hirschsprung’s disease.
History of Paediatric Laparoscopy:
The first case of laparoscopy in paediatric surgery was reported by Stephen Gans in 1971. The availability of the smaller instruments expanded the role and applications of laparoscopy and thoracoscopy in very small infants and newborns. Initially, the application of laparoscopy in children was for diagnostic purposes.
Gans first case was the successful verification of a hernia on the opposite side of an endoscope introduced through the hernia sac. In this series, he included, a 2kg one day old baby with ascities. The weight of a paediatric patient ranges from a few pounds in a newborn to over 200 pounds in an adolescent.
The paediatric surgery is the last truly general surgical specialty which is unique because of the variability in the patient’s size and anatomical and physiological characteristics. The weight of a paediatric surgical patient ranges from a few pounds in a newborn to over 200 pounds in an adolescent.
Paediatric laparoscopic surgeons in India operate on a variety of anatomical areas including the chest, abdomen, the head and neck and the extremities. The laparoscopic paediatric surgeons perform procedures in newborn babies to correct the congenital anomalies like esophageal atresia, diaphragmatic hernia, duodenal atresia and many others. At the extreme cases, the bariatric procedures are performed in morbidly obese adolescents. Paediatric surgeons are well acquainted with the state of the art technology like the use of single incision surgery, robotic surgery in newborns and infants, minilaparoscopy and single port laparoscopic surgery.
Often, an increasingly sophisticated and informed patient requests the laparoscopy over traditional open procedures. The parents select the Best Surgeons for Paediatric Surgery in India based on their laparoscopic skills.
Advantages of Paediatric Laparoscopy:
Smaller incisions
Greater surgical precision
Less postoperative pain
Decreased risk of infection
Decreased cost of care
Better clinical information
Reduced length of stay in the hospital
Shorter recovery
Improved cosmesis
Laparoscopic Kidney Stone Removal – Renal Calculi Management
Kidney stones are hard objects, made up of millions of tiny crystals. Most kidney stones form on the interior surface of the kidney, where urine leaves the kidney tissue and enters the urinary collecting system. Kidney stones can be small, like a tiny pebble or grain of sand, but are often much larger.
Kidney stones come in a variety of mineral types:
Calcium stones: Most kidney stones are composed of calcium and oxalate. Many people who form calcium containing stones have too much calcium in their urine, a condition known as hypercalciuria There are several reasons why hypercalciuria may occur. Some people absorb too much calcium from their intestines. Others absorb too much calcium from their bones. Still others have kidneys that do not correctly regulate the amount of calcium they release into their urine. There are some people who form calcium oxalate stones as a result of too much oxalate in the urine, a condition known as hypercalciuria In some cases, too much oxalate in the urine is a result of inflammatory bowel disease, such as Crohn’s disease or ulcerative colitis, or other times it may be a consequence of prior intestinal surgery. Calcium phosphate stones, another kind of calcium stone, are much less common than calcium oxalate stones. For some people, calcium phosphate stones form as a result of a medical condition known as renal tubular acidosis.
Struvite stones: Some patients form stones that are composed of a mixture of magnesium, ammonium, phosphate and calcium carbonate, which is known as struvite. These stones form as a result of infection with certain types of bacteria that can produce ammonia. Ammonia acts to raise the pH of urine, which makes it alkaline and promotes the formation of struvite.
Uric acid stones: Uric acid is produced when the body metabolizes protein. When the pH of urine drops below 5.5, urine becomes saturated with uric acid crystals, a condition known as hypercalciuria. When there is too much uric acid in the urine, stones can form. Uric acid stones are more common in people who consume large amounts of protein, such as that found in red meat or poultry. People with gout can also form uric acid stones.
Cystine stones: Cystine stones are rare, and they form only in persons with an inherited metabolic disorder that causes high levels of cystine in the urine, a condition known as cystinuria.
How are kidney stones diagnosed?
Most people are diagnosed with kidney stones after the thunderclap onset of excruciating and unforgettable pain. This severe pain occurs when the kidney stone breaks loose from the place that it formed, the renal papilla, and falls into the urinary collecting system. When this happens, the stone can block the drainage of urine from the kidney, a condition known as renal colic. The pain may begin in the lower back and may move to the side or the groin. Other symptoms may include blood in the urine (hematuria), frequent or persistent urinary tract infections, urinary urgency or frequency and nausea or vomiting.
When your doctor evaluates you for a kidney stone, the first step will be a complete history and physical examination. Important information regarding current symptoms, previous stone events, medical illnesses and conditions, medications, dietary history and family history will all be collected. A physical examination will be performed to evaluate for signs of a kidney stone, such as pain in the flank, lower abdomen or groin.
Your doctor will perform a urinalysis, to look for blood or infection in the urine. A blood sample will also be collected so that kidney function and blood counts can be measured.
Even though all of these tests are necessary, a kidney stone can only be definitively diagnosed by a radiologic evaluation. In some cases, a simple X-ray, called a KUB , will be adequate to detect a stone. If your doctor requires more information, an intravenous pyelogram (IVP) or a computed tomography (CT) scan may be necessary.
Sometimes kidney stones do not cause any symptoms at all. Such painless stones can be discovered when your doctor is looking for other things on X-rays. Sometimes, although a stone does not cause any pain, it can cause other problems, such as recurring urinary tract infections or blood in the urine.
How can kidney stones be prevented?
If you have had one kidney stone, you are likely to form another. To reduce your chances of forming another stone, the first step is to determine why your original stone formed in the first place. At the Brady Urological Institute, we believe in the adage, “An ounce of prevention is worth a pound of cure,” so we place great emphasis on a thorough metabolic evaluation, so that therapies can be appropriately directed towards reducing the risk of recurrent stone disease.
If you passed your stone on your own and still have it, your doctor will send it to a laboratory to be analyzed to see what it is made of. Usually, if your stone is removed by ureteroscopy or PERC , your doctor will send a piece of the stone for analysis too. The composition of a stone is an important piece of information to have, as treatment is specific to the type of stone.
Because we know that kidney stones form when the urine has too high a concentration of crystals and/or not enough substances that protect against the crystals, a detailed analysis of the metabolism of a stone former is important. Typically, the metabolic evaluation of a stone former consists of a simple blood test and two 24-hour urine collections.
The results of these metabolic studies will provide an assessment of the risk of future stone formation. One or more of the following diagnoses and treatments may be made based on these metabolic data.
Symptoms of Kidney Stones:
A kidney stone may or may not cause any signs and symptoms until it has moved into the ureter-a tube connecting the kidney and bladder. The symptoms occurring at this point include:
Pain on urination
Severe pain in the side and back, below the ribs
Nausea and vomiting
Pain that spreads to the lower abdomen and groin
Persistent urge to urinate
Pink, red or brown urine
Fever and chills if an infection is present
Causes:
Though the exact causes of kidney stone formation are not known, the most credible sources believe that stones are the result of mineral super saturation and crystallization in the urine. Age, heredity, sex, environment, diet, urinary infection and metabolic diseases are probably involved in the stone formation. The primary causes include:
Dehydration and lack of sufficient fluid ingestion
Inadequate urinary drainage
Foreign bodies in the urinary tract
Urinary infections
Metabolic diseases like cystinuria, hyperparathyroidism, intestinal dysfunction
Diet with excess calcium, oxalates and vitamin abnormalities- vitamin D excess, vitamin A deficiency
Use of certain medications like diuretics that increases the levels of uric acid.
Laparoscopic Removal of a Kidney Stone Overview:
The laparoscopy or keyhole surgery is performed for the kidney stone that are not amendable to treatment by endoscopy and laser, ESWL (extra corporal shock wave lithotripsy) or percutaneous nephrolithotomy (PCNL) surgery. It is suitable for patients who are taking or receiving anti-coagulation (blood thinning agents) therapy. The laparoscopic pyelolithotomy (for kidney stones) and laparoscopic ureterolithotomy (for ureter stones) can be done together with pyeloplasty.
Often these procedures are performed under general anesthesia and would require a hospital stay for 2-3 days. About three or four small 5mm-10mm incisions are made on the abdomen to expose and remove the stones. An internal fine plastic tube called a stent is placed in the urine tract after the surgery and would be removed after 1-2 weeks.
Since it is likely to be a pre-planned operation so you should have plenty of time discussing it with your consultant before undergoing this procedure. Learn more about Kidney stone removal laparoscopic surgery and send us your query to know the Kidney stone operation charges in India.
What are the benefits of this procedure?
Less morbidity
Faster recovery periods
Less Pain
Shorter Hospital Stay
Helpful to patients requiring their stones to be removed in a single operative session.
Beneficial for patients who have a large single renal stone or renal anomalies like UPJ obstruction or ectopic kidney.
Laparoscopic Radical Prostatectomy – Procedure, Advantages & Results
Laparoscopic radical prostatectomy (LRP) is a form of radical prostatectomy, an operation for prostate cancer. Contrasted with the original open form of the surgery, it does not make a large incision but instead uses fiber optics and miniaturization.
Who is a candidate for laparoscopic radical prostatectomy?
Anyone diagnosed with a localized prostate cancer may benefit from LRP. However, the decision to undergo a prostate cancer surgery revolves around numerous considerations, including the severity of the prostate cancer and other illnesses. Following factors are considered during the preoperative evaluation: age, prostate biopsy findings, pre-biopsy PSA prostate-specific antigen levels, height and weight, previous prostate cancer treatments, smoking history, other illnesses, current medications and previous surgery.
Advantages of laparoscopic radical prostatectomy:
Reduced blood loss
Improved visualization
Reduced post-operative pain
Almost eliminates the blood transfusion
Shorter hospital stay
More rapid return to normal daily activity
Before the Procedure:
You will be asked to undergo a complete physical exam and some other tests. Your healthcare provider will ensure that the medical problems like high blood pressure, diabetes and heart or lung problems are bring controlled.
If you smoke, you’ll be asked to stop smoking several weeks before the surgery. You should inform your doctor about the vitamins, drugs and other supplements you are taking, even the ones you bought without a prescription.
During the weeks before your surgery, you’ll be asked to stop taking aspirin, ibuprofen, vitamin E and any other blood thinners or drugs that make it hard for your blood to clot. Ask your doctor which drugs you should still take on the day of the surgery. Drink only clear fluids on the day before your surgery. In some cases, you may be asked to take a special laxative on the day before your surgery to clean the contents out of your colon.
You will not be allowed to eat or drink anything after midnight the night before the surgery. The medicines prescribed by your doctor should be taken with a small sip of water. Book your appointment for the Best prostate cancer treatment in Mumbai, by contacting our website.
What happens during LRP?
You will be under general anesthesia so that you are asleep and pain free. During, the laparoscopic radical prostatectomy surgery, the surgeon makes several small incisions in the belly. A lighted viewing instrument called as a laparoscope is then inserted into one of the incisions. The surgeons use some special instruments to reach and remove the prostate through the other incisions. This procedure takes around 2-3 hours and the majority of patients spend about 1 night in the hospital before returning home.
Men undergoing LRP will have a catheter passed through the urethra that will stay in place for a week. Prior to removing the catheter, a dye test is performed for ensuring that the seal between the bladder and the urethra has been healed. After this, the catheter is removed and upon passing the urine, men may then return home.
A robotic-assisted laparoscopic radical prostatectomy is a surgery performed by creating small incisions in the belly with the help of the robotic arms that translate the surgeon’s hand motions into finer and more precise action. This surgery is usually performed by specially trained doctors.
After the Procedure:
After the laparoscopic radical prostatectomy, you may go home the day after the procedure. You may need to stay in the bed until the morning after the surgery. You will be encouraged to move around as much as possible. The nurses will help you change your position in the bed and also show you exercises to keep the blood flowing. You will also learn to cough or deep breaths in order to prevent pneumonia. You will need to perform these steps every 1 to 2 hours. You may need to use a breathing device to keep your lungs clear.
Post surgery, you may receive pain medicines in your veins or may require to take the pain pills. You are asked to wear stocking on your legs to prevent the blood clots. You may feel spasms in your bladder and will have a Foley catheter in your bladder when you return home.
Laparoscopic Pyeloplasty – UPJ
Laparoscopic Pyeloplasty provides patients with a safe and effective way to perform reconstructive surgery of a narrowing or scarring where the ureter (the tube that drains urine from the kidney to the bladder) attaches to the kidney through a minimally invasive procedure.
This operation is used to correct a blockage or narrowing of the ureter where it leaves the kidney. This abnormality is called a ureteropelvic junction (UPJ) obstruction which results in poor and sluggish drainage of urine from the kidney. UPJ obstruction can potentially cause abdominal and flank pain, stones, infection, high blood pressure and deterioration of kidney function.
When compared to the conventional open surgical technique, laparoscopic pyeloplasty has resulted in significantly less post-operative pain, a shorter hospital stay, earlier return to work and daily activities, a more favorable cosmetic result and outcomes identical to that of the open procedure.
The Surgery
Diagram of surgical procedure on the kidney Ureteropelvic Junction (UPJ) Obstruction
Laparoscopic pyeloplasty is performed under a general anesthetic. The typical length of the operation is 3-4 hours. The surgery is performed through 3 small (1cm) incisions made in the abdomen. A telescope and small instruments are inserted into the abdomen through these keyhole incisions, which allow the surgeon to repair the blockage/narrowing without having to place his hands into the abdomen.
A small plastic tube (called a ureteral stent) is left inside the ureter at the end of the procedure to bridge the pyeloplasty repair and help drain the kidney. This stent will remain in place for 4 weeks and is usually removed in the doctor’s office. A small drain will also be left exiting your flank to drain away any fluid around the kidney and pyeloplasty repair.
Potential Risks and Complications
Diagram of surgery on the kidney Laparoscopic dismembered pyeloplasty
Although this procedure has proven to be very safe, as in any surgical procedure there are risks and potential complications. The safety and complication rates are similar when compared to the open surgery. Potential risks include:
Bleeding: Blood loss during this procedure is typically minor (less than 100 cc) and a blood transfusion is rarely required. If you are still interested in autologous blood transfusion (donating your own blood) prior to your surgery, you must make your surgeon aware. When the packet of information is mailed or given to you regarding your surgery, you will receive an authorization form for you to take to the Red Cross in your area.
Infection: All patients are treated with broad-spectrum intravenous antibiotics prior to starting the surgery to decrease the chance of infection from occurring after surgery. If you develop any signs or symptoms of infection after the surgery (fever, drainage from your incision, urinary frequency, discomfort, pain or anything that you may be concerned about) please contact us at once.
Hernia: Hernias at incision sites rarely occur since all keyhole incisions are closed carefully at the completion of your surgery.
Tissue / organ injury: Although uncommon, possible injury to surrounding tissue and organs including bowel, vascular structures, spleen, liver, pancreas and gallbladder could require further surgery. Injury could occur to nerves or muscles related to positioning.
Conversion to open surgery: this surgical procedure may require conversion to the standard open operation if extreme difficulty is encountered during the laparoscopic procedure. This could result in a larger standard open incision and possibly a longer recuperation period.
Failure to correct UPJ obstruction: Roughly 3% of patients undergoing this operation will have persistent blockage due to recurrent scarring. If this occurs additional surgery may be necessary.
Laparoscopic Nephrectomy
Laparoscopic Nephrectomy provides patients with a safe and effective way to remove a diseased or cancerous kidney. Laparosopic nephrectomy is a minimally invasive technique, which provides patients with less discomfort and equivalent results when compared to the larger incision required with traditional open surgery. When compared to conventional open surgery, laparoscopic nephrectomy has resulted in significantly less post-operative pain, a shorter hospital stay, earlier return to work and daily activities, a more favorable cosmetic result and outcomes identical to that of open surgery.
Surgery :
Laparoscopic nephrectomy is performed under a general anesthetic. The typical length of the operation is 3-4 hours. The surgery is performed through 3 small (1cm) incisions made in the abdomen. A telescope and small instruments are inserted into the abdomen through these keyhole incisions, which allow the surgeon to completely free and dissect the kidney without having to place his hands into the abdomen. The kidney is then placed within a plastic sack and removed intact through an extension of one of the existing incision sites.
Risks and Complications:
Bleeding: Blood loss during this procedure is typically minor (less than 100 cc) and a blood transfusion is needed in less than 5% of patients. If you are interested in autologous blood transfusion (donating your own blood) prior to your surgery, you must make your surgeon aware. When the packet of information is mailed or given to you regarding your surgery, you will receive an authorization form for you to take to the Red Cross in your area.
Infection: All patients are treated with intravenous antibiotics, prior to starting surgery to decrease the chance of infection from occurring after surgery. If you develop any signs or symptoms of infection after the surgery (fever, drainage from your incisions, urinary frequency/discomfort, pain or anything that you may be concerned about) please contact us at once.
Tissue / Organ Injury: Although uncommon, possible injury to surrounding tissue and organs including bowel, vascular structures, spleen, liver, pancreas and gallbladder could require further surgery. Injury could occur to nerves or muscles related to positioning.
Hernia: Hernias at incision sites rarely occur since all keyhole incisions are closed carefully at the completion of your surgery.
Conversion to Open Surgery: The surgical procedure may require conversion to the standard open operation if difficulty is encountered during the laparoscopic procedure. This could result in a larger standard open incision and possibly a longer recuperation period.
Risks and Complications
- Bleeding: Blood loss during this procedure is typically minor (less than 100 cc) and a blood transfusion is needed in less than 5% of patients. If you are interested in autologous blood transfusion (donating your own blood) prior to your surgery, you must make your surgeon aware. When the packet of information is mailed or given to you regarding your surgery, you will receive an authorization form for you to take to the Red Cross in your area.
- Infection: All patients are treated with intravenous antibiotics, prior to starting surgery to decrease the chance of infection from occurring after surgery. If you develop any signs or symptoms of infection after the surgery (fever, drainage from your incisions, urinary frequency/discomfort, pain or anything that you may be concerned about) please contact us at once.
- Tissue / Organ Injury: Although uncommon, possible injury to surrounding tissue and organs including bowel, vascular structures, spleen, liver, pancreas and gallbladder could require further surgery. Injury could occur to nerves or muscles related to positioning.
- Hernia: Hernias at incision sites rarely occur since all keyhole incisions are closed carefully at the completion of your surgery.
- Conversion to Open Surgery: The surgical procedure may require conversion to the standard open operation if difficulty is encountered during the laparoscopic procedure. This could result in a larger standard open incision and possibly a longer recuperation period.Laparoscopic Partial Nephrectomy :
Laparoscopic Partial Nephrectomy provides patients with a safe and effective way to remove a small renal tumor, while preserving the remainder of the kidney. This is a minimally invasive technique, which provides patients with less discomfort and equivalent results when compared to the traditional open surgery.When compared to the conventional open surgical technique, laparoscopic partial nephrectomy has resulted in significantly less post-operative pain, a shorter hospital stay, earlier return to work and daily activities, a more favorable cosmetic result and outcomes that appear to be identical to that of open surgery. Partial nephrectomy has become a standard procedure for select patients with renal cell carcinoma (esp. small < 4cm, peripherally located tumors). The results of partial nephrectomy are less satisfactory in patients with larger renal cell carcinomas, leaving radical nephrectomy (removing the entire kidney) as the standard approach.Surgery :
Laparoscopic partial nephrectomy is performed under a general anesthetic. The typical length of the operation is 3-4 hours. The surgery is performed through 4 small (1cm) incisions made in the abdomen. A telescope and small instruments are inserted into the abdomen through these keyhole incisions, which allow the surgeon to completely free and dissect the tumor without having to place his hands into the abdomen. The defect in the kidney is then sewn closed with sutures and a special sealant glue. The tumor is then placed within a plastic sack and removed intact through an extension of one of the existing incision sites.Risks and Complications:
Although this procedure has proven to be very safe, as in any surgical procedure there are risks and potential complications. The safety and complication rates are similar when compared to the open surgery. Potential risks include:Bleeding: Blood loss during this procedure is typically minor and a transfusion is needed in less than 5% of patients. If you are interested in autologous blood transfusion (donating your own blood) prior to your surgery, you must make your surgeon aware. When the packet of information is mailed or given to you regarding your surgery, you will receive an authorization form for you to take to the Red Cross in your area.
Infection: All patients are treated with intravenous antibiotics, prior to starting surgery to decrease the chance of infection from occurring after surgery. If you develop any signs or symptoms of infection after the surgery (fever, drainage from your incisions, urinary frequency/discomfort, pain or anything that you may be concerned about) please contact us at once.
Tissue / Organ Injury: Although uncommon, possible injury to surrounding tissue and organs including bowel, vascular structures, spleen, liver, pancreas and gallbladder could require further surgery. Scar tissue may also form in the kidney requiring further surgery. Injury could occur to nerves or muscles related to positioning.
Hernia: Hernias at incision sites rarely occur since all keyhole incisions are closed carefully at the completion of your surgery.
Conversion to Open Surgery: The surgical procedure may require conversion to the standard open operation if difficulty is encountered during the laparoscopic procedure. This could result in a larger than standard open incision and possibly a longer recuperation period.
Urine Leak: If the urinary collecting system of the kidney needs to be cut across in order to remove the kidney tumor, it is usually sutured closed. If urine leaks out of this hole, you may need to have an internal drainage tube (stent) to help seal the leakage. On rare occasion you may require additional surgery
We are a network of surgeons, experts and hospitals in the field of laparoscopic surgical procedures. Our experts are the most sought after by both domestic and international patients. This is because of the expertise that resides in our network of experts, the state of the art infrastructure in our hospitals and compassion shown by everyone you will interact with during the various steps of your laparoscopic surgery in India.
Our hospitals are internationally accredited and have the latest tools. Surgeons will make the determination whether to conduct the surgical procedures with the assistance of a robot.
If you need a surgical procedure, you need to look no further www.laparoscopysurgeries.com Site will take care of you. Although it is hard to list all our services, we state a sample of the services we provide
- Patient Care:
- Hospitals are Joint Commission International (JCI) accredited and reputed for providing best in class laparoscopic surgeries
- Laparoscopic surgeons are thought leaders in their field
- Dedicated patient support available; ask us for anything…Anything.
- Top surgeons will review patient medical report and determine the best course of treatment. If non-surgical treatment is still an option, we will be glad to recommend you of such an option.
Specialist consultation as requested by the patients - Comprehensive care so that patient recovery is fast post-surgery
- For our patients who need language translation and interpretation services, we offer these services.
Laparoscopic Cystectomy
The surgical procedure in which the bladder is removed is called a radical cystectomy. Bladder cancer tends to spread to other areas of the body, and thus the bladder and the surrounding organs are usually removed.
Purpose :
Cystectomy is most commonly performed to treat cancer of the bladder. Once a patient has been diagnosed with bladder cancer, a staging system is used to indicate how far the cancer has spread and determine appropriate treatments. Superficial tumors isolated to the inner lining of the bladder (stage 0 or I) may be treated with non-surgical therapies such as chemotherapy or radiation, or with partial or simple cystectomy. Radical cystectomy is the standard treatment for cancer that has invaded the bladder muscle (Stage II, III, or IV). Muscle-invasive cancer accounts for 90% of all bladder cancers.
Other conditions that may require cystectomy include interstitial cystitis (chronic inflammation of the bladder), endometriosis that has spread to the bladder, severe urinary dysfunction, damage to the bladder from radiation or other treatments, or excessive bleeding from the bladder.
Description
Partial cystectomy
During partial or segmental cystectomy, only the area of the bladder where the cancer is found is removed. This allows for most of the bladder to be preserved. Because the cancer must not have spread to the bladder muscle and must be isolated to one area, partial cystectomy is only used infrequently for the patients who meet these select criteria.
The patient is first placed under general anesthesia. After an incision is made into the lower abdomen, the bladder is identified and isolated. The surgeon may choose to perform the operation with the bladder remaining inside the abdominal cavity (transperitoneal approach) or with the bladder lifted outside of the abdominal cavity (extraperitoneal approach). The cancerous area is excised (cut out) with a 0.8 in (2 cm) margin to ensure that all abnormal cells are removed. The bladder is then closed with stitches. The pelvic lymph nodes may also be removed during the procedure. After the cancerous tissue is removed, it is examined by a pathologist to determine if the margins of the tissue are clear of abnormal cells.
Simple or radical cystectomy:
While partial cystectomy is considered a bladder-conserving surgery, simple and radical cystectomy involves the removal of the entire bladder. In the case of radical cystectomy, other pelvic organs and structures are also removed because of the tendency of bladder cancer to spread to nearby tissues. After the patient is placed under general anesthesia, an incision is made into the lower abdomen. Blood vessels leading to and from the bladder are ligated (tied off), and the bladder is divided from the urethra, ureters, and other tissues holding it in place. The bladder may then be removed.
The surgical procedure for radical cystectomy differs between male and female patients. In men, the prostate, seminal vesicles, and pelvic lymph nodes are removed with the bladder. In women, the uterus, fallopian tubes, ovaries, anterior (front) part of the vagina, and pelvic lymph nodes are removed with the bladder. If the surgery is being performed as a treatment for cancer, the removed tissues may be examined for the presence of abnormal cells.
Urinary diversion:
Once the bladder is removed, a new method for excreting urine must be created. One commonly used approach is the ileal conduit. A piece of the small intestine is removed, cleaned, and tied at one end to form a tube. The other end is used to form a stoma, an opening through the abdominal wall to the outside. The ureters are then connected to the tube. Urine produced by the kidneys flows down the ureters, into the tube, and through the stoma. The patient wears a bag to collect the urine.
For continent cutaneous diversion, a pouch is constructed out of portions of the small and large intestine; the ureters are connected to the pouch and a stoma is created through the abdominal wall. Urine is removed by inserting a thin tube (catheter) into the stoma when the pouch is full. Alternatively, a similar pouch called a neobladder may be created, attached to both the ureters and the urethra, in an attempt to preserve as close to normal bladder function as possible.
Diagnosis/Preparation :
The medical team will discuss the procedure and tell the patient where the stoma will appear and what it will look like. The patient will receive instruction on caring for a stoma and bag. A period of fasting and an enema may be required.
Aftercare :
After the operation, the patient is given fluid-based nutrition until the intestines begin to function normally again. Antibiotics are given to prevent infection. The nature of cystectomy means that there will be major lifestyle changes for the person undergoing the operation. Men may become impotent if nerves controlling penile. .
Risks :
Cystectomy is a complex surgery, involving the manipulation of many internal organs in your abdomen. Because of this, cystectomy carries with it certain risks, including:
Bleeding
Blood clots
Heart attack
Infection
Pneumonia
Rarely, death can happen after surgery
Since cystectomy is a surgery not just to remove the bladder but also to create a urinary diversion, the surgery includes additional risks, such as:
Dehydration
Electrolyte abnormalities
Urinary tract infection
A blockage that keeps food or liquid from passing through your intestines (bowel obstruction)
A blockage in one of the tubes that carries urine from the kidneys (ureter blockage).
Laparoscopic Cystocele Repair – Surgery,Procedure & Benefits,
A cystocele is the protrusion or prolapse of the bladder into the vagina. A number of surgical interventions are available to treat cystoceles.
Purpose :
A prolapse occurs when an organ falls out of its normal anatomical position. The pelvic organs normally have tissue (muscle, ligaments, etc.) holding them in place. Certain factors, however, may cause those tissues to weaken, leading to prolapse of the organs. A cystocele may be the result of a central or lateral (side) defect. A central defect occurs when the bladder protrudes into the center of the anterior (front) wall of the vagina due to a defect in the pubocervical fascia (fibrous tissue that separates the bladder and vagina). The pubocervical fascia is also attached on each side to tough connective tissue called the arcus tendineus; if a defect occurs close to this attachment, it is called a lateral or paravaginal defect. A central and lateral defect may be present simultaneously. The location of the defect determines what surgical procedure is performed.
Factors that are linked to cystocele development include age, repeated childbirth, hormone deficiency, menopause, constipation, ongoing physical activity, heavy lifting, and prior hysterectomy. Symptoms of bladder prolapse include stress incontinence (inadvertent leakage of urine with physical activity), urinary frequency, difficult urination, a vaginal bulge, vaginal pressure or pain, painful sexual intercourse, and lower back pain. Urinary incontinence is the most common symptom of a cystocele.
Surgery is generally not performed unless the symptoms of the prolapse have begun to interfere with daily life. A staging system is used to grade the severity of a cystocele. A stage I, II, or III prolapse descends to progressively lower areas of the vagina. A stage IV prolapse descends to or protrudes through the vaginal opening. Surgery is generally reserved for stage III and IV cystoceles.
Diagnosis/Preparation:
Physical examination is most often used to diagnose a cystocele. A speculum is inserted into the vagina and the patient is asked to strain or sit in an upright position; this increase in intra-abdominal pressure maximizes the degree of prolapse and aids in diagnosis. The physician then inspects the walls of the vagina for prolapse or bulging.
In some cases, a physical examination cannot sufficiently diagnose pelvic prolapse. For example, cystography may be used to determine the extent of a cystocele; the bladder is filled by urinary catheter with contrast medium and then x rayed. Ultrasound or magnetic resonance imaging may also be used to visualize the pelvic structures.
Women who have gone through menopause may be given six weeks of estrogen therapy prior to surgery; this is thought to improve circulation to the vaginal walls and thus improve recovery time. Antibiotics may be administered to decrease the risk of postsurgical infection. An intravenous (IV) line is placed and a Foley catheter is inserted into the bladder directly preceding surgery.
Aftercare:
A Foley catheter may remain for one to two days after surgery. The patient is given a liquid diet until normal bowel function returns. The patient also is instructed to avoid activities for several weeks that cause strain on the surgical site; these include lifting, coughing, long periods of standing, sneezing, straining with bowel movements, and sexual intercourse.
Risks:
Risks of cystocele repair include potential complications associated with anesthesia, infection, bleeding, injury to other pelvic structures, dyspareunia (painful intercourse), recurrent prolapse, and failure to correct the defect.
Normal results:
A woman usually is able to resume normal activities, including sexual intercourse, in about four weeks after the procedure. After successful cystocele repair, symptoms recede, although a separate procedure may be needed to treat stress incontinence.