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Entering the era of "kinder, gentler" surgery.

As previously reported in Medical Update, the advent of laparoscopic gallbladder surgery in recent years has had a profound effect upon the surgical treatment of gallbladder disease. Working through three tiny incisions in the abdomen, the surgeon is able to view the diseased organ through the laparoscope, remove its contents by suction to reduce its size, and then remove it through one of these incisions.

The traditional approach to abdominal surgery is an incision large enough to provide a good view to the diseased organ and its surroundings, with adequate space for the instruments required to remove or repair it. Cutting and suturing skin, muscle layers and other tissues imposes a severe strain on the body's healing processes, producing the pain and general debilitation that follows major surgery.

The laparoscope--a long, narrow, fiber optics tube-enables the surgeon to view the operating field through a small slit in the abdomen. Cutting and suturing instruments are inserted through two other small incisions, through one of which the shrunken gallbladder is removed.

In eliminating the need for the traditional large abdominal incision, hospital stay and postoperative complications have been greatly reduced, and the patient more quickly returns to normal activity. By making one of the three incisions through the umbilicus (belly button), the patient is left with only two tiny scars instead of the usual horrendously large one.

As might be expected, surgeons are now beginning to use laparoscopy in other surgical procedures, particularly ones that require techniques and skills similar to those used in gallbladder surgery. Such procedures as appendectomy and repair of duodenal ulcers, for example, are now being performed with laparoscopy. Dr. Stephen Datena, a specialist in general and critical-care surgery at Methodist Hospital in Indianapolis, recently operated on an 87-year-old man with a perforated duodenal ulcer, who had a number of other serious medical problems. The patient complained of no pain from the incision during the first postoperative day and had no complications from the surgery, in spite of his other medical problems.

The surgical techniques employed in such conditions as gallbladder removal, appendectomy, and repair of duodenal ulcers and inguinal hernia are relatively simple and can be learned quickly by general surgeons. On the other hand, laparoscopic surgery for more complicated conditions that require extensive localized cutting and suturing is best done by surgeons who have had extensive experience in the simpler procedures.

"Unfortunately, many current courses in laparoscopic surgery are probably no adequate preparation for some of the more technically demanding procedures," says Dr. Datena.

He also notes that laparoscopic appendectomies and hernia repairs, which normally involve less surgical trauma, may not yield such clear benefits over open surgery as does laparoscopic gallbladder surgery.
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Title Annotation:laparoscopic surgery
Publication:Medical Update
Date:Dec 1, 1992
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