Thapa P B
Department of Surgery, Kathmandu Medical College, Sinamangal, Nepal.
Kathmandu Univ Med J (KUMJ). 2010 Apr-Jun;8(30):261-4. doi: 10.3126/kumj.v8i2.3572.
Laparoscopic surgery involves performing surgery through small incisions in abdominal wall to get access. Primary goal of this procedure is to achieve good cosmetic outcome, reduced post operative pain, early recovery and reduced hospital admission.
The main objective of this study is to see the feasibility and benefit of performing advance laparoscopic surgery in a place where basic laparoscopic surgery is done and to share my experience while performing it.
A retrospective study of case sheets and discharge summary from 1st May 2008 till 1st August 2009 was done. Altogether eight patients underwent different advanced laparoscopic procedure. Cases done for the fi rst time in the institute and those done by himself were only included. Technical feasibility, use of devices like harmonic scalpel, need for incision extension, operative time, blood product requirement, ambulation and enteral feed, post operative hospital stay and patients satisfaction regarding minimal scars were assessed.
Total eight patients underwent advance laparoscopic surgery. There were two common bile duct (CBD) exploration of which one was transcystic exploration, one total laparoscopic abdominoperineal resection (APR) for rectal cancer, one laparoscopic assisted right hemicolectomy for carcinoma ceacum, one laparoscopic assisted sigmoid colectomy for recurrent sigmoid volvulus, two laparoscopic right nephrectomy for non functioning right kidney, one retroperitoneal pyelolithotomy and one laparoscopic assisted splenectomy for massive splenomegaly with haemolytic anaemia. All procedures were technically feasible with basic laparoscopic instruments. However harmonic scalpel was required for splenectomy due to difficult hilum dissection. Ureteroscope was used as a choledochoscope in CBD exploration. Blood transfusion was required only in patient with low preoperative haemoglobin. Early ambulation and enteral feed was done within 24 hours in all and within 48 hours in patients who had bowel anastomosis. Post operative hospital stay was 5-8 days. Cosmetic scar was appreciated by all. Although long term oncological outcome is yet to come in malignancy case, biopsy report of laparoscopic APR identified 13 nodes which shows complete nodal dissection on oncological principal basis.
Advanced laparoscopy is feasible, safe and effective in the hand of surgeons performing basic laparoscopic surgeries with guidance from surgeons who have long experience on same procedures but by open method.
腹腔镜手术是通过腹壁上的小切口进行手术以进入体内。该手术的主要目标是获得良好的美容效果、减轻术后疼痛、促进早期恢复并减少住院时间。
本研究的主要目的是探讨在已开展基础腹腔镜手术的地方进行高级腹腔镜手术的可行性和益处，并分享我在实施该手术过程中的经验。
对2008年5月1日至2009年8月1日期间的病历表和出院小结进行回顾性研究。共有8例患者接受了不同的高级腹腔镜手术。仅纳入在该机构首次开展的病例以及由本人实施的病例。评估了技术可行性、超声刀等设备的使用情况、切口延长的必要性、手术时间、血液制品需求、下床活动和肠内营养情况、术后住院时间以及患者对微小疤痕的满意度。
共有8例患者接受了高级腹腔镜手术。其中包括2例胆总管探查，其中1例为经胆囊管探查；1例直肠癌全腹腔镜腹会阴联合切除术；1例盲肠癌腹腔镜辅助右半结肠切除术；1例复发性乙状结肠扭转腹腔镜辅助乙状结肠切除术；2例无功能右肾的腹腔镜右肾切除术；1例腹膜后肾盂切开取石术；1例巨大脾肿大伴溶血性贫血的腹腔镜辅助脾切除术。所有手术在使用基础腹腔镜器械的情况下技术上均可行。然而，由于脾门解剖困难，脾切除术需要使用超声刀。在胆总管探查中，输尿管镜被用作胆道镜。仅术前血红蛋白低的患者需要输血。所有患者均在24小时内实现早期下床活动和肠内营养，接受肠吻合术的患者在48小时内实现。术后住院时间为5 - 8天。所有患者对美容疤痕都很满意。尽管恶性肿瘤病例的长期肿瘤学结果尚未得出，但腹腔镜腹会阴联合切除术的活检报告发现了13个淋巴结，从肿瘤学主要依据来看显示完全淋巴结清扫。
在有长期开放手术经验的外科医生指导下，对于开展基础腹腔镜手术的外科医生而言，高级腹腔镜手术是可行、安全且有效的。
