Minimally Invasive Surgery
Our two surgeons at Martin & Woodyard Surgery have extensive experience with minimally invasive surgeries such as laparoscopy and robotic assisted laparoscopy. Both surgeons trained in the era when these technologies were developed and have years of experience—more than 40 years combined—with minimally invasive techniques.
These minimally invasive procedures are typically done through small punctures, utilizing a laparoscope for the visualization of the tissues. This allows for more precise dissection, identification of vital structures, less damage to normal tissues and better overall outcomes. With smaller incisions, patients experience less postoperative pain and shorter time to full recovery. These techniques are most commonly used for gallbladder surgeries, hernia repairs and colon resections.
High-definition monitors, which offer resolutions that are many times greater than that of a regular household television, are used for these operations, and the da Vinci robots are used for robotic procedures. Minimally-invasive techniques are not appropriate for every case, and your surgeons can help you to decide which procedure is most suited for your medical problem.
Robotic surgery, or robot-assisted surgery, is a newer variation of a minimally invasive or laparoscopic procedure. Robotic surgery performed with the da Vinci Surgical System was approved by the Food and Drug Administration in 2000. The surgical robot does not work alone—its arms are controlled at all times by the surgeon who is seated at a computer near the operating table. Robots make some minimally invasive techniques easier to perform than traditional laparoscopic surgery.
The robot has two side-by-side cameras that give the surgeon a high-definition, three-dimensional view of the surgical site that a standard laparoscopy does not do. The instruments also have more dexterity than laparoscopic instruments and allow for maximum precision and range. For example, the robot can easily suture in the abdomen which is difficult to do laparoscopically.
Most traditional laparoscopic procedures can also be performed with the robot. Examples include gallbladder removal (cholecystectomy), groin hernias (inguinal), abdominal wall hernias (ventral), stomach surgery and colon surgery.
Before a robotic cholecystectomy is performed, the patient is administered a medication that allows for better visualization of the bile ducts; this method is not widely available with traditional laparoscopic surgery. Some gallbladders can be removed with only three 8-mm incisions using the robot.
The robot also allows for several new ways of closing hernias. The primary hernia hole can be sutured closed, which cannot be done easily with open or laparoscopic repairs. Additionally, the mesh can be larger and can also be sutured in place instead of using metal tacks. This method of suturing is less painful for the patient.
Laparoscopic surgery involves the use of a fiber-optic laparoscope that is inserted through a small incision in the abdominal wall or chest and connected to a high-definition camera system that projects images of the tissues of interest onto television screens.
For abdominal laparoscopic surgery, the initial incision is usually made at the umbilicus or navel. We use this site because it is located in the center of the abdomen where the tissue is thinnest, and it is also an ideal place for hiding a scar. Using a small incision, about 3/4”, a plastic tube called a trocar is placed through the incision into the abdominal cavity. Carbon dioxide is then pumped into the abdominal cavity through tubing connected to the trocar to raise the abdominal wall away from the organs. We use carbon dioxide because it is not flammable like oxygen and it is absorbed by the tissue. Some laparoscopes have an operating channel so that only one instrument and one incision are needed. In most cases, additional trocars are placed strategically in the abdominal wall depending on the type of surgery being performed.
For gallbladder surgery and inguinal hernia repairs, there are usually three trocars. One is placed at the navel for the laparoscope; two additional trocars are placed above the navel in the midline or right upper quadrant for gallbladder surgery, or in the lower midline for hernia surgery. Similar trocar placements are used for other surgeries. If a stapling device is used during the procedure, then an additional trocar of the same size as the one at the navel is placed to accommodate that instrument. The instruments for grasping, stapling devices, clip appliers, retractors and cautery devices used during laparoscopic surgery are masterfully crafted and engineered devices.
- Smaller incisions result in less postoperative and a faster return to normal activities.
- The visualization with the laparoscope allows for a more precise dissection of tissues, identification of vital structures and safer procedures.
- The physiologic stress on the body and on tissues is lessened due to less dissection, smaller incisions and less pain.
- Areas in the body can often be seen more clearly with a laparoscopic approach than with an open technique.
- With our surgeons, the procedures done with a laparoscope will often be faster and require less anesthesia time than the same procedure done using an open technique.
- In some cases, inflammation or infection can be so severe that tissues cannot be safely handled and the problem cannot be corrected with a laparoscopic approach.
- In patients with intestinal blockages, due to swelling of the blocked intestine, there is not enough space in the abdominal cavity for a laparoscopic approach.
- Some tumors or cancers cannot be safely removed laparoscopically due to their size or location.
- In patients with prior abdominal surgeries, the scar tissue that may have formed can prevent a safe laparoscopic approach. However, previous abdominal surgery is not a contraindication for a laparoscopic procedure.
- Almost all laparoscopic procedures do require general anesthesia and some patients are too ill for general anesthesia.
Many common surgical procedures that may have been done with an open technique in the past can now be done using a minimally invasive approach such as a laparoscopic surgery.
A minimally invasive procedure results in less damage to normal tissues, more precise surgery on the tissue of interest, less pain due to small incisions and, finally, a faster return to normal activity.
Types of laparoscopic surgery we offer:
- Gallbladder removal (cholecystectomy)
- Inguinal hernia repair
- Hiatal hernia repair
- Colon resections for diverticular disease, polyps or cancer
- Appendix removal (appendectomy)
- Exploratory surgeries and biopsies