Laparoscopic Solid Organ Surgery

Overview

Laparoscopy is a surgical technique performed to examine the organs in the belly. It can also examine a woman's reproductive organs. Laparoscopy employs a narrow, illuminated tube equipped with a video camera. The tube is known as a laparoscope. It is inserted through a small cut or incision in your abdomen. The images from the video camera may be seen on a computer screen.

Laparoscopy has the advantage of being less intrusive. That is, it makes a very little cut in the stomach. Laparoscopy often takes less time and produces faster results than open surgery. A tiny tissue sample for testing may be obtained by laparoscopy (a biopsy). It can also be used to remove organs such as the appendix (appendectomy) or the gallbladder (cholecystectomy).

 

What is considered a solid organ?

The organs in the abdomen conduct a variety of duties, the most important of which is digestion. Organs that transmit food are hollow by definition, and hence are not considered solid organs. From the mouth to the anus lies a vast network of hollow organs that convert the food you ingest into components that support the body. The esophagus, stomach, small intestine (or small bowel), colon, and rectum are among these organs.

However, other organs generate secretions that act on the food we eat, as well as manage the amount and distribution of the sorts of food and water that the human body need to exist. Because the liver, pancreas, spleen, and adrenal glands are not hollow, they are classified as solid organs.

The solid organs are several abdominal organs that have a solid consistency and are not hollow and perform varied activities. The liver, spleen, kidneys, adrenal glands, pancreas, ovaries, and uterus are all examples of solid organs. Distinct from hollow organs such as the stomach, colon, gallbladder, and so on.

 

What is Laparoscopic Solid Organ Surgery?

Laparoscopic solid surgery, which eliminates the need for big incisions, makes solid organ resection (or removal) easier. It has transformed how surgeons handle many general surgical problems. Although laparoscopic procedures cannot be employed for every treatment or every patient, they have grown in popularity.

Laparoscopic techniques have substantially improved a surgeon's capacity to do a surgery (such as solid organ excision) with less pain and a faster recovery time for the patient. This is one example of a broader trend toward "minimally invasive therapy," which reduces treatment burdens. The ultimate objective would be to treat all ailments externally, with no invasive or open treatments required.

 

What are the benefits of laparoscopic surgery?

For a variety of reasons, laparoscopic surgery is preferred to open surgery and more invasive techniques. Surgeons can perform resections and involved surgical procedures utilizing a fiber optic camera known as a laparoscope and specially designed equipment by operating via small incisions carefully put around the abdomen area.

Laparoscopic surgery decreases blood loss during surgery while also resulting in reduced post-operative scars. Furthermore, laparoscopic surgery lowers postoperative problems such as infection, blood clots, and hernias, as well as postoperative discomfort, necessitating less analgesics. Because the incisions are tiny (the process is also known as keyhole surgery), patients often recover faster and have fewer adverse effects as they recuperate.

 

What is Laparoscopic Splenectomy?

The spleen is a tiny organ (not involved in digestion) that is largely buried below the stomach and lower ribs on the left side of the belly. Its major purpose is to filter blood by eliminating and recycling old blood cells. Furthermore, the spleen produces white blood cells that help in the healing of injured tissues and stores a reserve of red blood cells in the case of a significant blood loss.

A splenectomy is the surgical removal of the spleen. A partial splenectomy is when portion of the spleen is removed, while a total splenectomy is when the entire spleen is removed. Because the spleen holds a large volume of blood, especially at rest, an injury or rupture of the spleen can result in significant internal bleeding and death.

 

Indications for Splenectomy:

Splenectomy is performed to address splenic disorders, symptoms, and ailments such as:

• The most frequent reason for splenectomy is a ruptured spleen, which generally happens as a consequence of a severe abdominal injury or an enlarged spleen (splenomegaly)
• Splenic abscess infection resistant to other treatments
• Blood illnesses that are resistant to alternative treatments, such as idiopathic thrombocytopenic purpura, polycythemia vera, sickle cell disease, and thalassemia
• Cancers such chronic lymphocytic leukemia, Hodgkin's lymphoma, Non- Hodgkin's lymphoma, and hairy cell leukemia.
• Noncancerous splenic cyst or tumor that cannot be removed
• Enlarged spleen causing discomfort and a sense of fullness
• Hereditary spherocytosis (HS)
• Splenic artery aneurysm

 

Procedure:

• The procedure is carried out under general anesthesia.
• A cannula is inserted into the abdomen, allowing it to expand with carbon dioxide gas to provide a working area.
• A laparoscope is inserted through one of the cannulas, and a video image of the internal organs and spleen is shown on a television display.
• Several cannulas are put in various areas on the abdomen to let the surgeon to insert tools into your stomach to remove your spleen.
• The spleen is removed from everything to which it is attached and placed within a special bag. The bag containing the spleen is inserted into one of your abdomen's smallest but biggest incisions.

In certain circumstances, the spleen is too big to be removed laparoscopically and must be removed by open conventional surgery. If there is a lot of scar tissue or trouble seeing clearly enough to conduct laparoscopy, an open operation may be needed. Another reason for avoiding laparoscopy is bleeding. While the decision on which type of surgery to undertake is normally made before to operation, if one of these issues arises during surgery, the surgeon may be forced to switch to open surgery.

 

Recovery after Laparoscopic Splenectomy:

A hospital stay is necessary following surgery for monitoring. An IV is used to provide pain medicines and fluids. A couple of days to a week is typical for an open splenectomy; laparoscopic splenectomy patients are generally discharged sooner. The usual recuperation time is four to six weeks.

As with any operation, problems are possible. Infection is one of the most prevalent spleen removal side effects. A splenectomy may potentially result in pneumonia or pancreatitis (inflammation of the pancreas). Antibiotics are frequently administered soon before surgery to avoid infection.

Living without the spleen renders patients more susceptible to infections, particularly hazardous bacterial infections that cause severe pneumonia, meningitis, and other serious diseases, since the spleen plays a crucial role in the body's immune response. Vaccinations are often administered to patients two weeks before to surgery or two weeks following emergency surgery. Other vaccines may also be advised.

 

What is Laparoscopic Adrenalectomy?

Adrenal glands, which are not involved in food digestion, are placed on top of the kidneys and produce hormones in reaction to stress as well as influence kidney functioning through secretions. Cortisol is a significant hormone produced by the adrenal gland that, in excess, can induce weight gain, rising blood sugars, menstrual abnormalities, increased thirst, higher blood pressure, and even more frequent infections. Sugar or salt cravings, low blood sugar, low blood pressure, skin rashes, allergies, depression, and anxiety are all symptoms of low cortisol. Cortisol levels, whether high or low, can cause sleep and tiredness problems.

An adrenalectomy is a surgical procedure that removes one or both of your adrenal glands. You may need surgery if a non-cancerous (benign) or malignant adrenal tumor is identified, or if it has migrated (metastasized) to the gland from another region, such as the kidney or lung. Tumors of the adrenal cortex raise blood levels of aldosterone, but tumors of the medulla produce significant variations in heart rate or blood pressure, which can be fatal. If one adrenal gland is gone, the other takes over complete control, eliminating the need for supplement drugs.

 

Indications for Adrenalectomy:

Adrenalectomy is a surgical procedure used to treat diseases, symptoms, and conditions affecting one or both adrenal glands, such as:

• Adrenal tumors, benign or malignant - most frequent reason; one or both adrenal glands may be removed; most adrenal tumors are benign (noncancerous)
• Excess hormone synthesis, which is frequently caused by a tumor
• Greater than two-inch increase in gland size

 

Procedure:

Open surgery is less common than laparoscopic adrenalectomies. Small incisions around the belly button are made in the abdomen to reach the adrenal glands during a minimally invasive adrenalectomy. Through one of the incisions, a small camera is placed. The abdominal cavity is inflated with gas to allow the surgeon to examine the adrenal glands properly. Small surgical instruments are introduced into the incisions, and the adrenal glands and blood arteries are cauterized. The adrenal glands are extracted through one of the incisions in a plastic bag.

Some adrenal glands or tumors on them are too big for laparoscopic excision and will require an open surgical operation. Large incisions are created beneath the ribs or along the sides of the body. Blood arteries are tied off to prevent excessive bleeding, and the abdominal cavity is cleaned with saline. Stitches are used to seal the incisions.

Cryoablation is another treatment option for adrenal tumors that employs computed tomography (CT) imaging to guide the placement of a probe used to freeze and eliminate adrenal tumors. Interventional radiologists frequently use cryoablation to treat metastatic small tumors when surgery is too risky.

 

Recovery after Laparoscopic Adrenalectomy:

A hospital stay of one to three days is typical after a laparoscopic adrenalectomy. Open operations necessitate a hospital stay of four to five days. The gas used to inflate the abdomen may cause some pain at the incision sites, as well as cramping or bloating.

Heavy lifting should be avoided for four to six weeks following surgery; however, individuals who have had an adrenalectomy can return to work as soon as they feel ready. If both adrenal glands were removed during the adrenalectomy, supplementary medication therapy to replace the hormones typically produced by the adrenal glands will be necessary. If only one of the adrenal glands is removed, the surviving adrenal gland can perform all of the duties that both previously performed.

 

What is Laparoscopic Pancreatectomy?

The pancreas is a gland roughly the size and shape of a small banana that is located in the upper abdomen, partially behind the stomach and near the spine. When food enters the stomach, particular pancreatic cells release pancreatic enzymes (or juices) into a network of tiny ducts that eventually flow into the duodenum, the first segment of the small intestine. As food passes through the stomach, these liquids help in digestion. The pancreas also produces two hormones, insulin and glucagon, which work together to maintain correct blood sugar levels in the body.

A pancreatectomy is the surgical removal of the entire or a portion of the pancreas. Pancreatectomy can be of several types:

• Pancreaticoduodenectomy
• Distal pancreatectomy
• Segmental pancreatectomy 
• Total pancreatectomy.

 

Indications for Pancreatectomy:

A distal pancreatectomy is often performed to remove benign or malignant pancreatic cancers detected in the pancreas's body or tail. Chronic pancreatitis and pancreatic damage are other reasons for a distal pancreatectomy.

A pancreatectomy is used to treat a wide range of pancreatic illnesses and disorders, including:

• Pancreatic cancer
• Benign and malignant tumors such as islet cell tumors, ampullary cancer, lymphoma, and papillary cystic neoplasms
• Cancer of the bile duct's distal (lower half) 
• Duodenal cancer
• Pancreatitis with necrotizing pancreatitis 
• Severe, chronic pancreatitis
• Severe hypoglycemia with hyperinsulinemia
• Trauma

 

Procedure:

An incision is made to allow a clear view of the pancreas and spleen. The abdomen is inflated with gas to offer the surgeon a clearer view of the abdominal cavity. The surgeon will next determine the size of the incision and if a less invasive laparoscopic surgery is necessary. The surgeon must decide how much of the pancreas and spleen to remove during surgery.

There are three small incisions: one for the camera, one for the surgical equipment, and one for the surgeon's hand. The diseased pancreas and, if required, the spleen are removed by the surgeon. The operation lasts three to four hours.

 

Recovery after Laparoscopic Pancreatectomy:

A catheter and/or an abdominal drainage tube may still be implanted after surgery. The amount of time spent in the hospital following surgery is determined by the type of operation and the individual's rate of recovery. After a distal pancreatectomy, most patients stay in the hospital for three to four days. For the first day or two, solid meals are prohibited. Pain relievers will be prescribed as needed. Fatigue may linger six to eight weeks after surgery, although it will gradually improve.

For at least eight weeks, heavy lifting (weighing more than five pounds) should be avoided. Any activity should be approved by a doctor; nevertheless, aerobic exercise, such as walking and stair climbing, will help you acquire strength and feel better overall. Exercises for coughing and deep breathing may be given.

 

What is Laparoscopic Hepatectomy?

The liver is the body's biggest solid organ. It eliminates toxins from the body's blood supply, keeps blood sugar levels stable, controls blood clotting, and performs hundreds of other essential activities. It is placed in the right upper abdomen, beneath the rib cage.

The surgical removal of the liver is known as a hepatectomy. For liver transplantation, partial hepatectomy is undertaken. The scope of surgery is determined by the patient's health as well as the liver's function. A portion of the liver or a whole lobe may be removed by the surgeon. In a partial hepatectomy, however, the surgeon leaves a perimeter of viable liver tissue. Only in a few situations is a liver transplant necessary.

 

Indications for hepatectomy:

A partial liver resection is often performed by a surgeon to remove a malignant, precancerous, or benign (noncancerous) lesion. Liver cancer can be primary, which means it starts in the liver, or secondary, which means it starts in another organ and spreads to the liver.

The following are the most frequent liver malignancies treated with partial hepatectomy:

• HCC (hepatocellular carcinoma) (primary liver cancer).
• Cholangiocarcinoma (primary liver cancer).
• Colorectal cancer with metastasis (secondary liver cancer).

Other benign lesions are:

• Gallstones in the intrahepatic ducts, which are the bile channels that go through your liver.
• A liver cystadenoma or a cyst if they induce symptoms.

As a living liver donor, you may potentially have a partial liver resection. This procedure involves the removal of a part of your healthy liver in order to give it to someone in need of a liver transplant. Both your remaining liver and your transplanted liver will regenerate into full-sized livers.

 

Procedure:

• During a hepatectomy, the surgeon makes two or three tiny incisions in the abdomen to insert tube-like surgical instruments
• The abdomen is then filled with gas, usually carbon dioxide, to aid the surgeon's view of the abdominal cavity.
• The surgeon then enters the laparoscope and instruments through these incisions and removes the affected portion of the liver by placing it inside a bag inside the body.

 

Recovery after Laparoscopic Hepatectomy:

In general, recovery following laparoscopic or robotic surgery is faster. You will heal at home for two to four weeks, but it will take another six to eight weeks before you can resume your typical activities.

Getting adequate protein and doing some little exercise (such as walking) every day will help you recover faster. Try to walk for at least 30 minutes every day, but take breaks as needed. For a while, you'll feel painful and weary. You may also have nausea at initially. These symptoms should subside during the first two weeks. Take it easy in the meanwhile.

 

What is Laparoscopic Nephrectomy?

The kidneys are two bean-shaped organs located on either side of your spine, behind your ribs and below your abdomen. Each kidney is around 4 to 5 inches long and about the size of a huge hand. It is the kidneys' function to filter your blood. They eliminate waste, regulate fluid balance, and maintain proper electrolyte levels in the body. All of your blood travels through them around 40 times every day.

Nephrectomy is a surgical surgery that involves the removal of all or part of the kidney. It is also used to extract a healthy kidney from a donor in preparation for transplantation. For a sick kidney, there are two methods of nephrectomy:

• Total nephrectomy: A total nephrectomy entails the removal of the entire kidney.
• Partial nephrectomy: A partial nephrectomy removes only the damaged or injured section of the kidney.

 

Indications for Nephrectomy:

The most common purpose for nephrectomy is to remove a kidney tumor. A kidney tumor can be either malignant or benign (noncancerous). Some patients require a nephrectomy if their kidney is the source of repeated infections or is no longer functioning properly. Nephrectomies are also used by surgeons to remove a healthy kidney for donation.

 

Procedure:

• The operation is conducted under general anesthesia and involves a few minor punctures or incisions in the abdomen.
• A laparoscope and equipment are passed via these keyhole incisions into the belly, allowing the surgeon to dissect the kidney.
• The kidney is then put in a plastic bag and removed via an extension of pre-existing incision sites.

 

Recovery after Laparoscopic Nephrectomy:

You will be allowed to eat and drink as much as you want. You'll be able to stroll to the shower and get out of bed. To keep you comfortable, you will be given pain medications on a daily basis, such as Panadol. Your wound drain will be removed if the drainage is modest. When you are mobile and your urine flow is adequate, your catheter will be removed as well. You will be allowed to go home once your drain has been removed, you have finished your course of intravenous antibiotics, you have been taught catheter care, and you are comfortable up and about.

There is a danger of infection and blood loss with any procedure. The kidneys have a significant blood supply, and operation always involves some bleeding. Antibiotics are frequently used during surgery to avoid infection. A blood transfusion may be required to compensate for blood loss after surgery in a limited percentage of patients. If you require a blood transfusion and choose to decline one, you must notify your surgeon and nurse prior to the procedure. Prior to surgery, you may be able to donate some of your own blood.

Your wounds should recover in a matter of days. However, the muscular layers beneath your skin will take longer to recover. As a result, it is important to avoid intense activities, hard lifting, and straining for two to three weeks. This includes lawn mowing, gardening, vacuuming, and carrying big laundry baskets.

 

Conclusion

Laparoscopic operations are growing more popular among both surgeons and patients because to lower discomfort, lower perioperative morbidity, and faster return to self-reliance. When opposed to procedures such as laparoscopic cholecystectomy, laparoscopy for solid organ surgery has evolved more slowly due to variables such as smaller case numbers and improvement of technology particular to surgeries involving the spleen, adrenal, pancreas, and liver. Future technological integration will enable surgeons to provide ever less morbid therapy focused at the greatest clinical outcome for the patient.