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Visceral surgery

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Dr. Stéphane BARCET

Dr. Wolfgang HAHN

Dr. Jean-Louis LORIN

 

 

Description :

The digestive surgeons in La Parisière are using standard open surgery as well as laparoscopic surgery (minimally invasive surgery).

Laparoscopy, which represents a huge progress in visceral surgery, has developed after the first cholecystectomy (removal of the gallbladder) in 1987, in Lyon.

Inert carbon dioxide is introduced into the peritoneal cavity in order to explore it with an optical instrument and an appropriate video camera. The surgeon can therefore introduce surgical instruments into the body to perform the intervention needed. The number of incisions (scars) as well as their size depends on the type of intervention.

This minimally invasive technique offers many advantages:

- It reduces the size of surgical incisions and therefore minimizes the risk of postoperative rupture.
- It decreases postoperative pain.
- It allows patients to resume eating more rapidly.
- It reduces the postoperative risks of complications due to prolonged stay in bed.

However, this technique presents risks that are not specific to minimally invasive surgery. For example:

- Infections, perforations or occlusions can occur during the intervention and alter the standard course of operations, be it in open surgery or laparoscopic surgery. We may therefore have to switch from laparoscopic surgery to standard open surgery (“conversion”). For instance, a trained surgeon performs more than 95% of laparoscopic cholecystectomies (removal of the gallbladder) but this percentage falls down to about 80% in case of inflammations such as cholecystitis.

It also presents risks that are specific to minimally invasive surgery:

- Wounds, perforations and haemorrhages are possible, particularly when introducing trocars and needles, as they can damage intra-abdominal organs, but also during the intervention as the visual field is more limited. This is quite rare but it can happen. In that case, suture must immediately follow and may require “conversion”.

- The establishment of a pneumoperitoneum with gas injection into the abdomen alters the body regulation mechanisms, which can cause disorders. Some patients will therefore not apply for this surgery. Sometimes, carbon dioxide can also cause pain in shoulders during the 2 days following the intervention.

Laparoscopy does not apply to all types of surgery. However, it has become a reference in some interventions such as gallbladder removal or other gynaecologic interventions. Its use has become more and more widespread and now concerns diseases such as inguinal hernia, gastroesophageal reflux disease and liver disorders, but also obesity surgery. Now, it has become possible to use laparoscopy to perform more important interventions such as colon removal when conditions are favourable.

Conclusion:

Laparoscopy offers many advantages such as minimally invasive surgery with best postoperative comfort for patients. However, minimally invasive surgery is not necessarily the best solution. Surgeons will choose between open surgery and laparoscopy during preoperative consultation, and they will decide which solution is best for the patient.

Laparoscopic surgery has been performed since 1989 in La Parisière which has progressively offered more and more laparoscopic interventions to its patients thanks to the progressive careful, diversified education of its surgeons in the best European centres.

Regular investments in state-of-the art materials such as HD video cameras, ultrasonic shears or monitoring devices allow us to keep our technical equipment up to date in order to offer the best conditions to the hospital’s surgeons who keep up their education regularly.

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