| Q.
Do you only remove the stones from the gall bladder? |
| A.
No, the gall bladder is removed with the stones exactly like
it would have been in an open operation. |
| Q.
How can it be removed from such a small hole? |
| A.
The human body has a great capacity to stretch. The holes can
stretch quite easily whiteout any harm to the body. In a way,
it is similar to child birth. |
| Q.
How is it disconnected from the liver and ducts? |
A.
The ends are clipped with titanium clips, which is a non
reactive element. The safety and superiority of titanium has
been proved over 50 years in its use for various purposes in
the body in India and abroad.
It is also possible to tie these structures like it is done
during open surgery. This procedure is slightly more difficult
technically and at present is being done by few surgeons only
who are doing mini/micro-laparoscopic surgery, which is going
to become the standard method in the 21st century.
|
| Q.
What is the recovery period? |
| A.
The patient can start drinking liquids soon after
coming out of the anesthesia which is about 4 hours after the
operation. They can start eating soon thereafter. The
patient is allowed to get off the bed 4 hours after the
surgery and walk to the toilet to pass urine. They are
usually allowed to go home the next day, can climb stairs and
the majority can get back to routine activity in 5 days
and back to work in about 10 days. |
| Q.
Is this operation safe in a fat patient? |
| A.
The operation is ideally suited for the fat patient as the
thickness of the tummy wall is immaterial when putting in the
telescope and instruments. This is in contrast to an open
operation where the fatter patient has a deeper and larger cut
causing more bleeding, stitches, and pain.
|
| Q.
Is it more risky for patients with other medical problems like
diabetes and blood pressure? |
| A.
No. On the contrary, the absence of any major cuts to the body
causes minimal disturbance to the physiology. Also the early
mobility and return to normal diet makes it easy for the body
to recover. |
| Q.
Is their any danger from the telescope inside the body? |
| A.
No, the telescope is used only to see and is not involved with
the operation. |
| Q.
Is there an increased risk of infection? |
| A.
No, the small cuts mean that less of the body is exposed to
infection. |
| Q.
Why do you approach the hernia from inside? |
| A.
The hernia is protrusion of the body contents through the
weakness in the muscle. It is logical that something coming
from inside is best dealt from inside. Also this way one does
not cut and weaken the already weak muscles at the hernia
site. |
| Q.
How safe is it to leave a mesh inside the body? |
| A.
The mesh used is the same as the one used for open operations
over last 30 years. Its safety and efficacy is beyond doubt as
proved by the numerous trials in the USA and Europe.
|
| Q.
Is this all very expensive? How can one justify the cost of
the equipment and surgery in a country like India? |
| A. The initial
cost of setting up is about Rupees ten lakhs which is nothing
when compared to the amount of money the government and
private hospitals spend on other things. Once the initial
setting up expenditure is covered, the cost of surgery is
actually less as has been proved by numerous studies in the
USA and the UK. |
| Q.
Will this mean very high bills in private institutions? |
| A.
No, as the hospital stay is reduced by 75%, the extra
operation cost will be compensated by the reduction in the
room charges.
The increased cost should be
compared with the gain associated by a quicker and more
productive return to work by the majority of the patients. The
hidden lowering of cost is due to less leave, early return to
normal activity and work, and also from the greatly reduced
disruption of the family routine. |
| Q.
What benefit is this to the government institutions? |
| A.
Owing to early discharge, it opens up beds for other patients
who would have otherwise have to wait for their treatment. The
government saves resources in terms of food, nursing care etc.
on these patients and it can be relocated to other patients.
|
| Q.
Who benefits the most from laparoscopic surgery? |
| A.
Everybody. The father who returns to work quickly (tremendous
benefit for the self employed ) , the mother can resume work
or get back to home soon and take charge of the disrupted
household as may the case be. Children are able to return to
school soon and do not miss out on studies or sport. |
| Q.
Is there any benefit to the employers? |
| A.
Yes, it means less sick leave and early return to work e.g.
after a gall bladder operation, an employee finds it difficult
to resume work till about 6 weeks to 3 months. Here, they can
be back to work in a week. |
| Q.
What about the poor people? |
| A.
In a country where manual labour is the main source of income
to the large majority, avoiding a cut in the muscles can only
have long term beneficial results. You can imagine the
significance to a rickshaw puller or a construction site
worker who can resume his work in two week after a
laparoscopic hernia repair compared to three months after
conventional open hernia repair.
|
| Q.
Is there any specific condition prevalent in India where it
has a special role? |
| A.
Yes, at times a surgeon has to do an operation of opening up
the abdomen or the chest to find out what is wrong with a
patient. This may be due to lack of availability of
sophisticated diagnostic tools like CAT scan, MRI scan etc. On
other occasions, even these investigations do not provide the
answer. In such situations, a diagnostic laparoscopy/
thoracoscopy can provide a quick diagnosis and on occasions
treatment. |
| Q.
Any particular disease? |
|
A.
TB of the abdomen is a difficult condition to diagnose. The
main complaint is usually non specific pain in the tummy and
on most occasions, the treatment is based on suspicion rather
than any objective criteria. In such situations, laparoscopy
can provide the answer.
The other
situation is when all X Rays and Scans point towards a
cancerous condition in side the body but treatment cannot be
started unless a part of it is biopsied and examined under the
microscope. Here instead of the tummy being cut open to get
the information, the laparoscope can be put in to see and also
take a biopsy. This is of immense benefit to patients who
require chemotherapy rather than surgery for the final
treatment.
|
| Q.
What is new in Laparoscopic Surgery ? |
| A. With the
advancement of technology, the engineers and manufacturers
have responded with telescopes of smaller diameter like 5 mm
and 3 mm as opposed to the 'conventional' laparoscopic 10mm
telescopes. Also instruments are being developed of 3 mm
diameter. This advancement is known as mini/micro/needloscopic
laparoscopic surgery. This is going to be the technique of 21st
century. |
| Q.
Are there any draw backs of laparoscopic surgery? |
|
A.
The danger is from the inexperienced laparoscopic surgeon as
there is rarely a more experienced person available for
guidance in case of difficulty. Unlike the USA and UK there is
no training program here and all depends on individual
enterprise. The safer surgeons do not consider it an insult to
their ego if they have to convert a laparoscopic procedure to
open in case of difficulty. Apart from this, the only other
thing is the reduction of sympathy levels from relatives as
the hospital stay is so short.
Unlike most
other professions, changes within the medical profession are
met with some resistance and scepticism. Successful examples
and a positive approach are essential for the implementation
of such programs. This figure should rise with increase in
awareness amongst general practitioners and the public. The
future generations while reading the history of surgery will
wonder why operations were ever done open.
|
|
|
| Q. What are the main advantages ? |
| A. There is no cutting of muscles hence
minimal pain and early return to normal activity. Secondly, as
the mesh is placed from inside covering the defect in a very
secure way, the chances of the hernia coming back is extremely
low. |
| Q. What is the recovery period? |
| A. The patient can start drinking
liquids soon after coming out of the anesthesia which is
about 4 hours after the operation. They can start eating
soon thereafter. The patient is allowed to get off the bed 4
hours after the surgery and walk to the toilet to pass
urine. They are usually allowed to go home the next day, can
climb stairs and the majority can get back to routine
activity in 5 days and back to work in about 10
days. |
| Q. What are the chances of the hernia
coming back? |
| A. Almost nil if the operation has been
done properly as has been shown in numerous studies abroad. |
| Q. Is it more risky for patients with
other medical problems like diabetes and blood pressure? |
| A. No. On the contrary, the absence of
any major cuts to the body causes minimal disturbance to the
physiology. Also the early mobility and return to normal diet
makes it easy for the body to recover.
|
| Q. Is their any danger from the
telescope inside the body? |
| A. No, the telescope is used only to see
and is not involved with the operation. |
| Q. Is their an increased risk of
infection? |
| A. No, the small cuts mean that less of
the body is exposed to infection. |
| Q. Why do you approach the hernia from
inside? |
| A. The hernia is protrusion of the body
contents through the weakness in the muscle. It is logical
that something coming from inside is best dealt from inside.
Also this way one does not cut and weaken the already weak
muscles at the hernia site. |
| Q. How safe is it to leave a mesh inside
the body? |
| A. The mesh used is the same as the one
used for open operations over last 30 years. Its safety and
efficacy is beyond doubt as proved by the numerous trials in
the USA and Europe.
|
| Q. Is this all very expensive? How can
one justify the cost of the equipment and surgery in a country
like India? |
| A. The cost of laparoscopic equipment
and the ' one use only (disposable) ' instrument that is used
to fix the mesh inside increases the cost of surgery.
Unfortunately these are still imported and will remain
expensive till thy are locally produced. However, the
increased cost should be compared with the gain associated by
a quicker and more productive return to work by the majority
of the patients. The hidden lowering of cost is due to less
leave, early return to normal activity and work, and also from
the greatly reduced disruption of the family rou-tine. |
| Q. Any advantage to the Indian situation
as compared to the West? |
| A. In the west, the support systems are much
better. Most patients travel by car or by public transport
which is user friendly like having steps reaching down to the
road, ramps and escalators at railway stations and subways.
Most people can afford a rest after surgery. In India, the
situation is quite the reverse. Buses have high steps and
usually it is a fight or at least a struggle to get on to the
bus which can move any time without any warning. There are no
ramps in most railway stations or subways. All systems require
straining if someone who has had surgery has to go out.
Scooters and cycle rides are not possible without straining.
Most people are self employed and cannot afford prolonged
rests. Hence minimally invasive treatment like laparoscopy for
hernia is more appropriate for countries like ours than to the
US and Europe.
|
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