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Laparoscopy

Laparoscopic surgery in Ahmedabad

Laparoscopic surgery – also called minimally invasive surgery (MIS), bandaid surgery or keyhole surgery, is a modern surgical technique in which operations in the abdomen are performed through small incisions (usually 0.5–1.5 cm) as opposed to the larger incisions needed in laparotomy.

Keyhole surgery makes use of images displayed on TV monitors to magnify the surgical elements.

Laparoscopic surgery includes operations within the abdominal or pelvic cavities, whereas keyhole surgery performed on the thoracic or chest cavity is called thoracoscopic surgery. Laparoscopic and thoracoscopic surgery belong to the broader field of endoscopy.

There are a number of advantages to the patient with laparoscopic surgery versus an open procedure. These include reduced pain due to smaller incisions and hemorrhaging and shorter recovery time.

The key element in laparoscopic surgery is the use of a laparoscope. There are two types:

(1) A telescopic rod lens system, that is usually connected to a video camera (single chip or three chip)

(2) A digital laparoscope where the charge-coupled device is placed at the end of the laparoscope, eliminating the rod lens system.

Also attached is a fiber optic cable system connected to a ‘cold’ light source (halogen or xenon or LED), to illuminate the operative field, inserted through a 5 mm or 10 mm cannula or trocar to view the operative field. The abdomen is usually insufflated, or essentially blown up like a balloon, with carbon dioxide gas. This elevates the abdominal wall above the internal organs like a dome to create a working and viewing space. CO2 is used because it is common to the human body and can be absorbed by tissue and removed by the respiratory system. It is also non-flammable, which is important because electrosurgical devices are commonly used in laparoscopic procedures

Procedures

Laparoscopic cholecystectomy is the most common laparoscopic procedure performed. In this procedure, 5–10 mm diameter instruments (graspers, scissors, clip applier) can be introduced by the surgeon into the abdomen through trocars (hollow tubes with a seal to keep the CO2 from leaking). Over one million cholecystectomies are performed in the U.S. annually, with over 96% of those being performed laparoscopically.

There are two different formats for laparoscopic surgery. Multiple incisions are required for technology such as the da Vinci Surgical System, which uses a console located away from the patient, with the surgeon controlling a camera, vacuum pump, saline cleansing solution, cutting tools, etc. each located within its own incision site, but oriented toward the surgical objective. The surgeon’s hands manipulate two haptic grippers which track hand movements and rotations while relaying haptic sensations back to the surgeon.

In contrast, requiring only a single small incision, the “Bonati system” (invented by Dr. Alfred Bonati), uses a single 5-function control, so that a saline solution and the vacuum pump operate together when the laser cutter is activated. A camera and light provide feedback to the surgeon, who sees the enlarged surgical elements on a TV monitor. The Bonati system was designed for spinal surgery and has been promoted only for that purpose.

Rather than a minimum 20 cm incision as in traditional (open) cholecystectomy, four incisions of 0.5–1.0 cm will be sufficient to perform a laparoscopic removal of a gallbladder. Since the gall bladder is similar to a small balloon that stores and releases bile, it can usually be removed from the abdomen by suctioning out the bile and then removing the deflated gallbladder through the 1 cm incision at the patient’s navel. The length of postoperative stay in the hospital is minimal, and same-day discharges are possible in cases of early morning procedures.

In certain advanced laparoscopic procedures, where the size of the specimen being removed would be too large to pull out through a trocar site (as would be done with a gallbladder), an incision larger than 10mm must be made. The most common of these procedures are removal of all or part of the colon (colectomy), or removal of the kidney (nephrectomy). Some surgeons perform these procedures completely laparoscopically, making the larger incision toward the end of the procedure for specimen removal, or, in the case of a colectomy, to also prepare the remaining healthy bowel to be reconnected (create an anastomosis). Many other surgeons feel that since they will have to make a larger incision for specimen removal anyway, they might as well use this incision to have their hand in the operative field during the procedure to aid as a retractor, dissector, and to be able to feel differing tissue densities (palpate), as they would in open surgery. This technique is called hand-assist laparoscopy. Since they will still be working with scopes and other laparoscopic instruments, CO2 will have to be maintained in the patient’s abdomen, so a device known as a hand access port (a sleeve with a seal that allows passage of the hand) must be used. Surgeons who choose this hand-assist technique feel it reduces operative time significantly versus the straight laparoscopic approach. It also gives them more options in dealing with unexpected adverse events (i.e. uncontrolled bleeding) that may otherwise require creating a much larger incision and converting to a fully open surgical procedure.

Conceptually, the laparoscopic approach is intended to minimise post-operative pain and speed up recovery times, while maintaining an enhanced visual field for surgeons. Due to improved patient outcomes, in the last two decades, laparoscopic surgery has been adopted by various surgical sub-specialties including gastrointestinal surgery (including bariatric procedures for morbid obesity), gynecologic surgery and urology. Based on numerous prospective randomized controlled trials, the approach has proven to be beneficial in reducing post-operative morbidities such as wound infections and incisional hernias (especially in morbidly obese patients), and is now deemed safe when applied to surgery for cancers such as cancer of colon.

The restricted vision, the difficulty in handling of the instruments (new hand-eye coordination skills are needed), the lack of tactile perception and the limited working area are factors which add to the technical complexity of this surgical approach. For these reasons, minimally invasive surgery has emerged as a highly competitive new sub-specialty within various fields of surgery.

The first transatlantic surgery (Lindbergh Operation) ever performed was a laparoscopic gallbladder removal.

Advantages:

There are a number of advantages to the patient with laparoscopic surgery versus an open procedure. These include:

  • Reduced hemorrhaging, which reduces the chance of needing a blood transfusion.
  • Smaller incision, which reduces pain and shortens recovery time, as well as resulting in less post-operative scarring.
  • Less pain, leading to less pain medication needed.
  • Although procedure times are usually slightly longer, hospital stay is less, and often with a same day discharge which leads to a faster return to everyday living.
  • Reduced exposure of internal organs to possible external contaminants thereby reduced risk of acquiring infections.
  • Although laparoscopy in adult age group is widely accepted, its advantages in pediatric age group is questioned. Benefits of laparoscopy appears to recede with younger age. Efficacy of laparoscopy is inferior to open surgery in certain conditions such as pyloromyotomy for Infantile hypertrophic pyloric stenosis. Although laparoscopic appendectomy has lesser wound problems than open surgery, the former is associated with more intra-abdominal abscesses
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General Surgery

Laparoscopic surgery in Ahmedabad

General surgery is a surgical specialty that focuses on abdominal contents including esophagus, stomach, small bowel, colon, liver, pancreas, gallbladder and bile ducts, and often the thyroid gland (depending on local reference patterns).

They also deal with diseases involving the skin, breast, soft tissue, and hernias.  Many procedures can be safely performed on an out-patient basis, allowing the patient to return home the same day after the immediate recovery period.

Expert treatment for patients who have conditions ranging from hernias and appendicitis to challenging and life-threatening diseases of the abdomen, liver, stomach, pancreas and intestines are available at Treya Surgicare.

At  Treya Surgicare we have a particular focus on minimal access (laparoscopic) surgery. Minimal access surgery is available for the surgical treatment of most abdominal disorders, including hernias and conditions of the stomach, intestines, gallbladder, pancreas and spleen.

General Surgery may sub-specialize into one or more of the following disciplines:

  • Trauma surgery

Some general surgeons obtain advanced training and specialty certification in this field alone. General surgeons must be able to deal initially with almost any surgical emergency. Often they are the first port of call to critically ill or gravely injured patients, and must perform a variety of procedures to stabilize such patients, such as intubation, burr hole, cricothyroidotomy, and emergency laparotomy or thoracotomy to stanch bleeding.

All general surgeons are trained in emergency surgery. Bleeding, infections, bowel obstructions and organ perforations are the main problems they deal with. Cholecystectomy, the surgical removal of the gallbladder, is one of the most common surgical procedures done worldwide. This is most often done electively, but the gallbladder can become acutely inflamed and require an emergency operation. Ruptures of the appendix and small bowel obstructions are other common emergencies.

  • Laparoscopic surgery

This is a relatively new specialty dealing with minimal access techniques using cameras and small instruments inserted through 0.3 to 1 cm incisions. Robotic surgery is now evolving from this concept (see below). Gallbladders, appendices, and colons can all be removed with this technique. Hernias are now repaired mostly laparoscopically. Most bariatric surgery is performed laparoscopically. General surgeons that are trained today are expected to be proficient in laparoscopic procedures.

  • Colorectal surgery

General surgeons treat a wide variety of major and minor colon and rectal diseases including inflammatory bowel diseases (such as ulcerative colitis or Crohn’s disease), diverticulitis, colon and rectal cancer, gastrointestinal bleeding and hemorrhoids.

  • Breast surgery

General surgeons perform a majority of all non-cosmetic breast surgery from lumpectomy to mastectomy, especially pertaining to the evaluation, diagnosis and surgical management of breast cancer.

  • Vascular surgery

General surgeons can perform vascular surgery if they receive special training and certification in vascular surgery. Otherwise, these procedures are performed by vascular surgery specialists. However, general surgeons are capable of treating minor vascular disorders.

  • Endocrine surgery

General surgeons are trained to remove all or part of the thyroid and parathyroid glands in the neck and the adrenal glands just above each kidney in the abdomen. In many communities, they are the only surgeon trained to do this. In communities that have a number of subspecialists, other subspecialty surgeons may assume responsibility for these procedures.

  • Transplant surgery

Responsible for all aspects of pre-operative, operative, and post-operative care of abdominal organ transplant patients. Transplanted organs include liver, kidney, pancreas, and more rarely small bowel.

  • Surgical oncology

Surgical oncologist refers to a general surgical oncologist (a subspecialty of general surgery), but thoracic surgical oncologists, gynecologic oncologists and so forth can all be considered surgeons who specialize in treating cancer patients. The importance of training surgeons who sub-specialize in cancer surgery lies in evidence, supported by a number of clinical trials, that outcomes in surgical cancer care are positively associated to surgeon volume—i.e., the more cancer cases a surgeon treats, the more proficient he or she becomes, and his or her patients experience improved survival rates as a result. This is another controversial point, but it is generally accepted—even as common sense—that a surgeon who performs a given operation more often, will achieve superior results when compared with a surgeon who rarely performs the same procedure. This is particularly true of complex cancer resections such as pancreaticoduodenectomy for pancreatic cancer, and gastrectomy with extended (D2) lymphadenectomy for gastric cancer.

  • Cardiothoracic surgery
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About Us

Treya Surgicare is a well-equipped center for advanced laparoscopy and GI surgery. Located at a prime location in heart of Maninagar, Ahmedabad.

Treya Surgicare was established with the motto of providing quality surgical care to the patients with focus on ethical protocol based management, patients’ disease awareness and complete health care. It was the vision of Dr Jaimish Gajjar, the driving force behind Treya Surgicare, to return to the society that which has been bestowed by the ALMIGTY.

Treya is the other name by which Gautam Buddha is referred to. The meaning of which is “One who walks the tri path of Love, Truth and Justice.” The logo of Treya Surgicare has three leaves which symbolize the three pillars of life – Love, Truth & Justice.

And true to the name, we aim to provide excellent surgical care based on ethics, compassion and honesty to the patients.

OUR VISION

Quality:

Quality is the foundation stone on which any institute or philosophy can survive for the longest time. In view of the same, we aim to provide the best quality care to the patient for maintaining excellence in healthcare services at par with the world. At Treya Surgicare there is no compromise at any level of quality care to the patient.

Compassion:

Compassion is the virtue bestowed upon human being by the GOD. It is the compassion which has made a humble human being to survive in this society and world and gives hope to many. Hence at Treya Surgicare we consider the patients as part of our family, not only to treat the disease for which the patient seeks us, but also to bring smile on the lips. Patients’ are not only cured of their physical ailment but are also made to feel happy and at home.

Honesty:

Honesty is a small word but caries a great meaning. Doctors being part of the noble profession are expected to be honest or ethical in other words. At Treya Surgicare the third aim is to be as honest to the patients and society as one can be. Honesty brings trust in our patients for building a life long healthy relationship.

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Post Operative Care

post-operative-care-after-srugery

Post Operative Period is the most crucial period for the patient and the relatives. At Treya Surgicare we take utmost care for the smooth post operative recovery of the patient.  There are few post operative instructions and information for the patients as mentioned below:

  • After the operation the patient may take some time to recover from the anaesthesia, this time varies from few minutes to may be an hour or so.  This depends upon the medical condition of the patient and the type of surgery.
  • Patient may feel sleepy immediately after the surgery/operation due to the sedation given during anaesthesia and sometimes during the recovery period.
  • Sometimes patients may have some discomfort while coming out of the sedation.  This gradually decreases over the period of time without any need of pain killer.  However as an when required analgesics/pain killers may be administered according to the instructions of the treating consultant.
  • Many of the times, patient may feel nauseated or may actually vomit in the immediate post surgical period.  This is common due to the effects of the anaesthetic agents. The patient usually recovers in in few hours.
  • Depending upon the type of procedure, patient may be allowed few sips of water after few hours of surgery. Liquids are allowed on the same day and light semi solid diet from next post operative day. In case of vomiting the same are withheld for some time and restarted.  Usually initially liquids are like tea/coffee/milk/juices/soups/water/coconut water etc.
  • Patients are usually advised semi solid diet which is non spicy and non oily for 2-3 weeks post operatively.
  • All the patients are advised to have small frequent meals in the immediate post operative days.  This is due to the chances of gastric bloating and belching in the post operative period due to the medications which me be advised during discharge.
  • Patient is advised moving of limbs in the post operative period to prevent deep venous thrombosis.  Also the it is advisable for the patient to go to the wash room on his/her own.  There are no physical restrictions of any kind in the post operative period.  It makes the patient feel relaxed and also helps in decrease of pain.  Early ambulation makes recovery faster and smoother.
  • In most of the laparoscopic procedures there is no restriction in any physical activity post surgery.  Patient can walk, jog, climb or even lift weight etc.  Patients can even drive two or four wheeler if he feels comfortable. This is in fact the advantage of minimal access surgery.
  • Depending upon the procedure, patients may be discharged on the first or the second post operative day in most of the cases unless there are no medical or social problems.  Patients as a routine are advised to follow up with the treating consultant after 3-5 days of discharge for dressings and wound examination.  After the dressings are done, patients can take bath or as advised by the doctor.  Once allowed, there are no special soaps or medications for bath.  Patient can use routine soaps for bath and stay clean.
  • Many of the times patients may develop some watery or bloody discharge from the wounds (particularly in case of obese/fatty patients).  This is usually not of much concern.  Many of  the times it is just lypolytic discharge.  Patients can themselves clean the discharge and get some primary dressings done.  In case of any anxiety patient may approach the hospital for inspection by the doctor.

This are the few instructions for smooth recovery of the patient.  Sometimes there may be some variation in the above depending upon the medical condition of the patient or the type of the disease pathology for which the patient was operated. We wish a speedy recovery to all the patients.