Laparoscopic Procedures: An Overview of Minimally Invasive Surgery

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Guest: Dr. David B. Adams - General and Gastrointestinal Surgery

Host: Dr. Linda Austin – Psychiatrist

Announcer: Welcome to an MUSC Health Podcast.

Dr. Linda Austin: I am Dr. Linda Austin. I am talking with Dr. David Adams, who is Professor of Surgery at the Digestive Disease Center here at MUSC. Dr. Adams, in the area where you have done a lot of work is in the laparoscopic removal of all sorts of organs of the abdomen. What are some of the organs that can be removed laparoscopically?

Dr. David B. Adams: So, there has been in the last 20 years a virtual laparoscopic revolution and of course the most known operation is to remove the gallbladder with a laparoscope called laparoscopic cholecystectomy or commonly even laser operation, people refer to it because the laser were used initially. But that field progressed rapidly and so virtually any operation that a gastrointestinal surgeon does can be done with the laparoscope just with minimally invasive techniques, making small incisions in the abdominal wall and putting a telescope and a TV camera in the abdomen and operating inside the abdomen with instruments that can replicate and do exactly what we could do with open surgery, so some of the new operation that we do involve removing the spleen with the laparoscope. The adrenal gland is a very small gland that sits in and it’s difficult to get tube placed, so that’s particularly well suited to a laparoscopic operation because what the laparoscope allows you do is to get to an area that’s difficult to approach through normal open techniques and it gives you great light to see what you need to see. It gives you great exposure so that nothing is in the way, you have a direct view of what you are looking at, and it gives you a magnified view. So, an adrenal gland is a tiny little gland about the size of a walnut that sits on top of the kidney and that’s an organ that if it has a tumor can be removed with the laparoscope and takes what used to be a big operation that people would stay in the hospital for a week or longer for it, makes it an overnight procedure. We are also able to remove portions of the pancreas, do pancreatic surgery with a laparoscope and to free up an organ that in text books is typically referred to as Tiger Country it’s a dangerous place to be, but with advantages of a laparoscope, with the magnified view, and with good exposure the pancreas can be removed and taken out through minimally invasive techniques.

Dr. Linda Austin: What are some reasons you would choose not to remove an organ laparoscopically?

Dr. David B. Adams: There are situation where you cannot determine exactly what the problem is. So, if you know exactly what you are going to do, if you have a clear cut mission, then the laparoscope is a good operation. If you have to figure out what’s going on, to say, differentiate a benign condition from cancer, then the laparoscope would not be good. If a patient had very severe inflammation and infection in the area, you are going to work in, and it was very, very unfriendly and dangerous, then the laparoscope wouldn’t be suitable then you would need to use traditional open techniques where you will have more fingers and hands available to take care of things that develop.

Dr. Linda Austin: So, the concern would be then if there were an infection or an abscess that you might spread that actually laparoscopically if better controlled will be open up, is that right?

Dr. David B. Adams: You may spread infection laparoscopically, but what’s more fearsome is that you can’t define normal anatomy, you can’t see where you are and so it’s easy to get lost laparoscopically if the anatomy is not straightforward.

Dr. Linda Austin: You make it all sound very simple and that everything is easily visible, but I can’t help it wonder how one learns how to do laparoscopic procedure. You know with open procedures, you have medical students and residents and fellow standing around watching the procedures. With this it would seem that you have one person at a time looking inside. How do you learn?

Dr. David B. Adams: Now, when we teach residents how to do surgery, we teach them two ways. We teach open techniques and then we teach laparoscopic and laparoscopic techniques are very fascinating to watch because it’s entirely different part of your brain where the most important part is not necessarily your motor skills, your ability to jump high and run fast, but it’s your perceptual skills. It’s how good you are at seeing things that are in two dimension and recreating that and making it three dimensions and it’s a gradual learning process that we are learning more and more about everyday, but it’s fascinating part of educating, teaching, and perceptual psychology fascinating.

Dr. Linda Austin: So when the residency fellows are learning that, do they learn with animal models or how do they go about learning?

Dr. David B. Adams: There is a graduated program in which laparoscopic skills are taught. So it’s starts out with the dry lab where they are working on computer simulated games and they will do simple techniques that accustom them to working with two hands on a TV camera and it would be a simple game such as moving a ball from one side of box to another. So, after doing simple games they could actually do operations on a TV screen such as removing a gallbladder. It’s not the same as doing it in the operating room, so after they?ve practiced in the laboratory, then they move to the operating room and gradually start out watching operations, holding the cameras, and then working side by side with the attending surgeon to do the same maneuvers.

Dr. Linda Austin: From your point of view, which procedure do you prefer given a choice, open or laparoscopic?

Dr. David B. Adams: If an operation can be done laparoscopically, it’s a wonderful elegant way to go. It’s not affective in all situations and then the traditional operations may be used and sort of the bottom line of all surgery is, you want to have the lowest amount of injury to the patient as possible, to be the least amount of trauma. So, sometimes that’s laparoscopic frequently it is, but occasionally there is less injury to the patient doing it with traditional open techniques.

Dr. Linda Austin: Thank you very much Dr. Adams.

Dr. David B. Adams: You?re welcome Dr. Austin.

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