What are the key advantages of laparoscopic surgery. How has laparoscopic technology evolved over time. What are the most common laparoscopic procedures performed today. How does laparoscopic surgery compare to traditional open surgery in terms of patient outcomes. What are the latest innovations in minimally invasive surgical techniques.

The Evolution and Principles of Laparoscopic Surgery

Laparoscopic surgery, also known as minimally invasive surgery, has revolutionized the field of surgery over the past few decades. This technique involves making small incisions and using specialized instruments to perform procedures inside the body while viewing the surgical site on a video monitor. But how exactly did laparoscopic surgery develop, and what are its core principles?

The history of laparoscopy dates back to the early 20th century, with the first laparoscopic procedure performed in 1901 by German surgeon Georg Kelling. However, it wasn’t until the 1980s that laparoscopic techniques began to be widely adopted for a variety of surgical procedures. The development of high-resolution video cameras and more advanced surgical instruments paved the way for the laparoscopic revolution.

At its core, laparoscopic surgery is guided by several key principles:

• Minimizing trauma to the patient through smaller incisions
• Enhancing visualization of the surgical site using specialized cameras and monitors
• Utilizing specialized instruments designed for minimally invasive techniques
• Maintaining a stable operative field through controlled insufflation of the abdominal cavity
• Emphasizing precise dissection and meticulous hemostasis

These principles allow surgeons to perform complex procedures with reduced patient discomfort, faster recovery times, and improved cosmetic outcomes compared to traditional open surgery.

Advantages and Benefits of Laparoscopic Techniques

Why has laparoscopic surgery become so prevalent in modern surgical practice? The advantages of this minimally invasive approach are numerous and significant for both patients and healthcare systems.

For patients, the benefits of laparoscopic surgery include:

• Smaller incisions, resulting in less postoperative pain
• Reduced risk of surgical site infections
• Shorter hospital stays and quicker return to normal activities
• Decreased blood loss during surgery
• Improved cosmetic outcomes with minimal scarring
• Lower risk of postoperative adhesions and hernias

From a healthcare system perspective, laparoscopic surgery offers advantages such as:

• Reduced overall costs due to shorter hospital stays
• Increased surgical efficiency and throughput
• Lower rates of surgical complications and readmissions
• Improved patient satisfaction and outcomes

These benefits have led to the widespread adoption of laparoscopic techniques across various surgical specialties, from general surgery to gynecology and urology.

Common Laparoscopic Procedures and Their Outcomes

Which surgical procedures are most commonly performed using laparoscopic techniques? The versatility of laparoscopy has allowed it to be applied to a wide range of operations across different specialties.

Some of the most frequently performed laparoscopic procedures include:

1. Cholecystectomy (gallbladder removal)
2. Appendectomy
3. Hernia repair (inguinal, ventral, and hiatal)
4. Colorectal resections
5. Gynecological procedures (hysterectomy, oophorectomy)
6. Bariatric surgery (gastric bypass, sleeve gastrectomy)
7. Nephrectomy and other urological procedures

Studies have consistently shown favorable outcomes for laparoscopic approaches compared to open surgery in these procedures. For example, a meta-analysis of laparoscopic versus open cholecystectomy found that laparoscopic patients experienced less postoperative pain, shorter hospital stays, and faster return to work, with no significant difference in complication rates.

Similarly, laparoscopic colorectal surgery has been shown to result in faster recovery of bowel function, reduced postoperative pain, and shorter hospital stays compared to open surgery, while maintaining equivalent oncological outcomes in cancer cases.

Technological Advancements in Laparoscopic Surgery

How has laparoscopic technology evolved to enhance surgical capabilities? The field of minimally invasive surgery has seen rapid technological advancements in recent years, further improving outcomes and expanding the range of procedures that can be performed laparoscopically.

Some key technological innovations in laparoscopic surgery include:

• High-definition 3D imaging systems for improved depth perception
• 4K ultra-high-definition cameras for enhanced visualization
• Articulating instruments with increased degrees of freedom
• Energy devices for precise tissue sealing and dissection
• Robotic-assisted laparoscopic systems
• Single-incision laparoscopic surgery (SILS) platforms
• Augmented reality and image-guided navigation systems

These advancements have allowed surgeons to tackle increasingly complex procedures with minimally invasive techniques. For instance, robotic-assisted laparoscopic surgery has enabled more precise dissection and suturing in confined spaces, particularly benefiting procedures such as prostatectomy and complex pelvic surgeries.

Challenges and Limitations of Laparoscopic Approaches

Despite its many advantages, laparoscopic surgery is not without its challenges and limitations. What are some of the obstacles faced by surgeons and patients when it comes to minimally invasive techniques?

Some key challenges in laparoscopic surgery include:

• Steep learning curve for surgeons transitioning from open techniques
• Limited tactile feedback compared to open surgery
• Potential for longer operative times, especially during the learning phase
• Technical difficulties in patients with extensive adhesions or obesity
• Higher equipment and technology costs
• Risk of specific complications such as trocar injuries or gas embolism

Additionally, certain complex procedures or emergency situations may still require conversion to open surgery if laparoscopic techniques prove insufficient. It’s crucial for surgeons to maintain proficiency in both open and laparoscopic approaches to ensure optimal patient care in all scenarios.

Training and Education in Laparoscopic Surgery

How do surgeons acquire and maintain the skills necessary for laparoscopic surgery? The unique technical demands of minimally invasive procedures require specialized training and ongoing education.

Key components of laparoscopic surgical training include:

1. Didactic education on laparoscopic principles and techniques
2. Simulation-based training using virtual reality simulators and box trainers
3. Hands-on laboratory experience with animal models
4. Graduated clinical experience under supervision
5. Ongoing assessment of technical skills and outcomes

Many surgical residency programs now incorporate comprehensive laparoscopic training into their curricula. Additionally, fellowship programs in minimally invasive surgery provide advanced training for surgeons seeking to specialize in these techniques.

Continuing medical education and skills maintenance are crucial in the rapidly evolving field of laparoscopic surgery. Surgeons often attend workshops, conferences, and hands-on courses to stay updated on the latest techniques and technologies.

Future Directions and Emerging Trends in Minimally Invasive Surgery

What does the future hold for laparoscopic and minimally invasive surgery? The field continues to evolve rapidly, with several exciting trends and innovations on the horizon.

Some emerging areas in minimally invasive surgery include:

• Natural Orifice Transluminal Endoscopic Surgery (NOTES): Performing procedures through natural body openings to eliminate external incisions
• Advanced robotic systems with haptic feedback and autonomous functions
• Miniaturization of surgical instruments and imaging devices
• Integration of artificial intelligence for surgical planning and intraoperative guidance
• Telesurgery and remote surgical mentoring
• Personalized surgical approaches based on patient-specific anatomical models and simulations

These advancements aim to further reduce surgical trauma, improve precision, and enhance patient outcomes. As technology continues to progress, the boundaries between traditional laparoscopy, robotic surgery, and endoscopic techniques are likely to blur, leading to increasingly sophisticated minimally invasive approaches.

The Role of Laparoscopy in Emergency Surgery

While laparoscopic techniques have become standard for many elective procedures, their role in emergency surgery continues to expand. How has laparoscopy impacted the management of acute surgical conditions?

Laparoscopy in emergency surgery offers several advantages:

• Diagnostic capability in cases of acute abdominal pain
• Ability to perform definitive treatment in many cases
• Reduced postoperative pain and faster recovery in critically ill patients
• Lower risk of wound complications in contaminated cases

Common emergency procedures performed laparoscopically include appendectomy for acute appendicitis, cholecystectomy for acute cholecystitis, and repair of perforated peptic ulcers. Studies have shown comparable or superior outcomes with laparoscopic approaches in these scenarios compared to open surgery.

However, the decision to use laparoscopy in emergency situations depends on various factors, including the patient’s condition, the surgeon’s experience, and the availability of appropriate equipment. In some cases, such as severe abdominal trauma or hemodynamic instability, open surgery may still be the preferred approach.

Laparoscopic Surgery in Pediatric Patients

How has laparoscopic surgery been adapted for use in pediatric patients? The principles of minimally invasive surgery have been successfully applied to a wide range of pediatric surgical procedures, offering significant benefits to young patients.

Advantages of laparoscopy in pediatric surgery include:

• Reduced postoperative pain and analgesic requirements
• Faster recovery and return to normal activities
• Improved cosmetic outcomes, which can be particularly important for children
• Excellent visualization of anatomical structures in small body cavities

Common pediatric laparoscopic procedures include appendectomy, cholecystectomy, fundoplication for gastroesophageal reflux, and various urological procedures. The use of laparoscopy in pediatric patients requires specialized equipment and techniques to account for the smaller body size and unique anatomical considerations in children.

As with adult laparoscopy, ongoing technological advancements continue to expand the range of pediatric procedures that can be performed using minimally invasive techniques.

Economic Implications of Laparoscopic Surgery

What are the economic impacts of laparoscopic surgery on healthcare systems? While laparoscopic procedures often involve higher initial costs due to specialized equipment and longer operating times, they can lead to significant cost savings in other areas.

Economic benefits of laparoscopic surgery include:

• Reduced hospital length of stay, leading to lower inpatient costs
• Faster return to work, reducing societal costs of lost productivity
• Lower rates of surgical site infections and other complications, reducing readmission costs
• Decreased need for postoperative pain medication

Several cost-effectiveness analyses have demonstrated the overall economic advantages of laparoscopic approaches for various procedures. For example, a study comparing laparoscopic to open colectomy found that despite higher operative costs, the laparoscopic approach was associated with lower total hospital costs due to shorter length of stay and fewer complications.

As surgeons become more proficient and technologies continue to improve, the cost-effectiveness of laparoscopic surgery is likely to further increase, making it an attractive option for healthcare systems seeking to optimize resource utilization and improve patient outcomes.

Patient Selection and Preoperative Considerations for Laparoscopic Surgery

How do surgeons determine which patients are suitable candidates for laparoscopic procedures? While laparoscopy offers many advantages, not all patients or conditions are equally suited for minimally invasive approaches.

Factors considered in patient selection for laparoscopic surgery include:

• Patient’s overall health status and comorbidities
• Body habitus and previous abdominal surgeries
• Nature and extent of the surgical condition
• Urgency of the procedure
• Surgeon’s experience and comfort level with laparoscopic techniques

Preoperative evaluation for laparoscopic surgery often involves:

1. Thorough medical history and physical examination
2. Appropriate imaging studies to assess anatomy and pathology
3. Optimization of chronic medical conditions
4. Discussion of potential need for conversion to open surgery
5. Patient education on the specifics of laparoscopic approaches

By carefully selecting appropriate candidates and thoroughly preparing patients for laparoscopic procedures, surgeons can maximize the benefits of minimally invasive techniques while minimizing potential risks and complications.

The Impact of Laparoscopy on Surgical Training and Education

How has the rise of laparoscopic surgery affected surgical training programs and the education of future surgeons? The shift towards minimally invasive techniques has necessitated significant changes in how surgical skills are taught and assessed.

Key impacts of laparoscopy on surgical education include:

• Integration of laparoscopic skills training into residency curricula
• Development of simulation-based training programs
• Increased emphasis on video-based learning and remote mentoring
• Creation of fellowship programs specialized in minimally invasive surgery
• Need for ongoing skills assessment and maintenance throughout a surgeon’s career

The learning curve for laparoscopic surgery has led to debates about how to balance training in both open and minimally invasive techniques. Some concerns have been raised about the potential erosion of open surgical skills as laparoscopy becomes more prevalent.

To address these challenges, many training programs have adopted a comprehensive approach that includes:

1. Early exposure to basic laparoscopic skills
2. Graduated responsibility in the operating room
3. Use of virtual reality simulators and box trainers
4. Structured assessment of technical skills
5. Emphasis on conversion to open surgery when necessary

By adapting educational approaches to the realities of modern surgical practice, training programs aim to produce surgeons who are proficient in both open and laparoscopic techniques, ensuring optimal patient care across a wide range of scenarios.

Reviewer of the Month (2021)

Posted On
2021-10-20 17:17:35

Over the year, many LS reviewers have made outstanding contributions to the peer review process. They demonstrated professional effort and enthusiasm in their reviews and provided comments that genuinely help the authors to enhance their work.

Hereby, we would like to highlight some of our outstanding reviewers, with a brief interview of their thoughts and insights as a reviewer. Allow us to express our heartfelt gratitude for their tremendous effort and valuable contributions to the scientific process.

September, 2021
Siv Fonnes, University of Copenhagen, Denmark

October, 2021
Steve Coppens, University Hospitals in Leuven, Belgium
Yagan Pillay, Prince Albert, Canada

November, 2021
Zenichi Morise, Fujita Health University, Japan

December, 2021
Edward Matsumoto, McMaster University, Canada

September, 2021

Siv Fonnes

Siv Fonnes is a postdoctoral researcher at Centre for Perioperative Optimisation at the Department of Surgery and an assistant managing editor at Cochrane Colorectal both situated at Herlev Gentofte Hospital, University of Copenhagen, Denmark. Her research mainly falls into two areas. The first area is general surgery, especially appendicitis and hernias. The second area concerns with publication and dissemination of research, especially regarding Cochrane reviews, systematic reviews, and meta-analysis. Her recent research projects focus on the gut microbiome in patients suffering from appendicitis or appendicitis-mimicking symptoms. Diagnostic laparoscopy and appendectomy are both regarded as simple and safe procedures by surgeons. However, for the patients, it may be the first time they undergo general anaesthesia and a surgical procedure, and they will have a subsequent convalescence period. Furthermore, not all patients suffer from appendicitis. These research projects will hopefully give a better understanding of the pathophysiology of appendicitis, improve the preoperative diagnostic methods, and help target the treatment for patients with abdominal pain, so some patients may avoid unnecessary surgery. More information about Dr. Fonnes can be accessed through ResearchGate, Google Scholar, Orcid and LinkedIn.

Dr. Fonnes considers a healthy peer review system to be both “professional and timely”. By “professional” she means giving feedback in a respectful and thoughtful manner. All researchers have used resources on preparing their research and manuscript, and this should be acknowledged by the peer reviewer. And by “timely” she means providing both peer review and editorial handling as efficiently as possible, so manuscript handling is not delayed for several months or years, which unfortunately may sometimes be the case.

Nonetheless, on the basis of a good system, biases are still inevitable in peer review. To minimize biases, Dr. Fonnes thinks the first step is to acknowledge their existence. Practically, she often uses a reporting guideline when reading through a manuscript to aid focusing on providing feedback on the sections of the manuscript that will eventually increase the transparency of the reporting. She suggests the use of equator-network which she finds extremely helpful to identify relevant guidelines.

Data sharing is getting more prevalent in scientific writing in recent years. To Dr. Fonnes, this is a topic with both benefits and drawbacks. On the one hand, data sharing will be beneficial in providing accurate evidence, thus eventually help future patients, and she supports the efforts made to promote data sharing. However, the safety of the participants’ data and the legislation regarding research data constitute a potential dilemma in some countries. The data and personal contribution of these participants should be handled with care and respect, so while the goal is admirable and important, the logistics may sometimes make sharing of transparent and accurate data impossible.

“I often find myself learning from and being inspired by peer reviewing manuscripts written by fellow researchers. Also, I feel obligated to conduct peer review for fellow researchers as I myself am depended on them when I submit a manuscript. Lastly, I find that simply keeping track of the number of peer reviews I have conducted add to my motivation. I use Publons and I am grateful for the service they provide,” says Dr. Fonnes.

(By Brad Li, Eunice X. Xu)

October, 2021

Steve Coppens

Dr. Steve Coppens is a clinical director of regional anesthesia and head of the Department of Anesthesiology at the University Hospitals in Leuven, Belgium. Dr. Coppens obtained his medical degree Cum Laudat at the Catholic University of Leuven in Belgium in 1996. He completed his residency in Anesthesiology in 2001 at the University Hospitals of Leuven. He worked from 2001 to 2008 in private practice and developed his skills for regional anesthesia. From 2008 to 2012, he worked in a level one trauma center in the Netherlands, where his core business was developing locoregional standards and enhancing ultrasound skills for trauma patients. He implemented a newly developed locoregional learning program in Leuven and was instrumental in developing the regional anesthesia fellowship program, recognized by the ESRA as center of excellence. PhD on enhanced recovery programs and RA in thoracic and major abdominal surgery is currently in progress. You may access Dr. Coppens’s profiles through LinkedIn, Twitter and Orcid.

“Skip the ego, and help the authors rather than yourself,” says Dr. Coppens when he is asked what a constructive review is. To him, a review would be constructive when the reviewer actively reads the paper, not as a means to show the editor how eloquent he/she is and how many faults or problems he/she can detect, but instead thinks about how the paper can be elevated to become better and maybe even great. On the contrary, a review would be destructive when the reviewer simply aims at displaying his/her own knowledge, showing off how much he/she knows about the topic, and writing as many comments as he/she can, not in a way to make the paper better, but in a way to promote oneself. Instead of being rude and impolite when addressing one’s concerns, a good reviewer should applaud everyone who puts effort in something. Even if it is not good, there are always redeeming factor and possibilities to make it better.

Speaking of the qualities a reviewer should possess, Dr. Coppens stresses that a reviewer should have the knowledge of one’s own strong and weak points, “You might be good at structured writing and possess a lot of knowledge of the literature and the topic, but maybe not so good at statistics, or the other way around. Seeking advice and adding your own doubts about the parts you cannot adequately evaluate yourself, e.g. advice an external statistician to double check if you are unsure yourself. Be humble. Be open. I always write my name after a review, because I stand by my decision.”

From a reviewer’s perspective, Dr. Coppens urges authors to follow reporting guidelines, e.g. STROBE and CONSORT during preparation of their manuscripts. Being methodical and using a standardized way is the only way to prevent making errors and to be thorough. It would be shame and a waste of time to put effort and work into research which ultimately fails and even arrives to wrong conclusions. Every researcher has a responsibility in that and that is why this methodical aspect is so important also for reviewers.

“I spend my allotted me-time to do peer reviews, and it might not be good for my work-life balance. I do extend my deadlines a few times because of this time shortages. However, somebody’s got to do this,” says Dr. Coppens.

(By Brad Li, Eunice X. Xu)

Yagan Pillay

Dr. Yagan Pillay serves as a general surgeon in Prince Albert, Saskatchewan, Canada. He completed his undergraduate education in South Africa. After completing medical school in Manipal, India and houseman ship in Durban, South Africa, he went into family practice in rural South Africa for two years before returning to do his surgical residency at the Nelson Mandela Medical School from 2000-2005. He worked as a trauma surgeon at University of Malaya Medical Centre in Kuala Lumpur, Malaysia from 2007-2008 and then returned to Prince Albert in 2008. His practice encompasses all aspects of rural surgery including endoscopy and rural clinics.  His surgical interests are hernia and laparoscopic surgery. Dr. Pillay is actively involved in the teaching of undergraduate medical students, surgery residents and acute care fellows. In 2019, he became a council member of the College of Physicians and Surgeons of Saskatchewan. A detailed profile of Dr. Pillay can be accessed here.

Dr. Pillay believes peer review plays a valuable role in science by verifying the credibility of scientific articles. Scientists do not have the requisite knowledge to be able to understand all the concepts being discussed in an academic paper. Peer reviewers with adequate knowledge of the science behind will be able to discern the scientific validity of the paper in question. This leads to a sense of trust in the publication and the journal itself.

During review, there are a number of questions a reviewer should ask, according to Dr. Pillay: 1) Is the article authentic? 2) Are the facts checked out? 3) Are the references used valid to the paper at hand? 4) What are the potential pitfalls that prevent publication of the paper? He further explains, “To ensure we deliver a scientifically valid article thereby allowing us as scientists to retain public trust especially in times like nowadays with the COVID pandemic, our search for the scientific truth must be above reproach. ”

Viewing from a reviewer’s angle, Dr. Pillay highlights the significance for authors to disclose Conflict of Interest (COI). If the research is being paid for by pharmaceuticals or medical products companies, the relationship must be laid out clearly in the COI. Only then can the research presented be reviewed with all the known variables. If an undisclosed relationship is discovered later, all academic credibility of the authors will be tainted. While funding is important, it should in no way influence the outcomes of the study at hand.

(By Brad Li, Eunice X. Xu)

November, 2021

Zenichi Morise

Zenichi Morise M.D., Ph.D., FACS, is Professor and Chairman at the Department of Surgery Fujita Health University School of Medicine, Founding Past Director of Fujita Health University Okazaki Medical Center, and Deputy Chief Editor, Fujita Medical Journal (The Official Journal of Fujita Health University), Japan. He serves on editorial boards of World Journal of Gastroenterology, Frontiers in Surgery, World Journal of Gastrointestinal Surgery, Fujita Medical Journal, and Mini-invasive Surgery. He is actively involved in academic activities. He is a Fellow of American College of Surgeons, Founding Member of International Laparoscopic Liver Society, and Member of International Society of Surgery, Society for Surgery of the Alimentary Tract, American Gastroenterological Association and International Hepato-Pancreato-Biliary Association. You may take a look at Dr. Morise’s reserch profile here.

To Dr. Morise, peer review plays a vital role in science. Since scientists sometimes do not know the specific condition and standard of each area around the world even for their own specialty fields, they can learn about the world standard under the process of peer review.

There are some key qualities a peer reviewer should possess, in Dr. Morise’s opinion. They should possess wide range of knowledge and solid opinion around their fields. Furthermore, they should also have the flexibility of hearing/accepting new findings/conceptual changes. 

From a reviewer’s point of view, Dr. Morise emphasizes the need for research to apply for institutional review board (IRB) approval. To him, studies should be universally acceptable, not be arbitrary, even from their planning stage. IRB can secure that point.

“There could be sometimes whole new findings and conceptual changes in submitted papers. Also, through peer reviewing, we can realize what’s happening in each area around the world,” says Dr. Morise.

(By Brad Li, Eunice X. Xu)

December, 2021

Edward D. Matsumoto

Dr. Edward Matsumoto is an Associate Professor in the Division of Urology, Department of Surgery at McMaster University in Hamilton, Ontario, Canada. He is the Program Director of the Advanced Laparoscopic, Robotics, and Endourology Fellowship and affiliated with the Centre for Minimal Access Surgery at St. Joseph’s Healthcare Hamilton. Dr. Matsumoto’s clinical interests include advanced endourological surgery, including laparoscopic and robotic radical prostatectomy, and minimally invasive management of kidney cancers and stone disease. His research interests include a multifaceted approach to surgical education, primarily focusing on laparoscopic and robotic simulation training (including the development and validation of simulation models) and the assessment of technical skills and intraoperative performance. He has over 100 peer-reviewed publications, has written 12 textbook chapters, and regularly presents his research at local, national, and international meetings. The list of Dr. Matsumoto’s works can be found here.

LS: Why do we need peer review?
Dr. Matsumoto: Peer review is the foundation of academia. “Seeking the truth” is what we as researchers strive for, and peer review is the “sine qua non” process of research. Without peer review, research publications are not worth the paper (or digital memory) they are printed on.  Clinicians cannot make important health decisions without validated and peer-reviewed data and clinical guidelines. Lives and the health of people depend upon reliable and valid research. As clinicians, we value research that is well-designed and critically appraised. Unfortunately, social media, or “Facebook Medicine”, often distorts the truth by placing the emphasis on “likes” or “views” as a way of validating opinions as fact. This has created a dangerous paradigm in the world today. Widespread misinformation about COVID-19 is an unfortunate example of how seeking the truth has fallen by the wayside. The peer-review process remains a vitally important academic duty we as researchers must perform.

LS: What are the qualities a reviewer should possess?
Dr. Matsumoto: Reviewers should have a sound understanding of research methodology and statistical acumen in order to provide high-quality feedback and recommendations to improve the dissemination of research. Furthermore, reviewers should have a strong background and demonstrated experience in the content being peer-reviewed. Familiarity with the nuances of the particular field will generate a robust critical appraisal of the body of work. It is vital to the peer-review process that the reviewer possess this expertise and recognize whether they are suited to perform a given review, as this allows for a just review process that will provide the most useful feedback and lead to a quality paper.

LS: Is it important for authors to disclose Conflict of Interest (COI)?
Dr. Matsumoto: Without question, it is important for authors to disclose any COI, as well as any funding sources used to conduct the research. Readers should be provided this knowledge, as interpretation of studies and their results may be influenced by authors’ COI and funding sources. Sound research methodology minimizes the potential for biases, and the peer-review process should identify studies where COI and funding sources may have influenced outcomes. Interpretation of studies is left to the end reader and disclosure of COI is critical to this process.

LS: Would you like to say a few words to encourage all the other reviewers?
Dr. Matsumoto: Peer review can be a thankless job, but at the same time can be personally rewarding. It can take up a significant amount of time and most often there is no financial reward. However, reviewers are the “gatekeepers” of the academic world. The efforts of reviewers allow us to trust the research we read in journals and apply data and recommendations to our clinical practice. We are fortunate to have many qualified reviewers that hold the peer-review process in the highest regard and take pride in their contribution to academia. As researchers, we rely on peer review to improve our own work; therefore, it is important to give back to this process as a reviewer. 

(By Brad Li, Eunice X. Xu)

a review – O&G Magazine

The journey of laparoscopy, which is now reaching single-incision and robotic surgery, began with our quest to find ways to reduce operative morbidity.¹ Since those first steps were taken, gynaecological surgery with the use of minimally invasive techniques continues to change rapidly. With computerised design and microchip-controlled safety features, the laparoscopic surgeon is dependent on the equipment and needs to understand the electromechanical function of the instruments. In this changing environment, it is vital to understand the characteristics of the commonly used surgical instruments. The basic equipment essential for any laparoendoscopic procedure includes: endoscope, camera, light source, video monitor, insufflator, trocars and surgical instruments. However, there are many variants of each available.

The cost effectiveness of disposable versus reusable instruments is a subject of debate. The choice of the instrument is multifactorial and depends on function, reliability and cost. So, during most laparoscopic procedures, a combination of disposable and reusable instruments is used. Frequently, disposable trocars and scissors are used, while reusable instruments can be graspers, coagulation spatula/hook and needle drivers. The commonly used laparoscopic instruments are described below.

Uterine manipulators

These allow uterine positioning and expand operating space. Several uterine manipulators are available – the HUMI® (Cooper Surgical), the RUMI® (Cooper Surgical), Spackman, Cohen, Hulka, Valtchev, Pelosi and Clearview® (Endopath). Some are reusable while others are disposable. Most come with a channel to perform chromotubation; however, some (such as Hulka tenaculum and Pelosi) lack this channel. With 210˚, Clearview has the greatest range of motion in the anterior-posterior plane. Hulka tenaculum, Spackman’s and Cohen’s have a straight shaft, hindering their range of motion and limiting their use in advanced laparoscopic procedures.²

Figure 1. Trocar sleeves or collars with different textures.

Veress needle

This is a specially designed needle with a blunt-tipped, spring-loaded inner stylet and a sharp outer needle, used to achieve pneumoperitoneum while performing closed laparoscopy. It is available in disposable and reusable form, with 12cm or a 15cm length.

Most injuries in minimally invasive surgery are associated with primary port insertion, leading to an unresolved debate on the benefits of various entry techniques (open, closed or direct entry). There is no evidence that any single technique is better in preventing major vascular or visceral complications, though there is a higher risk of failed entry with closed entry. The most recent Cochrane review concluded there is a lower risk of vascular injury with the direct entry in comparison to use of Veress needle.³

Trocars/cannulas

These are used to create small passageways through the abdominal wall and are available in different textures (see Figure 1). Disposable and reusable trocars in various sizes are available and share the following common parts:

• Sharp tips cut an entry path through the abdominal wall while blunt tips stretch the tissues apart to gain access to the peritoneal cavity.
• Sleeve: is the working channel. Trocar sleeves or collars can have textures on the outer surface of the trocar that help it anchor to the abdominal wall. Some have an internal inflatable balloon at their tip and plastic/rubber ring to provide anchorage.
• Valve: different valve systems prevent gas leaking from trocars and allow the insertion of instruments.
• Side port: many trocars come with a side port that allows for gas insufflation or smoke evacuation.

Laparoscopes

The telescopes used in laparoscopy are available in sizes ranging from 2mm up to 12mm. The 10mm size is the one most commonly used in gynaecology. Similar to a hysteroscope, a laparoscope can come with an angle of view such as 0˚, 30˚ or 45˚. In an angled-view scope, the direction of vision points away from light source attachment. The 0˚ telescope offers a forward view corresponding to the natural approach and is preferred by most gynaecologists. It is useful if a less-experienced assistant is available. The 30˚ telescope can be rotated to enlarge field of view and can be advantageous for complicated cases. The 45˚ telescope is useful in single-incision laparoscopies, but is not commonly available. Every laparoscope has an engraved number by the eyepiece that specifies the viewing angle.

Figure 2. A range of grasper jaws.

Instrument dimensions

The commonest diameter for laparoscopic instruments is 5mm, though they range from 2–12mm. The narrower diameter (less than 5mm) instruments have less shaft rigidity and therefore are more flexible and more fragile than the wider versions. Standard instruments’ length ranges from 34–37cm. In bariatric patients or for single-site laparoscopy, 45cm-long instruments are useful.

Non-energy devices

Most laparoscopic instruments offer only four degrees of freedom of movement: in/out, up/down, left/right and rotation. In addition, certain devices called articulating/roticulating instruments offer angulation at their tips, which can be particularly useful in achieving triangulation while performing single-incision laparoscopy.⁴

Graspers and scissors usually have an insulated sheath, a central working device, a handle and a rotating capability at the working end.

Ringed handles are similar to the conventional ring handle found on most needle holders used in open surgery. They can be in line or directed 90˚ in relation to the working axis. Some handles are in between these two:

• a pistol handle allows integration of several functions; and
• a co-axial handle is in the instrument axis.

The handles come with different types of ratchets that provide a locking mechanism.

Scissors with curved tips, analogous to Metzenbaum, are commonly used. Most endoscopic scissors can also be attached to the electrosurgical unit. Scissors are produced with variety of tips.

Grasper jaws (see Figure 2) are either are single action (one fixed jaw and one articulated jaw) or double action (both jaws articulated). Single-action jaws close with a stronger force ideally suited for an instrument such as a needle driver. Double action allows the jaws to open wider, so they are better suited as a dissection tool. Numerous grasper variants exist, with the inner side of the jaws having different surface properties, depending on the intended use:

• Traumatic: deep serrations or toothed tip for secure grasping.
• Atraumatic: finely serrated for gentle handling.

Equally, laparoscopic tenacula are also available with single-toothed and doubletoothed jaws.

Many styles of needle drivers are available and selection largely depends on surgeon’s preference. The jaws are either curved or straight. They commonly have a flat or finely serrated grasping surface, enabling them to grasp the needle in all directions. Certain needle-holders (termed self-righting) have a dome-shaped indentation inside their jaws that automatically orientates the needle in a perpendicular direction, thus making it easier to grasp the needle. However, if there is a need to load the needle at an oblique angle, the indentation can make it harder. The needle drivers also have various types of handles (such as finger grip, palm grip, pistol grip) as described previously.

Myoma screws are in the shape of a probe with a corkscrew tip. They are frequently used during myomectomy.

The suction irrigator is a multipurpose piece of equipment. Most use a trumpet valve but some have a sliding valve. The irrigation system can be powered by various mechanisms including pressure bag or a pump. Omentum, fallopian tube or bowel can get drawn into the suction probe and care must be taken to release the attached tissues gently.

The aspiration needle is a 16/22-gauge needle used for aspiration and injection of fluids.

There are two types of knot pushers available: the closed-end and the open-end knot pusher. Both have their advantages and disadvantages.

Energy devices

Energy sources include monopolar, bipolar, advanced bipolar, harmonic, combined and morcellator devices. Monopolar devices are commonly used in endometriosis resection and for incising the vaginal cuff during laparoscopic hysterectomy. Various types of monopolar hooks and spatula are available and most scissors have an attachment to connect monopolar lead.

Bipolar devices contain the continuous waveform electrical current between the jaws of the forceps and hence reduce the chances of damage to adjacent tissue. They achieve tissue sealing and haemostasis by thermal coagulation, though they lack the ability to cut. The classic bipolar device is the Kleppinger bipolar forceps. Several types of bipolar devices, many of them in form of graspers, are now available.⁵

The surgical evolution of the energy devices, particularly with advanced bipolar features, has been the central point in exponential growth of laparoscopic procedures. The gain in popularity of these devices can be gauged by the fact that they are sometimes now used for open surgery and even vaginal surgery.⁶

Bipolar devices (such as LigaSure™, Gyrus PKS™ and EnSeal®) provide haemostasis for vessels up to 7mm. They provide a low voltage, have an impedance-based feedback that modifies the energy delivered and tissue temperature is regulated to be below 100°C. The bipolar energy thus delivered denatures the collagen and elastin in vessel walls. Denatured tissue, tissue apposition and pressure seal the vessel walls in a process called coaptive coagulation. In comparison to the traditional bipolar instruments, these devices have reduced thermal spread, diminished charring and reduced sticking. However, some of these devices require a specialist electrosurgical unit and they are costly.⁷

LigaSure (Covidien) provides a continuous bipolar waveform and has an integrated cutting mechanism. GyrusPK (Gyrus ACMI) delivers a pulsed bipolar waveform that allows tissue and device tip to cool during the energy off phase, but lacks the ability to cut. Enseal (Ethicon) has nanometre-sized conductive particles that direct the energy and control temperature between the jaws. Like LigaSure, it is multifunctional, with an I-Blade™ to cut the sealed tissue.

Harmonic devices have a piezoelectric crystal in their handpiece that converts the electrical energy into ultrasonic energy. This energy is delivered to the active blade at the tip of the instrument causing it to vibrate at 55 000Hz. The tip of the device cuts mechanically with a degree of collateral thermal coagulation used for haemostasis. There is no active current in the tissue. The advantage of harmonic devices is lower temperature (<80°C) as compared to other energy devices, hence reduced thermal spread and less charring. As a result of mechanical vibrations, in lower density tissue the intercellular water is vaporised at lower temperatures (<80°C) causing a ‘cavitation effect’ that can help in dissection by separating tissue layers. They are FDA approved for <5mm vessel sealing. Though harmonic devices operate at low temperatures, the active blade of the device becomes very hot and can remain so for some time. Care should be taken not to touch the vital structures with the jaws of the device for several seconds after activation.

Thunderbeat® (Olympus) combines both advanced bipolar electricity and ultrasonic energy in a single, multi-functional, handactivated instrument and can potentially reduce the surgical time.

Morcellators can be important tools for specimen removal during procedures, such as myomectomy, when a large amount of tissue is retrieved laparoscopically. Various types of morcellators are available on the market. The key safety maxim is to keep morcellator tip close to abdominal wall, to pull the tissue into the morcellator and not push the morcellator into the tissue. Morcellators require ports that are bigger than 5mm. Morcellation has recently been in news with a US Food and Drug Administration safety communication in 2014 swiftly followed by new and/or revised guidelines, including a joint statement by AGES and RANZCOG. To prevent tissue dissemination, power morcellation in an isolation bag has been proposed. Recently, an in-bag morcellation device (Alexis™ Contained Extraction System) has also been made available.^{8 9 10}

References

1. Behnia-Willison F, Foroughinia L, Sina M, McChesney P. Single incision laparoscopic surgery (SILS) in gynaecology: feasibility and operative outcomes. ANZJOG 2012; 52: 366-70.
2. Van den Haak L, Alleblas C, Nieboer TE et al. Efficacy and safety of uterine manipulators in laparoscopic surgery: a review. Arch Gynecol Obstet 2015; 291.
3. Ahmad G, Gent D, Henderson D et al. Laparoscopic entry techniques. Cochrane Database Syst Rev 2015; (31): CD006583.
4. Berber E, Akyuz M, Aucejo F et al. Initial experience with a new articulating energy device for laparoscopic liver resection. Surg Endosc 2014; 28: 974-8.
5. Harrell AG, Kercher KW, Heniford BT. Energy sources in laparoscopy. Semin Laparosc Surg 2004; 11: 201-9.
6. Lakeman MM, The S, Schellart RP. Electrosurgical bipolar vessel sealing versus conventional clamping and suturing for vaginal hysterectomy: a randomised controlled trial. BJOG 2012; 119: 1473-82.
7. Sankaranarayanan G, Resapu RR, Jones DB et al. Common uses and cited complications of energy in surgery. Surg Endosc 2013; 27: 3056-72.
8. UPDATED Laparoscopic Uterine Power Morcellation in Hysterectomy and Myomectomy: FDA Safety Communication. Nov 2014. www.fda.gov/MedicalDevices/Safety/AlertsandNotices/ucm424443.htm .
9. The Royal Australian and New Zealand College of Obstetricians and Gynaecologists. Tissue Extraction at Minimally Invasive Procedures (C – Gyn 33) Review Nov 2014.
10. Cohen SL, Einarsson JI, Wang KC et al. Contained power morcellation within an insufflated isolation bag. Obstet Gynecol 2014; 124: 491-7.

Operation laparoscopy – “Laparoscopy as it is. Description, my emotions, photos in the dynamics of suture healing. I share as much detail as possible.

Good afternoon. Today I want to share with you my experience of undergoing such a procedure as laparoscopy.

It all started back in 2014, when, after five years of marriage, my husband and I decided to go to a family planning center to find out the reason for not being pregnant. I passed all the necessary tests, and was sent by the attending physician for a pelvic ultrasound. To my shame, I confess that this procedure took place for the first time, so I felt extremely uncomfortable and tense. In general, in my youth, I paid little attention to my health and the verdict: “A neoplasm in the uterine region” somehow completely stunned me.

On stiff legs, I went to my doctor for clarification, already counting in my head how many years I had left and what still needed to be done. Seeing my reaction, the doctor laughed for a long time. She assured me that it was just a small tumor “most likely a fibroid”, which is absolutely not dangerous, and certainly does not affect my reproductive functions, the worst thing is that she brings with her this discomfort from frequent urge to urinate, so how the formation presses on the bladder. On that they decided: they couldn’t help me (diagnosis – healthy) and sent me to get pregnant on my own. The only reservation of our happy parting with the doctor was that it was necessary to check again in a couple of years (to do an ultrasound).

In the following years, I regularly controlled my fluid intake, especially before long trips, my “neoplasm” brought me only discomfort and nothing more. Then the pains began – very painful first days of the cycle, and such that not all painkillers helped, it twisted so that it was often impossible to walk. Further more: daily nagging pains like with cystitis, general decrease in immunity and a state of constant fatigue . By 2018, I began to notice visual changes in the body – swelling in the lower abdomen, as if I were in a position. But of course, all this didn’t fit into a single picture in my head – I paid more attention to sports to change the relief of the body, drank vitamins to increase immunity (which, for some reason I didn’t understand, didn’t work), consumed a lot of coffee to cheer up and not sleep on the go.

By April, I had been ill with all the childhood diseases that my colleague’s child had in the garden, and since childhood I have been distinguished by excellent health, and a rare infection stuck to me … Probably, this made me think. I somehow looked at myself differently and, having brought all the symptoms together, lowered my head, moved to the ultrasound.

And this is what I found out: subserous uterine myoma with abundant blood supply, due to which it grows at a tremendous rate. So since 2014, it has increased slightly more than twice and by the time of the operation it corresponded to twelve weeks of pregnancy.

This time a more qualified doctor explained everything to me :

• subserous uterine fibroids is a benign tumor that occurs in every third woman

9 0041 is a node adjacent to the outer serosa of the uterus, in my case, it was on a thin stalk, protruding beyond the boundaries of the uterus

• fibroids are a natural contraceptive
• necrotic and dystrophic processes, infection can join, peritonitis develops – this is instant hospitalization and surgical intervention.

Verdict: must be removed by laparoscopy!

WHAT IS IT?

Laparoscopy is a minimally invasive method of diagnosis and surgical treatment. In the process of its implementation, all manipulations are performed through small (about 10-15 mm) holes – 3 punctures are made: in the umbilical region, on the left and right sides of the straight line of the abdomen in the abdominal cavity using special tools. The laparoscope, which is equipped with a video system, allows you to visualize what is happening during the procedure.

Trocars – ports for endoscopic instruments – are placed in the places described above. About 30-40 liters of carbon dioxide is injected into the abdominal cavity to straighten the peritoneum and improve visualization. The surgeon inserts a laparoscope at the periumbilical point and examines the surface of the uterus. Next, fixation of the myomatous node is performed with endoscopic clamps, after which the myomatous node is isolated and husked with a hook-coagulator.

_______________________________________________________________________________

Before a planned operation, it is necessary to undergo mandatory training, which includes the following types of tests: , HIV;

– general urinalysis;

– electrocardiography;

– Ultrasound of the pelvic organs;

– gynecological smear.

It also requires the opinion of the therapist about the possibility or impossibility of transferring general anesthesia.

Bring with you:

– dressing gown, slippers, nightgown

– compression stockings or elastic bandages

– razor (can be done at home)

– pads (preferably night ones), since after the operation it can tint

_______________________________________________________________________________

DAY ONE

My hospitalization was scheduled for lunch time, and the operation itself the next day. At the same time, I was warned that breakfast should be hearty, since after breakfast there was a taboo on solid food. After dinner, you should stop eating altogether, also exclude drinks, and from six in the evening it is also forbidden to drink water. I was escorted to the ward at about two o’clock, so I missed lunch.

An hour later, the surgical assistant came and asked me in detail about the anamnesis, an anesthesiologist came an hour later with similar questions, most of all he was interested in weight, height. This information was necessary for him to calculate the exact dosage of anesthesia. After, almost before the lights out, the most terrible person appeared …. a nurse … with the phrase: “Girls, for an enema!”.

Phew, and here I had no experience. I have never experienced such feelings before. I will not describe the procedure and the sensations during it, but I remembered this experience for a long time.

And again this phrase was heard the next morning at six in the morning. The second time is easier.

Prohibition of food, drink and enema is preparation for surgery. The intestines before the operation must be completely cleaned. Also, on the eve before going to bed, it is necessary to put on compression stockings, they are allowed to be removed only at the time of taking a shower before the operation. Further, before, after and within two days after surgery, they can not be removed. It is impossible from the word IMPOSSIBLE at all. The need for stockings is due to the risk of venous thrombosis after surgery.

DAY TWO. OPERATION

It was nine o’clock in the morning when they came for me. Without warning, they simply rolled a gurney into the ward and ordered to undress and lie down. Right there, in the ward, they put a urinary catheter, put a cap on their heads and drove off into the sunset… vein and the use of endotracheal anesthesia, in other words, a tube is inserted into the throat. Then I was afraid that I would fall asleep, they would start the operation and I would suddenly wake up, that I would feel everything, but I wouldn’t be able to move (as in that film), that my heart would stop … in short, I wound myself up almost to neurosis.

I was taken to the operating room, and I was shaking like an aspen leaf, the nurses cheered me up with jokes as best they could, and I thought only about my fears and how I would appear to my husband, interfering with life. And God! how hungry I was!

The operating room amazed me with its size. A bunch of monitors, equipment, people in masks, bright lighting hits the eyes. I moved with my catheter from the wheelchair to the operating table, which is more like a regular gynecological chair. I immediately saw the familiar face of the anesthesiologist, who was already putting the needle into my arm, then I felt something warm running through the vein and I only had time to ask him: “Is this it? Now cut off? ”, In response I hear:“ Yes, sleep ”and emptiness.

Woke up abruptly. Someone took the pipe out of his mouth.

This is my surgeon: “Open your eyes and don’t close them. Do not sleep. How are you feeling?”.

“It’s fine, but can I eat already?”

“What do you want?”

“I want everything!”

“Then you can’t” and laughter.

The operation was planned, all my organs remained with me, nothing new was found. Fuu!

The next day is like a fog. Terrible drowsiness, they came, put a dropper with antibiotics, ordered her to follow it herself – as it would come to an end, shut off the supply of the solution.

I was allowed to drink in the late afternoon a little bit and in small sips, food was still not given, and in fact I didn’t feel like eating at all. I feel so-so, although I thought it would be much worse, I read different stories about what a terrible waste after anesthesia – shivering, spinning, etc. – I did not have a single symptom, later they explained to me that it all depends on the quality of the solution.

Before going to bed, they offered to give me an injection of an anesthetic, I agreed and regretted it – the pain from the injection is even stronger than after the operation. Subsequently, she decided to refuse such anesthesia. In fact, it doesn’t hurt much, I had similar pains on the first day of the cycle, so it was customary for me to endure.

On the same day, during visiting hours, my husband was allowed to come. He sat, groaned, groaned, said that I was green and sailed home, leaving a “cockerel” on the pillow. They were not allowed to eat.

The next morning I woke up and was told to start getting up and walking – this is important for the normalization of blood circulation processes in the organs. They fed me porridge and pills.

Made a dressing. Well, like a dressing …. they removed the bandages from the punctures and anointed with brilliant green.

Immediately after the operation

The wounds were not covered with plaster anymore, they said that the stitches should breathe.

Lying down and breathing

By the evening I started having complications. During laparoscopy, gas is injected into the abdominal cavity, which is then removed after the operation, the remaining gas is released naturally, including through the pores of the skin. My girlfriend had gas coming out through her collarbones, the pain was so severe that the doctors had to massage her collarbones, but I didn’t have gas at all. As a result, the stomach was greatly swollen, pain appeared – it was impossible to lie or sit.

One doctor came and looked, touched, then another, then the head of the department came, the last one came the nurse and ordered to go for an enema. At first I didn’t believe my ears, I joked, laughed, but no, stomped – it hurts a lot, after the operation they don’t resort to this procedure at all … they gave me a lot of pills and the next day the bloating began to slowly pass, bringing relief. Doctors decided that this was a complication from antibiotics and the dropper was canceled. Although the intravenous catheter was removed only on the fourth day. This is also a different story,0016 catheter is placed on the elbow during the operation, then it is removed only when all antibiotics and other liquids are instilled, it is not convenient to sleep with it, you are constantly afraid that in a dream you will inadvertently pull out the needle, the arm does not bend completely because I will give a long needle inside, Plus, inflammation begins and, as a result, pain.

Well, yes, all this is poetry ….

As a result, I spent a total of 5 days in the hospital + a week at the hospital. Upon discharge, he was given care instructions.

2. 9 0016 Wash only in the shower, do not use a washcloth
3. Apply iodine once a day

Stitches they are removed on the 7-10th day, if they are not self-absorbable, as in my case, then the threads will dissolve in a few weeks, depending on the material.

FOR THE PERIOD OF REHABILITATION at home:

1. Moderate exercise
2. Diet: Eliminate fatty and spicy foods from the diet. Fractional nutrition
3. Walking in compression stockings for a couple of weeks
4. Do not lift more than 4 kg
5. Monitoring the restoration of stable bowel function
6. Abstinence for a month

________________________________________________________________________________

DYNAMICS of suture healing in pictures

One month after surgery

Two months after surgery

Three months after surgery

As a result, after laparoscopy, acute pains disappeared, but adhesions remained, which periodically pull. Minus two kg on the scales due to the removal of the tumor. Cycle normalization. And most importantly – the opportunity to increase the family. These are all pluses. Of the minuses: undermined immunity, deterioration of the skin, nails, hair. But all these minuses are fixable, but the pluses allowed me to start leading a healthy and active lifestyle again.

In general, laparoscopy is considered one of the safest methods of exposure , complications after it in gynecology are quite rare. During the rehabilitation process, there is rarely a need for additional medication, since usually the recovery takes place in a short time and on its own. I was prescribed only a suspension to normalize the gastrointestinal tract.

In general, dear ladies, if you have indications for laparoscopy and at the same time have doubts and fears, then discard them and boldly decide on this step. The recovery is fast, there are a lot of positive moments and the operation itself is not terrible. Love yourself and take care of your health.

Thank you for reading, I hope my experience was useful to you and helped you decide on something very important.

operation in Kyiv, prices and reviews at the Leomed clinic

Leomed clinic > Services > Laparoscopy > Laparoscopic surgery

Advantages of laparoscopic treatment at LeoMed Medical Center

• Modern innovative technologies
• Minimal tissue trauma
• Postoperative recovery period of several hours
• Highly qualified surgeons
• No scarring

LAPAROSCOPIC SURGERY CAN MANAGE THE FOLLOWING DISEASES:

• Umbilical hernias
• Inguinal hernias
• Hernias of the linea alba
• Diaphragmatic hernias

• Calculous cholecystitis
• Gallbladder (cholicystectomy)
• Gallbladder polyps

Our specialists

Andrey Goncharenko

Surgeon, vascular surgeon, ultrasound. First category.

Work experience – 12 years.

more

In surgery, the main components of effective treatment are the experience of the surgeon and the technique by which the surgical intervention is performed. Also of no small importance are the type of anesthesia, the tactics of postoperative treatment, the state of health of the patient at the time of the operation, the conditions of stay in the clinic.

Laparoscopic surgery at the LeoMed clinic took into account all of the above components of quality treatment. For surgical treatment, mainly laparoscopic techniques are used, which is possible only thanks to the innovative equipment of the clinic and experienced qualified medical personnel.

Laparoscopic surgery is considered the “gold standard” today and there is nothing surprising about it! This technique, in comparison with traditional surgery, has many advantages – it is effective, safer and faster, and does not leave any cosmetic defects behind!

However, the clinic often charges higher prices for services in the direction of laparoscopy than for traditional open surgery.

Laparoscopy of a hernia

The most common pathology with which patients come to the clinic is a hernia. Laparoscopy of a hernia is performed using a modern technique of tension-free hernioplasty, which allows you to save the patient from a hernia without damaging the tissues with a minimal likelihood of recurrence in the future.

Laparoscopy of a hernia involves removal of the hernia through small openings in the anterior abdominal wall. Hernial gates are closed with a special mesh, or with their own tissues. Laparoscopy of a hernia in most cases is performed under local anesthesia, which is much easier for patients to tolerate.

The SILS (Single-Incision Laparoscopic Surgery) technique is actively used, which is the latest achievement in minimally invasive laparoscopic surgery and allows the doctor to perform operations through one very small skin incision in the navel, which subsequently heals without scars and scars in the shortest possible time .

SILS laparoscopic surgery is widely used in LeoMed Medical Center and has already won a lot of positive feedback from patients.

Modern rooms with special functional beds, which are provided by the LeoMed Laparoscopic Surgery Clinic, make the stay of patients in the hospital as comfortable as possible and create all conditions for a faster and easier postoperative period. During the recovery period, constant monitoring of the patient’s condition is mandatory.

Prices for laparoscopy

What are the prices for laparoscopy services? Clinic “Leomed” harmoniously combines price and quality, thanks to which it has earned rave reviews from patients. Loyal prices, regular promotions, advantageous service packages – all this is offered to its patients by Leomed.

Cost of our services

Laparoscopic inguinal hernia aloplasty (excluding cost of anesthesia)

UAH 15000.00

Laparoscopic umbilical hernia repair (excluding cost of anesthesia)

18000.