Laparoscopic cancer surgery

1.     What is laparoscopic surgery?

Laparoscopy is a type of surgery in which operation is performed using very small incisions (3mm to 12mm) over skin with the help of a camera and fine instruments. This type of surgery can be used to perform surgery in thorax, abdomen and pelvis.Other names for laparoscopic surgery is Minimal Invasive surgery, Keyhole surgery or band-aid surgery.

 

2.     Why do we need it?

Cancer surgeries involves resection of multiple organs to achieve complete removal of disease. This requires good tissue exposure for which big incisions need to be taken over the body cavity. Also due to prolonged surgery the interior of our body is exposed to environment for a long time during surgery which leads to an increased risk of infections. Keyhole/ Laparoscopic surgery provides very good vision due to recent advances in lens and camera system that we use and which can be inserted in the body cavity through less than 1 cm incisions.

3.     What are advantages of laparoscopy in cancer surgery?

Advantages for Surgeons:

 Very good vision.

Minute details of surgery visible.

High precision surgery can be carried out due to camera magnification.

Advantages for the patient:

Less Blood loss.

Reduced rate of infection.

Decreased postoperative pain.

Early discharge from hospital.

Early resumption of normal day today activity.

Less incidence of post-operative incisional hernia

4.     Does it require extra expertise/experience apart from conventional cancer surgery training?

Yes. It requires extensive skill based training after receiving conventional cancer surgery training. Not every surgeon is comfortable with advanced laparoscopic surgery. It requires dedicated extra hours of commitment and willingness to improve surgical skill using fine laparoscopic instruments. Remember “NOT ALL SURGEONS ARE CANCERSURGEONS AND NOT ALL CANCER SURGEONS ARE LAPAROSCOPIC SURGEONS” It takes yearsof training and experience in all three aspects- CANCER, SURGERY andLAPAROSCOPY.

5.     What are the costs involved?

At the face value Laparoscopic surgery might seem to be slightly costly compared to open surgery. However when other costs are taken into account such as increased hospital stay, more pain killers, more number of surgical site dressings and increased cost of antibiotics ( if there is infection, which is more likely in open surgery) then cost of laparoscopic surgery is actually less or similar compared to open surgery. Not to forget the decreased pain in postoperative period which makes every penny worth.

6.     Which cancer surgeries can be done with laparoscopic approach?

Almost all cancers of thorax (i.eEsophagus, mediastinum, thymus, lung), abdomen (i.e stomach, intestines, rectum, liver, gallbladder, pancreas, urinary bladder, prostate, kidney, uterus, cervix and ovary) can be operated with laparoscopic surgery.

 

7.     Is laparoscopy oncologically equivalent to open surgeries?

Recently multiple trials taking place all over the world have evaluated oncological safety of laparoscopic surgery in cancers of almost all the organs and proved that long term survival outcomes are similar if not better than open surgeries. Also with the help of these clinical trials it has been established without doubt that laparoscopic surgery definitely has short term advantages as mentioned above.

 

8.     How is Laparoscopic surgery performed?

This surgery is performed usually under general anaesthesia which mean you will be unconscious during the procedure with little or no memory of it. After few small laparosopic procedures such as cholecystectomy patients can be discharged after few hours of surgery on the same day.

9.     Do you need any preparation for laparoscopic surgery?

Since this procedure requires general anaesthesia you will be asked for overnight fasting for about 6-8 hours.

If you are on blood thinners depending upon the disease that you have and medicines that you are taking your surgeon will inform you to stop them after consulting anaesthetist and your cardiologist.

If you are on Diabetic medication you may be asked to skip your medicines on the day of surgery.

However if you are a hypertensive or hypothyroid patient you will be asked to take your medications early morning with sips of water.

If you smoke it is advisable to stop smoking atleast a week before planned surgery to decrease chance of post-operative lung infections.

You will be encouraged to perform breathing exercises and moderate walking to improve your effort tolerance about one to two weeks before surgery. This is important as it will reduce the risk of post-operative complications and help the medical team in your post-operative recovery and early hospital discharge.

Our team’s professional dietician will advise you on specific diet that will increase your protein and immunity levels to assist in post-operative recovery.

Based upon the cancer on which surgery is being performed you may be advised to take certain medications a day prior to surgery to clean your bowel.

Apart from the above tetanus prophylaxis and lignocaine allergy test will be performed before the surgery. You might be given an anxiolytic the night before surgery for you to have a sound sleep. Antibiotics will be administered half hour before surgery.

You will be counselled in detail about the surgery, its risk, benefits, expected complications and also disease prognosis atleast 12 hours before the planned surgery and asked to sign a written informed consent for the same.

PLEASENOTE: DO NOT SIGN THE CONSENT FORM TILL THE PRIMARY SURGEON OR A DOCTOR OFHIS/HER SURGICAL TEAM EXPLAINS YOU ABOUT THE PROCEDURE IN DETAIL AND ANSWERSALL YOUR QUERIES RELATED TO THE PROCEDURE.

10.  How will the procedure done in the Operation theatre?

Most of the surgeries are performed in morning hours except when the OT waiting list is long and priority is given to children and emergency cases.

On the day of surgery you will be asked to have your hair clipped and an antiseptic bath will be given along with oral hygiene.

Inside the operation theatre you will be received by a team of OT staff, anaesthetist and surgical team. After confirming 1^st part of surgical safety checklist you will be administered General anaesthesia.

Surgical site will be cleaned with a combination of antiseptics and surgical sheets will be placed around the surgical site.

After the surgeon completes the 2^nd part of Surgical safety checklist, he will make a small cut (usually less than a cm) and a tube is inserted through which carbon dioxide is pumped into your tummy. This will expand your abdomen and help the surgeon see clearly and provide more space to work. A camera is then inserted through the same tube and insides of your abdomen/thorax is visualised on the High definition screen present in front of the surgeon. The same is also visualised by assisting surgeons and OT Staff on different screens in the Operating room in real time.

Further small incisions will be made to insert fine instruments to carry out the surgery. Total time of surgery is variable depending upon the type of surgery. At the end of the surgery, 3^rd part of the Surgical safety check list will be completed and carbon dioxide will be removed from your abdomen and small incisions will be closed either with stitches or surgical clips and adhesive dressing is applied.

11.  How will be my recovery during post-operative period?

After laparoscopy, you may feel dizzy and disoriented due to some effects of anaesthetic drugs. Other side-effects of anaesthesia like nausea and vomiting should pass off quickly.

You will be monitored in recovery room for few hours by trained nurses till you are fully awake and then you will be shifted to your ward. However sometimes in major surgeries you might be shifted to Critical care ICU to monitor your condition and recovery for few days.

In the ward you will be managed by a team of well trained nurses, physiotherapist and dieticians. If you have a stoma, a professional stoma staff will make regular visits for your counselling and training of stoma management.

Your surgeon and members of the surgical team will pay you visit regularly to monitor your recovery.

Laparoscopic surgical wounds are very small and rarely get infected. You will be almost pain free the next day of surgery and will be allowed oral sips of water depending on type of surgery performed. You will also be encouraged to walk out of bed pain free with the help of our physiotherapists.

In an uneventful recovery you will be discharged much earlier compared to open surgery. Before discharge you will be counselled by a team of doctors and nursing staff about your diet and medications and when to return for follow up. You will also be counselled regarding the warning signs that you will need to know for any emergency visits to the hospital.

For about a week after surgery you may feel slight pain or discomfort depending upon the nature of surgery. These will pass off with time and medications prescribed during discharge. You may feel some itching over your throat which is due to insertion of tube to assist breathing during anaesthesia. With the help of warm saline water gargles and some pain killers this will wean off soon.

For a few days after surgery you might feel more weak than usual which is due to excess energy in your body being diverted for healing process. Take regular diet, meds, exercise and rest as advised by your surgeon.

12.  How much time does it take for complete recovery and start of normal activities after laparoscopic surgery?

Depending upon the indication for which laparoscopic surgery was performed it usually takes 5-20 days before you become fit for routine activities. However some supra major surgeries like e.g. pancreatic cancer may take upto 12 weeks to recover. Advantage of laparoscopic surgery is significantly early resumption of normal activities compared to open surgeries and less wound related complications like infection, hernia etc.

Your surgical team can give you more information about when you'll be able to resume normal activities.

13.  When and who to seek medical advice?

Cancer surgeries are usually major surgeries. It is always recommended that someone responsible stays with you at home. In case of following signs and symptoms you may need to contact the emergency helpline number provided during discharge.

1.     Fever with/ without chills

2.     Persistent vomiting despite medicines

3.     Persistently increasing abdominal pain

4.     Redness, pain, swelling, bleeding and discharge from abdominal wounds

5.     Severe pain and swelling one one/both legs

6.     Burning/ pain sensation while passing urine.

 

You can mail your Laparoscopic cancer surgery related queries to arvindlapsurgeon@gmail.com/drajeetramantiwari@gmail.com