Laparoscopic inguinal hernia repair total extraperitoneal TEP
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Laparoscopic surgery
Since the early 90s, minimally invasive surgery known as laparoscopic surgery has becomed widely popular for gastrointestinal and general surgery. All interventions for simple colecistectomy are normally performed by laparoscopy. The approach to the biliary tract is more complex, but increasingly more coledocotomies and extraction of stones are possible with this technique. In patients with acute appendicitis without excessive evolution reduces postoperative discomfort, hospital stay and the rate of wound infections. In a progressive manner and with the new technology of micro-optical systems, and our greater experience in different fields, its use has spread to other pathologies: hiatus hernia, splenectomy, colon surgery, adrenal surgery, and in particular the correction of inguinal hernia.
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Bile ducts
Virtually all simple cholecystectomies are done by laparoscopic. The approach to the biliary tract is more complex, but increasingly more surgeons practice choledochotomy and extraction of stones with this technique, in fact it depends on the diameter of the bile duct, since below a diameter of 1 cm it is usual the need to convert to open surgery, or plan it in advance. Special mention deserves cholecystectomy for acute cholecystitis, sometimes gangrenous and perforated; almost always is amenable to excision by laparoscopy, but conversion it is not unusual in some patients. Becuase of elderly tourism, many of my patients with biliary pathology present with stablished acute cholecystitis and laparoscopic surgery has been possible in more than 90% of cases.
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Splenectomy
Once a surgeon becomes well trained in laparoscopic surgery, laparoscopic splenectomy will be performed with a wider field view and more control of blood vessels, diminishing the risk of blood loss. The approach to the short gastric and splenic vessels is easier and safer. The specimen will be removed after being fragmented in a special bag, without interfering with the histological evaluation.
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Colon surgery
Although initially the laparoscopic approach was recommended only for benign tumors, and recurrent, simple diverticulitis, its use extends know to complicated ones and malignancies of the colon in all its locations: right, transverse, left and rectosigmoid. In fact, cases are now selected depending on the age, sex, location of tumor, associated diseases, and certainly surgeon’s experience.
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Suprarenal surgery
What is striking in the laparoscopic approach to this gland is the better access and exposure. It allows identification of the adrenal vein on both sides with less bleeding and early ligation, if required by the underlying pathology, such as with pheochromocytoma.
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Hiatus hernia
The surgical technique of choice when surgery is indicated in cases of hiatus hernia is the Nissen fundoplication. It creates an antireflux mechanism by surrounding the fundus of the stomach around the lower esophagus. Laparoscopy also permits closure of the hiatus after a more anatomical disection.
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Other diseases
Liver cysts, atypical liver resections, lymphnode biopsies, lysis of adhesions in small bowel obstruction, etc.., can be approached by laparoscopy. In recent years also gastric, pancreatic and kidney surgery have found their place in the indications for laparoscopic surgery . Deserves a special mention surgery for morbid obesity, for which the laparoscopic approach is themost reccomended; this latter condition is not treated by this surgeon.
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NOTES surgery
This is a new step in the progress of minimally invasive surgery. Still in an experimental phase, the approach and removal of operated viscera occurs through natural orifices such as vulva, mouth or anus. It remains to be confirmed that there is no incresed risk of infection, bleeding or other complications; as well as the need for new instruments and technology.
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Traditional open surgery
Obviously, most of the daily practice still treated by open conventional surgery, depending of the underlying pathology or anatomical region, such as thryroid surgery, parathyroid, breast, varicous veins, soft tissue tumors, etc.
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