Laparoscopic Laser Surgery

Development of endoscopic surgical techniques is among the most important developments of today’s modern medicine. Laparoscopy is the form of endoscopic surgery implemented in intra-abdominal operations. Nearly all of the operations are now being performed with this technique as laparoscopic surgery has been used more commonly in the recent 20 years and experienced surgeons have grown up within this period. While this technique was used for very limited and simple operations or only for diagnosis before 15 years, it can also be used for many difficult operations such as cancer operations now.

When implemented by experienced teams, endoscopy technique can be used in 95% of gynecologic operations. In endoscopic surgery or minimal invasive surgery, the operations are performed in vitro and then intra-abdominal image is transferred to monitor with camera system. In gynecologic diseases, the endoscopic surgery is divided into two types: laparoscopy or hysteroscopy. When the operation is performed through abdomen it is called laparoscopy, and it is called Hysteroscopy in intrauterine operations performed by entering through vagina.

How Laparoscopic Operations are Performed?

Laparoscopic laser surgery is performed under general anesthesia. A 1 cm umbilical incision is made and abdominal cavity is inflated with 3-4 liters carbon dioxide (CO2) gas by means of a needle. Then, an optic tube (laparoscope) is placed within abdomen by entering through the belly.

This optic system is connected to a video-camera system and intra-abdominal image is reflected on the monitor screen. In that way, laparoscope can be moved to any intra-abdominal region and followed on the screen. Then, a hole of 0.5 cm is made on pubic regions. These holes are used to insert the tools to be used for operation. Differently from conventional laparoscopy operations, a laser system except for camera is connected to the end of laparoscope in laparoscopic laser surgery. Therefore, there is an optic duct in the laparoscope and a second duct through which laser beams will pass. With laser energy controlled by a surgeon, the operations such as cutting, burning and stopping bleeding can be performed on intra-abdominal organs. Use of laser offers many advantages for laparoscopic surgery and shortens the duration of operation significantly. Short duration of operation means that the patient will subject to less anesthesia and recover more quickly. Laser device is mounted to laparoscope inserted through belly by means of laser lever. Laser device produces laser beams revealed by the atoms stimulated and activated by electrical energy. Direction of laser beams can be directed to the desired organ or region by means of the mirrors within laser lever. Different laser sources are used in laparoscopic surgery (CO2, Argon, Nd: YAG laser etc). In our center, especially CO2 is used for this purpose. It has many advantages over other laser types.

Many operations can be performed by means of laser and two holes of 0,5 cm made on pubic regions. Laser beam is used as a lancet within abdomen and allows for operation. With this technique, simple operations can be performed such as tube ligation for the purpose of birth control as well as advance level operations such as resection of myoma, hysterectomy easily through these 3 holes in the same

This technique has many clinic advantages. Therefore, all open operations have been giving their places to laparoscopic and endoscopic techniques gradually in all branches.

The advantages are:

1- The operations are performed without making wide incisions; that is, without incising the abdomen. There is no wide operation scar on the skin. All operations are performed through 3 small holes made in belly and pubic region. No aesthetically disturbing scar occurs on the skin.
2- As laparoscopy operations are performed with micro-surgery principles, minimal damage occurs within abdomen and operation sites and recovery becomes easier and quicker.
3- Operation-related intra-abdominal adhesions occur less after laparoscopy. As more adhesions occur in open operations, laparoscopy should especially be recommended to the women who want to have baby. Sometimes, obstructions occur depending on the adhesions in tubes after an open operation.
4- Opportunity and success of treatment increases as the regions which are difficult to monitor within abdomen can be monitored easily by means of laparoscopy method.
5- General state of patient is well as the patient experiences less pain after laparoscopic operations. The need to use analgesic is low.
6- Duration of staying in hospital is shorter after laparoscopic operations. Generally, the patient is discharged on the same or following day. It becomes easier and faster for the patient to stand up and return to normal physical activities. The patient recovers faster as abdominal wall isn’t incised.
7- The time to return work is only 1 week. This time is 6-7 weeks after conventional operations.
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