Without laparoscopy, no endo-abdominal outpatient surgery, no rapid recovery after surgery.
Laparoscopy was first used in abdominal surgery (removal of the gallbladder) by a French surgeon, Doctor Philippe Mouret, in 1987 in a private clinic in Lyon; it should be noted that for a technique which immeasurably revolutionized global surgery, little recognition was given to it.
A NOW WELL KNOWN, WELL CODIFIED TECHNIQUE:
- After performing a classic general anesthesia by a trained anesthetist
- Injection of a gas mixture into the abdominal cavity by simple puncture in order to seperate the various organs it contains from each other; in most cases it is then possible without danger to:
- Introduce the trocars (a kind of hollow cylindrical tube) through which the viewing camera and operating instruments will pass: forceps, scissors, coagulator, stapler, glue, prostheses ...
MANY ADVANTAGES:
- No large scars causing postoperative pain, fewer hernias, fewer infections (the openings through which the trocars pass measure 5 to 15 millimeters; no muscle sections)
- Much faster resumption of intestinal transit without vomiting so no aspiration tube passed through the nose
- This technique has also made it possible to use the robot, which allows the surgeon to operate in areas that are difficult to access even with classic laparoscopic surgery (revision surgery on the upper part of a bypass, for example).
Only one constraint:
Except for the occurrence of some pain in the shoulders due to the gas injected into the stomach and which disappears within a few hours, the only requirement of this technique is general anesthesia.
Indeed, while the intra-abdominal organs are not sensitive to pain, the wall itself is - and in a very significant way - and the swelling of the belly (pneumoperitoneum essential to creating an operating space) would not be bearable without deep general anesthesia.
Loco regional epidural-type anesthesia widely used in lower abdominal surgery only numbs the lower abdomen and is therefore incompatible with laparoscopic surgery.
ANESTHESIA:
Anesthesia, whatever the form, has always been somewhat of a mystery to patients so much so that for several years now a consultation with an anesthesiologist has become mandatory before any surgery.
The procedure is well organized: more than 48 hours and less than 3 weeks before the surgery. It is up to the patient to make an appointment with an anesthesiologist when your surgeon specifies it, with all the documents in your possession, including your most recent prescriptions (indeed certain medications: anticoagulants, blood thinners, anti-inflammatories, must be modified).
The anesthesiologist sometimes requests additional cardiac or respiratory tests, for example, so he may sometimes want to see you again with the latest results. This consultation allows you to ask any last questions to which you might not have the answer.
For monitoring purposes, a stay of variable duration in the recovery room is mandatory after any outpatient surgery, then in the outpatient department: some clinical and biological checks will be carried out (nurse, anesthesiologist, surgeon).
You will eventually be given prescriptions, medical leave documents, transport vouchers, etc. and your designated person can usually bring you back home.
CONCLUSION:
Thus, all conditions are fulfilled for Improved Recovery after Surgery, or better Rapid Recovery after Surgery, a new program which leads to improved patient satisfaction by, DIMINISHING:
- Pain, vomiting
- Stress and immobilization
- Gastric or urine catheters
- Postoperative medical leave time
- Cost of surgeries on society as a whole
♦ To make an appointment with Dr. Bruto RANDONE, ENGLISH SPEAKING Visceral and Digestive Surgeon, at the Clinique Internationale du Parc Monceau, 21 Rue de Chazelles, 75017 Paris, France, or at the Clinique Bizet, 23 Rue Georges Bizet, 75116 Paris, click on Contact.
