Approaches to Acute and General Surgery
Within the field of acute and general surgery, minimal access, minimally-invasive, or laparoscopic (lap-rah-sca'-pick) approaches have become the standard approach.
Laparoscopic surgery is the operation of choice for procedures such as cholecystectomy (gallbladder removal) or Nissen fundoplication (wrapping the stomach around the esophagus to correct GERD, or gastroesophageal reflux disease). Generally, the benefits of laparoscopic procedures include less postoperative pain and therefore, less pain medication, faster healing for a quicker return home, and smaller, less noticeable scars after healing.
What is Minimal Access Surgery?
Minimal access surgery is completed with one or more small incisions instead of a large incision. The surgeon passes a telescope with a video camera through a small incision (usually only 1/4" long) into a body cavity. The surgeon then views the surgery on a TV monitor. Surgical instruments are then passed through other similar little incisions. The surgeon examines and operates on the area in question by viewing magnified images on the television. When the telescope is used to operate on the abdomen, the procedure is called laparoscopy. When used in the chest, the procedure is called thoracoscopy, and when used in a joint, it is called arthroscopy.
The introduction of minimal access surgery into common practice began in 1985, when laparoscopic cholecystectomy was first performed to remove a diseased gallbladder. In the immediate years thereafter, a small number of surgeons in the U.S. pioneered the development of laparoscopic techniques for this and other surgical applications. Recognizing the importance of their potential to improve patient care, Columbia University was one of the very first U.S. academic institutions to support the development of minimal access technologies and techniques. Columbia initiated key research protocols in the physiology and immunology of laparoscopic surgery, which provided critical data during the next decade. The compelling results of these studies clearly dictated the wisdom of applying minimal access techniques to more types of surgeries; hence the establishment of the NewYork-Presbyterian Minimal Access Surgery Center and expansion of its training facilities in 1998.
The laparoscope, a fiber-optic telescope, is inserted through one port and attached to a camera. It sends images from the abdominal cavity to television monitors placed for easy viewing by all the operating room personnel. Thus, the surgeon and his or her assistants can view the abdominal cavity and its contents. Through the remaining ports, long-handled instruments are used to perform various procedures.
Endoscopy is a minimally invasive diagnostic tool, used to view the inside of organs, inspect for abnormalities and take biopsies. A small camera and light source are mounted onto a flexible tube which can be inserted into the mouth (to inspect the esophagus, stomach and duodenum) or the anus (to inspect the large bowel).
Upper endoscopy is usually performed to evaluate symptoms of persistent upper abdominal pain, nausea, vomiting, or difficulty swallowing. It is also the best test for finding the cause of bleeding from the upper gastrointestinal tract.
Upper endoscopy is more accurate than x-ray films for detecting inflammation, ulcers, or tumors of the esophagus, stomach and duodenum. Upper endoscopy can detect early cancer and can distinguish between benign and malignant conditions when biopsies of suspicious areas are obtained. Biopsies are taken for many reasons and do not necessarily mean that cancer is suspected.
Upper endoscopy is also used to treat conditions present in the upper gastrointestinal tract. A variety of instruments can be passed through the endoscope that allow many abnormalities to be treated directly with little or no discomfort, for example, stretching narrowed areas, removing polyps (usually benign growths) or swallowed objects, or treating upper gastrointestinal bleeding. Safe and effective endoscopic control of bleeding has reduced the need for transfusions and surgery in many patients.
If you suspect you have an urgent surgical issue, contact your medical provider immediately or go to the closest emergency room.
If you have any questions for our Acute Care team, contact s at (212) 342-1734.