Dr. Vivek Bindal : Best Laparoscopic Surgeon in Delhi NCR
Dr. Vivek Bindal is the Best Laparoscopic Surgeon in Delhi. He is Director & Head – Max Institute of Minimal Access, Bariatric & Robotic Surgery
Laparoscopic surgery have made it possible to provide cure for hernia with small incisions, fast recovery, minimal pain and blood loss, and low recurrence.
Robotic surgery is the latest platform to perform minimal access surgery. It provides with better-advanced instrumentation, more degrees of freedom, three dimensional magnified vision, tremor filtration and many other advantages in performing the surgery. It makes surgery for complex abdominal wall hernias minimally invasive, more precise and leads to faster recovery.
Abdominal Wall Reconstruction (AWR) is the concept of reconstructing the abdominal wall anatomy, so that the functionality of abdominal wall is restored after hernia surgery. Dr. Bindal does all types of AWR procedures and surgeons visit him from all over the country and abroad to learn the hernia surgery skillset.
Dr. Bindal has been trained in advanced hernia skills and abdominal wall reconstruction at Cleveland Clinic Hernia center, USA. He has performed minimally invasive hernia repairs for extremely complex abdominal wall hernias. He has published in many international journals and is regularly invited to speak on the subject in national and international conferences.
Laparoscopic surgery, also known as minimally invasive surgery, is a surgical technique that utilizes small incisions and specialized instruments to perform procedures within the abdomen or pelvis. It involves the use of a laparoscope, which is a thin, long tube with a camera and light source attached to it. This allows the surgeon to view the surgical area on a monitor and perform the procedure by manipulating instruments inserted through small incisions. Laparoscopic surgery offers several advantages over traditional open surgery, including smaller incisions, reduced pain, shorter hospital stays, faster recovery times, and improved cosmetic outcomes. It is commonly used for procedures such as cholecystectomy (gallbladder removal), appendectomy, hernia repair, hysterectomy, and nephrectomy (kidney removal).
Advantages of Laparoscopic Surgery
- Smaller Incisions: Laparoscopic surgery uses small incisions, typically less than 1 centimeter, compared to the larger incisions required in traditional open surgery. This results in less trauma to the body and reduced scarring.
- Reduced Pain: The smaller incisions and the use of specialized instruments result in less tissue damage, leading to reduced post-operative pain and discomfort for patients.
- Faster Recovery: With laparoscopic surgery, patients often experience faster recovery times compared to open surgery. They may have shorter hospital stays and can return to their normal activities sooner.
- Reduced Blood Loss: The precise and controlled nature of laparoscopic surgery helps minimize blood loss during the procedure, reducing the need for blood transfusions.
- Lower Risk of Infection: The smaller incisions and reduced tissue trauma decrease the risk of infection after surgery.
- Improved Cosmesis: Laparoscopic surgery offers better cosmetic outcomes as the smaller scars are more aesthetically pleasing compared to the larger scars associated with open surgery.
- Reduced Hospital Stay: In many cases, laparoscopic procedures allow for shorter hospital stays, allowing patients to recover in the comfort of their own homes sooner.
- Quicker Return to Work: Due to the faster recovery time, patients can often return to work or their daily activities sooner after laparoscopic surgery compared to open surgery.
Overview of the Procedure
During a laparoscopic surgery procedure, the following steps are typically involved:
Patient Preparation: The patient is positioned on the operating table and given anesthesia, which may be general anesthesia or local anesthesia with sedation, depending on the procedure and patient’s condition.
Trocar Placement: Small incisions, usually about 0.5 to 1 centimeter in size, are made in the abdomen. Trocars, which are specialized ports, are these incisions to provide access the laparoscope and surgical instruments.
Creation of Pneumoperitone: Carbon dioxide gas is introduced the abdominal cavity one of the trocars. This creates a pneumoperitoneum, which to create space for the surgeon to work and improves.
Insertion of Laparoscope: laparoscope, a thin tube with a light source and camera at the end, is one of the tro. laparoscope transmits images of surgical area to a monitor, allowing the surgeon to see inside the.
Manipulation of Instruments Additional smallisions may be made to insert specialized surgical instruments through the tro. These instruments are used by the surgeon to manipulate, perform dis, and carry out the necessary steps of the procedure.
Visualization and Dissection: The surgeon uses the laparoscope and instruments to visualize and dissect the targeted area within the abdomen or pelvis. The laparoscope provides a magnified view of the surgical site, enhancing precision and accuracy.
Hemostasis and Closure: Any bleeding vessels are controlled using specialized instruments or energy devices. At the end of the procedure, the surgeon removes the instruments and trocars, and any incisions are closed with sutures or adhesive strips.
It’s important to note that the specific steps and details of the procedure may vary depending on the type of laparoscopic surgery being performed. The surgeon will tailor the approach based on the patient’s condition and individual needs.
Patient evaluation is an essential part of the pre-operative preparation for laparoscopic surgery. It involves assessing the patient’s medical history, conducting physical examinations, and performing relevant diagnostic tests. The purpose of patient evaluation is to ensure that the patient is suitable for the procedure and to identify any potential risks or contraindications.
During patient evaluation, the following aspects may be considered:
Medical History: The patient’s medical history is reviewed to identify any pre-existing medical conditions, previous surgeries, allergies, or medications that may impact the surgery or anesthesia.
Physical Examination: A thorough physical examination is conducted to assess the patient’s overall health, vital signs, and any specific factors that may affect the surgical procedure, such as abdominal tenderness or hernias.
Laboratory Tests: Blood tests may be performed to evaluate the patient’s blood count, liver and kidney function, and coagulation profile. Additional tests, such as imaging studies or electrocardiograms (ECGs), may be ordered based on the patient’s specific needs.
Anesthesia Evaluation: The patient may undergo an anesthesia evaluation to assess their suitability for anesthesia and to determine the appropriate anesthesia technique for the procedure.
Risk Assessment: The surgeon evaluates the patient’s individual risks and discusses potential complications or adverse events associated with laparoscopic surgery. This allows for informed consent and shared decision-making between the patient and healthcare team.
Patient Education: Patient education is an integral part of the evaluation process. The patient is provided with information about the procedure, expected outcomes, potential risks, and post-operative care instructions.
By conducting a comprehensive patient evaluation, healthcare providers can ensure that the patient is well-prepared for the laparoscopic surgery and that any potential risks are identified and addressed before proceeding with the procedure.
Informed consent is a crucial component of the patient-doctor relationship and is obtained before any medical procedure, including laparoscopic surgery. It involves providing the patient with detailed information about the procedure, its risks, benefits, alternatives, and potential complications. The patient is then given an opportunity to ask questions and fully understand the information presented before voluntarily giving consent to proceed with the surgery.
During the informed consent process for laparoscopic surgery, the following aspects are typically discussed:
Nature of the Procedure: The surgeon explains the nature of the laparoscopic procedure, including its purpose, how it will be performed, and the expected outcome.
Risks and Complications: The potential risks and complications associated with laparoscopic surgery are discussed, such as bleeding, infection, organ or vessel injury, anesthesia-related complications, and the possibility of conversion to open surgery if necessary.
Benefits: The potential benefits of laparoscopic surgery are explained, such as smaller incisions, reduced pain, faster recovery, shorter hospital stays, and improved cosmesis.
Alternatives: The patient is informed about alternative treatment options, if available, and their associated risks and benefits. This allows the patient to make an informed decision regarding their preferred course of treatment.
Recovery and Post-operative Care: The expected post-operative care, recovery process, and any restrictions or lifestyle modifications that may be necessary following the surgery are discussed.
Questions and Discussion: The patient is encouraged to ask questions and seek clarification on any concerns or doubts they may have regarding the procedure or its potential outcomes.
Once the patient has received all the necessary information and understands the details of the laparoscopic surgery, they can provide informed consent by signing a consent form. This indicates that they have voluntarily agreed to undergo the procedure with full awareness of its risks and benefits.
Fasting guidelines are typically provided to patients before undergoing laparoscopic surgery to ensure their safety during the procedure. These guidelines help minimize the risk of complications related to anesthesia and aspiration (inhaling stomach contents into the lungs) during surgery. The specific fasting instructions may vary depending on the patient’s age, medical condition, and the time of their scheduled surgery. It is essential for patients to follow these guidelines strictly.
The general fasting guidelines for laparoscopic surgery typically include:
NPO (Nil Per Os) Status: This means no oral intake of food or drink for a specific period before the surgery. The typical fasting period is usually 6 to 8 hours for solid foods and 2 to 4 hours for clear liquids.
Solid Foods: Patients are usually instructed to avoid consuming solid foods for at least 6 to 8 hours before the scheduled surgery. This includes items such as meat, bread, fruits, vegetables, and any other solid items.
Clear Liquids: Patients may be allowed to consume clear liquids up to a certain time before the surgery, typically 2 to 4 hours prior. Clear liquids include water, clear fruit juices without pulp, black coffee or tea without milk or cream, and clear broth.
It is important for patients to adhere to these fasting guidelines to prevent complications such as aspiration during anesthesia. Failure to follow the fasting instructions may result in the delay or cancellation of the surgery.
However, it is essential for patients to consult with their healthcare provider or surgeon for specific fasting instructions tailored to their individual needs and medical condition. They will provide personalized instructions based on factors such as age, overall health, and the medications the patient is taking.
Bowel Preparation (if required)
Bowel preparation is a process that may be required before certain laparoscopic surgeries to ensure that the colon and rectum are clear of stool and debris. This preparation helps improve visualization during the procedure and reduces the risk of contamination or infection. Bowel preparation instructions may vary depending on the type of surgery and the surgeon’s preference.
Here are some general guidelines for bowel preparation:
Clear Liquid Diet: Typically, the day before the surgery, patients are instructed to follow a clear liquid diet. This includes consuming clear fluids such as water, broth, clear juices (without pulp), and gelatin. It is important to avoid any solid foods or drinks with red or purple coloring.
Medications: Patients may be advised to stop taking certain medications or supplements that can interfere with bowel preparation or increase the risk of bleeding. It is essential to follow the specific instructions provided by the healthcare provider regarding medication management.
Bowel Cleansing Agents: A laxative or bowel cleansing agent may be prescribed by the healthcare provider to help empty the bowels. This may include oral medications, such as polyethylene glycol (PEG) solutions, which help to induce bowel movements and clear the colon.
Timing: The timing of bowel preparation instructions will vary depending on the specific protocol provided by the healthcare provider. Typically, patients are instructed to start the bowel preparation process the day before the surgery and continue until a specified time.
It is crucial for patients to closely follow the bowel preparation instructions provided by their healthcare provider. Proper bowel preparation enhances the safety and effectiveness of laparoscopic surgery by providing a clear surgical field and reducing the risk of complications.
Patients should consult with their healthcare provider or surgeon to receive personalized instructions tailored to their specific needs and medical condition.
An anesthesia consultation is an important step in the pre-operative preparation for laparoscopic surgery. It involves a meeting between the patient and an anesthesia provider (anesthesiologist or nurse anesthetist) to evaluate the patient’s overall health, discuss anesthesia options, and address any concerns or questions related to anesthesia during the surgical procedure.
During an anesthesia consultation for laparoscopic surgery, the following aspects may be covered:
Medical History: The anesthesia provider will review the patient’s medical history, including any underlying medical conditions, previous surgeries, allergies, and current medications. This information helps determine the patient’s suitability for anesthesia and identify any potential risks or complications.
Physical Examination: A brief physical examination may be conducted to assess the patient’s general health, vital signs, and any specific factors that may impact the administration of anesthesia during the surgery.
Anesthesia Options: The anesthesia provider will discuss the different anesthesia options available for laparoscopic surgery. This may include general anesthesia, regional anesthesia (such as spinal or epidural anesthesia), or a combination of both. The benefits, risks, and expected outcomes of each option will be explained to help the patient make an informed decision.
Pre-operative Instructions: The patient will receive specific instructions regarding fasting guidelines (as discussed earlier), pre-operative medication management, and any other preparations required before the surgery. These instructions are important to ensure the patient’s safety and well-being during the procedure.
Addressing Concerns: The anesthesia consultation provides an opportunity for the patient to ask questions or express concerns related to anesthesia, such as potential side effects, post-operative pain management, or previous experiences with anesthesia. The anesthesia provider will address these concerns and provide reassurance as needed.
Informed Consent: If the patient is satisfied with the information provided and agrees to proceed with the chosen anesthesia technique, they will be asked to provide informed consent by signing a consent form. This indicates that they understand the risks and benefits associated with anesthesia administration during the laparoscopic surgery.
Overall, an anesthesia consultation ensures that the patient is well-prepared for the anesthesia experience during laparoscopic surgery and allows for open communication between the patient and the anesthesia provider. It helps to optimize patient safety and comfort throughout the surgical process.
Patient positioning is a crucial aspect of laparoscopic surgery as it allows the surgeon to access the surgical area effectively and ensures patient safety and comfort during the procedure. The specific positioning will depend on the type of surgery and the surgeon’s preference. However, there are some common patient positioning techniques used in laparoscopic surgery:
Supine Position: The supine position is a common starting position for laparoscopic surgery. The patient lies flat on their back with arms at their sides or on armrests. This position provides easy access to the abdomen and allows for proper placement of trocars (ports for instruments).
Trendelenburg Position: In some laparoscopic procedures, such as pelvic or abdominal surgeries, the Trendelenburg position may be used. The patient’s head is lowered, and the operating table is tilted, so the patient’s feet are higher than their head. This tilting helps to displace the abdominal organs towards the chest, providing a better view and access to the surgical area.
Reverse Trendelenburg Position: The reverse Trendelenburg position is the opposite of the Trendelenburg position. The patient’s head is elevated, and the operating table is tilted so that the patient’s feet are lower than their head. This position may be used for upper abdominal surgeries, allowing better exposure of the upper abdominal organs.
Lateral Position: In certain laparoscopic procedures, such as kidney or gynecological surgeries, the patient may be positioned on their side (lateral position). This allows access to the desired surgical site and provides optimal visualization for the surgeon.
Lithotomy Position: For laparoscopic procedures involving gynecological or urological surgeries, the lithotomy position may be used. In this position, the patient’s legs are placed in stirrups, flexed, and elevated, allowing better access to the pelvic area.
It’s important to note that patient positioning during laparoscopic surgery requires careful attention to prevent complications such as pressure injuries, nerve damage, and circulatory issues. The surgical team takes precautions to ensure proper padding, support, and regular monitoring of the patient’s positioning throughout the procedure.
The specific patient positioning technique and adjustments will be determined by the surgeon based on the surgical goals, patient anatomy, and individual considerations for each case.
- Creation of Pneumoperitoneum
- Insertion of Laparoscope
- Manipulation of Instruments
- Visualization and Dissection of Surgical Area
- Hemostasis and Closure
Common Laparoscopic Procedures
- Laparoscopic Cholecystectomy
- Laparoscopic Appendectomy
- Laparoscopic Hernia Repair
- Laparoscopic Hysterectomy
- Laparoscopic Nephrectomy
- Recovery Room Monitoring
- Pain Management
- Resumption of Diet and Activity
- Wound Care and Dressing Changes
- Follow-up Visits
Complications and Risks
- Organ or Vessel Injury
- Anesthesia-related Complications
- Conversion to Open Surgery
- Summary of Laparoscopic Surgery
- Future Developments and Advancements