Urology

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Laparoscopic Surgery

Laparoscopic or keyhole surgery is used extensively at the RUH. Almost every abdominal operation has the potential for keyhole surgery if the circumstances are right.

Surgeons at the RUH have a wealth of experience in this area of work and several were involved in pioneering the development of laparoscopic surgery almost 20 years ago. The trust has hosted a national conference on keyhole surgery and runs teaching courses for young surgeons in a dedicated surgical skills laboratory on the site.

The range of keyhole operations we offer demonstrates that we have both the knowledge and skills to deal with the most complex situations.

Principles of Laparoscopic Surgery

The key principle of laparoscopic surgery is the reduction of the surgical wound for any given operation to the smallest possible size. This is achieved by using a telescope and TV camera to view the abdominal cavity so the surgeon can see the organs and tissues.

Several tiny incisions may be made so that surgical instruments can be introduced. These techniques allow a faster recovery, as there are fewer disturbances of healthy organs in the abdomen and less discomfort from the surgical scar. There is also a greatly enhanced cosmetic appearance afterwards, which may not be important to all our patients but demonstrates our commitment to providing the best possible care.

Pros and Cons of Laparoscopic Surgery

A direct comparison between a conventional open approach and a keyhole approach to any given operation almost always demonstrates an advantage for keyhole surgery – particularly reduced pain, improved speed of recovery and less scarring. However, laparoscopic surgery is often more complex and may demand more from the surgeon and the team and does carry some risks.

What are the risks?

The surgeon uses CO2 gas to fill the abdominal cavity to create a safe working space inside the patient’s tummy.

It is still a tight space, however, and occasionally normal tissues can be accidentally injured during a keyhole operation. This is rare but can occur in one in every 500 operations, although in most cases the problem is easily correctable. The risk is greater in those who have had previous abdominal surgery where internal scarring can reduce the working space in the tummy still further.

New developments

We are constantly updating our knowledge, techniques and equipment. We are using the latest technology, including different ways of controlling bleeding during surgery and techniques to the further reduce the already small number of scars.

Operations using Laparoscopic techniques

Laparoscopic cholecystectomy
(removal of gall bladder)

Removal of the gall bladder is the most common keyhole operation and applicable to all patients.

We have no restrictions regarding patient weight or age.

Only patients with particularly complex gall bladder disease are likely to need open surgery.

We carry out many of these operations on a day case basis and our success rate is 98.6%. Patients with co-existing conditions may need to stay in overnight.

Laparoscopic appendectomy
(removal of appendix)

This is another common operation, the main advantage of the keyhole approach is the ability to confirm the diagnosis (or spot some other cause of the symptoms) in addition to minimising scarring. Laparoscopic surgery tends to reduce the risk of wound infection which can occur in around 10% of conventional “open” operations. Also, following keyhole surgery, most patients can resume full activity and return to work sooner.

Laparoscopic Hernia Repair

We use keyhole surgery extensively for hernia repair in more complex cases – these include bilateral inguinal hernias (a hernia on both sides of the groin), recurrent groin hernias and incisional hernias. This allows patients to be treated on a day case basis and to recover faster.

Keyhole surgery may be less advantageous for a first operation for a single groin hernia repair. This can be done under a local anaesthetic. Our specialist hernia clinic allows a full discussion of all the options.

Laparoscopic Hiatus Hernia Repair and
Anti Reflux Surgery

We have extensive experience of keyhole surgery for hiatus hernia and both our upper GI surgeons have trained both in the UK and abroad in this field.

This is one of the operations most suited to a laparoscopic approach – both the access and view that the surgeon can achieve and the reduced post operative recovery time compared with traditional open surgery are greater for this operation than for any other.

Laparoscopic Colorectal Surgery

Our surgeons have been involved with laparoscopic bowel surgery from its inception and we are steadily increasing the number of patients who can benefit from it.

The safety of keyhole surgery to treat cancer has been well established by large randomised controlled trials in which the RUH has participated. For cancer patients who have keyhole surgery, not only is hospital stay reduced but they recover quicker, which is especially valuable to those who undergo subsequent chemotherapy treatment.

We also perform many operations for non cancerous bowel disorders including inflammatory bowel disease and rectal prolapse.