| What is emergency laparoscopy? Laparoscopy | | | | The emergency laparoscopy is done in the same |
| was initially used for diagnostic and therapeutic | | | | way as elective laparoscopy. The only thing is |
| purposes. But with the advancement of medical | | | | that the surgeon must be well qualified. |
| sciences, the role of laparoscopy was extended | | | | Emergency Laparoscopy is generally performed |
| for emergency settings also. Emergency | | | | under general anesthesia. Once the patient is |
| Laparoscopic treatment of acute abdomen was | | | | under anesthesia, a urinary catheter is inserted to |
| first proposed by Philippe Mouret in 1990 and since | | | | collect urine during the procedure. To begin the |
| then it is being widely used for abdominal | | | | procedure, a small incision is made just below the |
| emergencies, especially- acute cholecystitis, | | | | navel and a cannula or trocar is inserted into the |
| appendicitis, perforated ulcers, Ectopic | | | | incision to accommodate the insertion of the |
| pregnancies,abdominal bleeding etc. Peptic ulcer | | | | laparoscope. Other incisions (one or two) may be |
| perforation is the second most frequent | | | | made in other areas of the abdomen to allow for |
| abdominal perforation requiring surgery and | | | | insertion of other laparoscopic instrumentation. A |
| accounts for 5% of abdominal emergencies. | | | | laparoscopic insufflation device is used to inflate |
| Dr. Manish Motwani, an eminent laparoscopic | | | | the abdomen with carbon dioxide gas to create a |
| surgeon and founder of Aastha healthcare, | | | | space in which the laparoscopic surgeon can |
| comments," When patients come to the | | | | maneuver the instruments. Laparoscopes, which |
| emergency room, we prefer laparoscopy as it | | | | have integral cameras for transmitting images |
| helps us to conduct an immediate diagnosis and | | | | during the procedure, are available in various sizes |
| can initiate treatment right there." Aastha is well | | | | depending upon the type of procedure being |
| equipped to handle any kind of emergencies. It is | | | | performed. The images from the laparoscope are |
| well equipped with all modern facilities and is | | | | transmitted to a viewing monitor, which the |
| supported by qualified and experienced surgeons. | | | | surgeon uses to visualize the internal anatomy and |
| Laparoscopic surgery has improved our | | | | guide any surgical procedure. After laparoscopic |
| management of surgical emergencies and in | | | | treatment is completed, the laparoscope, cannula, |
| certain conditions is now an essential part of our | | | | and other instrumentation are removed, and the |
| armamentarium. What is clear is that as surgical | | | | incision is sutured and bandaged. |
| expertise and technology both continue to | | | | Generally the patient recovers faster than he |
| improve, so the remit for laparoscopic surgery will | | | | would in an open surgery. But Ofcourse it all |
| expand, to the benefit of our patients. | | | | depends upon on the diagnosis of the patient at |
| When emergency laparoscopy is performed, | | | | the time of operation and what the surgeon did |
| there can be two clinical scenarios : | | | | to treat the disease. In most of the cases, the |
| * In some emergency cases, diagnosis is done | | | | patients are encouraged to move about after |
| and a specific line of action is planned. | | | | few hrs of surgery. They can resume their |
| Laparoscopic procedures are then performed. | | | | normal activities after 7-12 days after surgery, |
| * In few cases, the abdominal pathology is | | | | depending upon the condition. |
| uncertain or doubtful. In these cases, the primary | | | | Benefits of emergency laparoscopy |
| aim of laparoscopy is diagnostic and then | | | | Emergency laparoscopy has a huge benefit of |
| corrective. | | | | providing faster recovery rate. Let us see the |
| What are the operations possible through | | | | benefits of emergency laparoscopy for patients: |
| emergency laparoscopy? | | | | * Accurate diagnosis of the pathology inside the |
| * Diagnostic Laparoscopy for Acute Abdominal | | | | abdomen. |
| Pain. | | | | * Diagnostic and therapeutic surgery is possible at |
| * Laparoscopy for Abdominal Trauma (Blunt and | | | | the same time. |
| Penetrating) . | | | | * Less post-operative pain. |
| * Laparoscopic Management of Intestinal | | | | * Faster recovery. |
| Obstruction. | | | | * Short hospital stay. |
| * Laparoscopic Management of Diverticulitis. | | | | * Less post-operative complications like wound |
| * Laparoscopy for Acute Appendicitis. | | | | infection, adhesion, hernia, etc. |
| * Complicated ovarian cysts. | | | | * Cost-effective in working group. |
| * Pelvic inflammatory diseases. | | | | Contraindications of emergency laparoscopy |
| * Acute salpingitis. | | | | Relative contraindications to emergency |
| * Intestinal adhesions. | | | | laparoscopy are : |
| * Mesenteric adenitis. | | | | * The general anaesthesia and the |
| * Ectopic pregnancy. | | | | pneumoperitoneum required as part of the |
| * Endometriosis. | | | | laparoscopic procedure may increase risk in |
| * Complicated Meckel's diverticulum. | | | | certain patient groups. Most surgeons would not |
| * Omental necrosis. | | | | recommend emergency laparoscopy in: |
| * Intestinal infarction. | | | | * Patients with cardiac diseases and COPD are |
| * Acute diverticulitis. | | | | not good candidate for emergency laparoscopy. |
| * Bedside Laparoscopy in the ICU. | | | | * Patients who have had previous extensive |
| * Laparoscopic Management of Perforated Ulcer. | | | | abdominal surgery, emergency laparoscopy may |
| * Laparoscopy for Intestinal Ischemia. | | | | be difficult. |
| * Laparoscopic Re-operations for Postoperative | | | | * Those with diminished cardio-pulmonary reserve |
| Complications. | | | | are also at risk because of the adverse effects |
| Emergency laparoscopic orchidectomy for torsion | | | | of the pneumoperitoneum on the CVS and a |
| of intra-abdominal testis. | | | | longer operative time. |
| How it is done? | | | | |