Laparoscopic Surgery

surgerySince the late 1990’s, the use of fiberoptic cameras to help perform surgery through small incisions has become more common. Laparoscopic surgery refers to operations that are performed through small incisions in the abdomen. There are typically at least three small incisions, usually less than one inch in length, through which the doctor puts the tiny lighted camera and long, thin instruments to do the surgery while watching on a video monitor. The first operation done using this minimally invasive technique, by general surgeons, was the laparoscopic cholecystectomy, that would be changing operations to operation. It remains one of the most commonly performed operations, along with laparoscopic appendectomy (removal of the appendix) and laparoscopic hernia repair.
The same minimally invasive technique can be used in chest surgery, when it is called thoracoscopy. Using small incisions, remarkably complex operations can be done in the chest cavity.

Laparoscopic Colectomy

unnamed (3)The colon is the last part of the digestive system. As contents pass from the small intestine through colon it absorbs and secretes nutrients, helping keep them in proper balance in the body. Eventually it’s remaining contents(feces) are passed into the rectum to be stored until they are eliminated through the anus. The colon is about 4 to 6 feet long and is broken down into 6 parts: : cecum, right (ascending) colon, transverse colon, left (descending) colon, sigmoid colon and rectum.

Surgery of the colon is sometimes necessary for both benign and malignant (cancerous) conditions. The most common reasons the colon needs to be removed are colon cancer, complications from diverticulitis, complications from inflammatory bowel disease, and bleeding. Most colon surgery involves removing a segment of the colon, not the whole colon. How much of the colon is removed depends on the location of the problem, and the blood supply to that section of the colon. In the case of cancer, the associated lymph nodes will also be removed as part of the operation.

 MINIMALLYLaparoscopic colectomy is actually a hybrid of the best of both open and laparoscopic techniques. Open colectomy involves a single large incision, through which the colon is removed. Laparoscopic colectomy uses the minimally invasive laparoscopic technique, using a thin camera and instruments which are placed through several incisions that are typically less than an inch in length.  The surgeon then uses the instruments to mobilize the colon, and prepare it for removal, including dividing all associated blood vessels and collecting lymph nodes, if necessary. Ultimately, a very small incision will need to be performed to remove the colon specimen, but the laparoscopic technique allows for this incision to be as small as possible. The open colectomy technique, which accomplishes the same goals as the laparoscopic technique, is associated with increased pain, length of hospital stay, wound infection, return of bowel function, hernia, and scar tissue leading to obstruction when compared to the laparoscopic technique. For these reasons, every effort is made to use the laparoscopic technique which has less pain, a shorter hospital stay, a lower rate of wound infection and hernia, and quicker return of bowel function.

 At our institution nearly 90% of colon surgery is performed with the laparoscopic(minimally invasive technique) by 2 attending surgeons in each case.

Post operatively the typical stay in the hospital is between 3 to 5 days.

Patients are ready for discharge from the hospital when they are able to tolerate drinking liquids without nausea, able to walk around the nursing unit, restarted bowel function, and in minimal pain. We expect to see all of our patients in the office about a week after discharge.

Our complication is extremely low, comparable with any major institution. Our surgical nursing, internists, physical therapists, wound care specialists, nutritionists and social workers are all involved when needed to make transition back to a normal life as quick and easy as possible.

Robotic Surgery

What is robotic surgery?

  DaVinciRobotic surgery utilizes the da Vinci robot, a computer enhanced surgical instrument that allows surgeons to perform precise, safe and minimally invasive procedures. Our surgeons control 3 or 4 robotic arms that are attached instruments placed within the patient’s body via very small incisions. Although the robot provides assistance, the entire procedure is performed by our surgeons and their surgical team.

What are the advantages of robotic surgery?

  –Robotic assisted surgery allows for a more precise operation as the robotics jointed wrist design has a range of motion that exceeds that of the human hand. It also has motion scaling and tremor reduction which further refines the surgeon’s hands movements.

– Robotic assisted surgery is performed through very small incisions (and in some cases a single small incision) which results in less pain and a much quicker recovery.

What types of robotic surgery do our surgeons perform?

Our surgeons perform a wide range of abdominal and thoracic robotic surgery. We have 2 of the only 3 surgeons performing robotic thoracic surgery in the San Francisco Bay Area and our surgeons have performed the most robotic lung resections in Northern California. Our surgeons have one of the most extensive robotic colorectal surgery experiences in the Bay Area as well.

Abdominal robotic operations that we perform:

  • Colon and rectal resections for cancer and benign diseases such as polyps and diverticulitis.
  • Removal of the spleen and adrenal gland
  • Pancreas resection for benign and malignant diseases
  • Gallbladder removal via a single small incision
  • Removal of anal and rectal masses without any incision
  • Treatment of gastroesophageal reflux

Thoracic robotic operations that we perform:

  • Lung resections for cancer and benign diseases
  • Removal of malignant and benign tumors of the mediastinum