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 Laparoscope operation- Is it an operation? |
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| Post Date : 2005/12/1 |
Contents :
Laparoscope operation- Is it an operation?
Several years ago, nobody will believe one tumor more than 18 – 20 centimeters can be removed via two to three wounds less than one centimeter. Uterine myoma or hysterectomy can all be done with the use of laparoscope, making the past miserable state of ' cutting thorax & belly wide open ' no longer existed. At the present, among the gynecology operations in advanced countries, more than 80% of laparotomies
are replaced by this kinds of ' small-wounds ' operations. In Taiwan, when we introduce this kind of operation method to the patients, they found that hard to believe, but can accept this kind of operation method soon. Moreover, most people are very satisfied with this kind of operation.
The laparoscope operation has become the mainstream
Laparoscope diagnosis, a familiar name to infertile women, is one of the basic examinations of infertility. The use of the laparoscope can be traced back to the beginning of the 20th century when Mr. Kenlin began with putting endoscope into the abdominal cavity of a dog. However, development of laparoscope was limited by the absence of light source. Not until 1947, Hawking's invention of the fiber, laparoscope had a break thought development. In 1974, laparoscope masters in Germany issued a series of surgery reports regarding removal of oviduct, uterine myoma, ovary, ovary cyst by use of laparoscope. It is when laparoscope started gaining ones’ attention. In recent years, medical centers in U.S.A. utilized the laparoscope to remove the uterus in succession, even for cancer operations. Hence the laparoscope operation replaced the traditional laparotomy gradually and became the mainstream of gynecology operation.
Invention of the revolutionary apparatus
The greatest difference between the operational laparoscope and the one for general diagnosis of infertility lies in the use of the high-efficiency inflating machine and irrigating system, combined with high resolution image system, and the usage of scissors, tweezers and the sew-up apparatus, all of these make up the modern revolutionary ' weapon ' of gynecology operation.
The high-efficiency inflating system can generate 15 to 20 liters of carbon dioxide per minute, which can maintain abdomen pressure. Hence it can keep good operation field, and will not injure the intestines, blood vessel or ureter.. With the help of equipment, constant abdomen pressure can be maintain, which can avoid “explosion” of abdomen.
Combined “Laser” with “water knife” makes perfect outcome
A tools called 'water knife ' is the special weapon generally found nowhere in laparotomies. It’s a system which utilizing water pressure to lysis the weakly bounding tissues. Generally speaking, the weak bounding tissues in the abdomen does not have much blood vessels, therefore, bleeding amount wound be minimal. Since the water can wash away the blood, this also makes the whole operation field clear. The high-energy laser system introduced in recent years makes the laparoscope operation easier. High-energy laser has ' remote access' and it also possess cutting and coagulating functions at the same time, making the laparoscope more accurate and faster.
The Cinema-like operation room
As the whole operation utilizes two or three 1-centimeter wounds on the abdomen, vision of the whole operation is conveyed to monitor via the laparoscope. By use of high resolution system, the operator, assistant, nurse and anesthesiologist can finish a difficult operation in a relaxing and happy mood.
Applications of laparoscope in gynecology and obstetrics
I. Infertility
1. Release of pelvic adhesion
2. Uterus suspension
3. Reproductive technology
4. Release of frimbial and ovary adhesion
II. Endometriosis
1. Electrocoagulation of endometriosis
2. Endometrioma resection
III. Oviduct operation
1. Ectopic pregnancy
2. Salpingectomy
3. Frimbrioplasty
4. Salpingostomy
IV. Ovary operation
1. oophorectomy
2. Ovarian tumors resection
V. Uterus operation
1. Removal of uterine myoma
2. Hysterectomy
VI. Cancer operation
1. Cervical Cancer
2. Ovarian cancer staging
VII. Others operations
Such as appendectomy and cholecystectomy.
Who are not suitable for laparoscope operation?
1. Patient with Intestinal obstruction or partial Intestinal obstruction
2. Patient with peritonitis
3. Patient with internal bleeding
4. Patient with Hernia
5. Patient with diaphramatic hernia
6. Patient with heart & lung disease
7. The unsuitable to be anaesthetized due to physical and psychological state
With this aspect, nearly 90% of the gynecology patients can use laparoscope operation instead of laparotomy. This can be use to explain the fact that gynecology beds in a lot of advanced nations have been reduced more than half.
Complications of laparoscope operation
In any operation or examination, complications appear unavoidably. But as for an experienced laparoscope doctor, it’s much safer than a conventional laparotomy. Dr. Sam, a master in laparoscope operation in Germany, found out that out of 8,900 cases of laparoscope operation, there were only 0.28% of complication. Among them 13 people suffered from massive bleeding, 9 were injured in the intestines, one person has ureter injured, and two suffered from cardioarrest due to anesthesia. Ten people out of these need to have urgent laparotomy. Fortunately, it caused no death or permanent injury, so we can say that the laparoscope operation is quite safe when done by an 'experienced’ doctor.
Laparoscope operation correspond with the demands of light, less , short ,and small
Information age comes, it makes everyone's life style becomes ' light, less, shor, and small'. Laparoscope operations correspond accordingly with these four demands. Laparoscope operation has much ' smaller ' wounds when compared to the conventional laparotomy, and the same goes to the case of 'pain'. The more significant thing is the recovery time is much ' shorter '. Of course, individual, family, and social productivities losses ' less ' as well. Hence we affirm that ' the era of the laparoscope operation ' has already come silently. In the upcoming ten years it will take place of most traditional laparotomy operation.
Graceful operation - Film appreciation in operating room
Due to improvement of TV image system, light source conveyance system, automatic stitch and coagulation equipment, originally traditional complicated operation with huge wound now can be performed with small wound. It is like we grabbed ' meal ' in hand formerly, and progress to usage of cutlery and chopsticks instead. An endoscope doctor precisely utilize various kinds of delicately designed ' chopsticks ' - -Long-handle apparatus, after putting them through the small wound (0.3~0.5 centimeters) of the abdomen or the chest, and then carrying them out through the operation. Therefore the patient’s recovery time will be much shorter and the after pain will be less as well.
Space capsule like operating room.
Since laparoscope operation use a lot of advanced equipment and instrument, patient lying on the operating table will feel himself like in the midst of space capsule; There are huge heart and lung monitor and an anaesthetizing machine nearby, huge TV image system and electric burning and coagulating equipment on the right-hand side, operation apparatus for abdominal cavity by the foot, and left-hand side being the laser system and water-knife equipment with irrigation functions. For this reason if it’s case patient has been anaesthetized already, he is sure to feel himself important and honored. However, the manpower and material resources of a laparoscope operation are more complicated compared to the traditional operation. Moreover, the instruments and equipments need special attention and maintenance. The following will introduce you to the functions of the equipments.
' TV image system ' makes operation like a movie appreciation party
With traditional operation wound of more than ten centimeters on the abdomen, the organ in need of operation is located in the abdomen deeply. It’s like something put in the deep well, and only the people around the well would be able to see the ' treasure '. Hence only the operator and his first assistant can visualize the operating process. However, TV image system changes the situation. It enable everyone including operator, assistant, nurse, and anesthesiologist in the operating room understand the operating courses, which then form an operation group. The image system has been developed up to three chips, with every inch comprises 700 horizontal lines and the definition of the image is improved. ‘Double eyes’ laparoscope system gives image a ' three-dimensional feelings '. Distortion caused by two-dimensional image from an old-modeled laparoscope has improved, making film appreciation more realistically than ever.
Inflating machine never causes a ‘explosion’ abdomen
In traditional operation, in order to get the clear vision one has to open abdominal cavity wide open and then stuffs gauzes inside. Unlike the conventional one, the laparoscope operation is to utilize gas to prop the abdomen open and press the intestines down to get a good operation field. In this way, apparatus can enter the abdominal cavity without hurting other organs. Generally speaking, laparoscope operation utilizes carbon dioxide to inflate and hold abdominal cavity open. Carbon dioxide is easy to absorb by the blood, does not exploded, and cause no air embolism. Traditionally nitrogen oxide was used to cause pneumoperitoneum, which also has anaesthesia function, and it strengthen the effect of anaesthesia. Therefore carbon dioxide is the best inflating media at present. Even so, long-term use of carbon dioxide is apt to the phenomenon of acidosis or cardiac arrhythmia. Patients with cardiovascular and lung problems must be very careful when using it.
Light source machine which generate 'cold light '
By utilizing conducting fibers, which can regulating the luminosity with the assistance of computer, this makes light source machine release soft luminance to the goal area. In addition to the separation of light and laparoscope, it not only keeps the sufficient luminosity but also avoids conductance of high-temperature. However, even though it’s so-called ‘cold light’, some heat energy still exists. Therefore, keep it away from organ is necessary to avoid tissue-injury.
Water knife with irrigating and absorbing functions
In order to reduce bleeding amount, operation must conducted according to anatomy planes. These anatomy planes are the weakest places among the tissues. Pressurizing the solution up to 300 mm. of mercury columns, like the fire fighting truck utilizing water to dash against the crowd having a demonstration, can prop up the surgery parts. During small bleeding, water knife can irrigate at the same time, so that the coagulating goal can be achieved rapidly.
Electric knife and laser knife
For effective cutting and coagulating in the operation, we must use the electric knife. The commonly used electric knife can be divided into monopole and dipole. The difference between the two is: monopole electric knife must utilize a formed electric current feedback circuit through the electric boards that exposed to the human body, then back to electric burning machine to take effect. Therefore, if the electric boards were route incorrectly, one will cause the electricity flows arbitrarily. Electricity voltage used for monopole electric knife were often up to thousands to several tens of thousands of volts, injury caused will be quite serious, such as skin-burn for a minor case, intestine injure or shock death due to cardiac arrhythmia for a serious one. Therefore, extreme attention must be followed while uses the electric knife. When using the bipolar electric knife, this complication will unlikely happen. But since the bipolar electric knife does not have ability of cutting, so it’s use is greatly restricted.
The use of laser can reduce cutting surface injure. In addition, it has extremely good accuracy, as we can say ' see and hit the very target with no problem '. Therefore, it’s veru helpful in a delicate operation. The most frequently used lasers are Nd-YAG, KTP and carbon dioxide laser. Gynecology and obstetrics relies mainly on the carbon dioxide laser and Nd-YAG laser. Carbon dioxide laser is easy to be absorbed by the water molecular and its’ penetrating ability is smaller than 0.5 millimeters, therefore the safety is affirmed. As to the newly revealed Nd-YAG, laser, it’s also shows penetrating capacity of 0.2 millimeters merely, and has better coagulating result than carbon dioxide laser. However, both have flaws : too expensive and ' redundant '. Consequently the electric knife is the popular apparatus compared to the noble laser equipment.
Automatic suture devices
Because the laparoscope operation uses two-dimensional vision rather than the three-dimensional one, so suture techniques used in the laparotomy is no longer suitable for the laparoscope operation. In order to solve this problems and reduce the use of electric coagulating devise, American Surgical Company and Johnson company research and develop the automatic suture-cutting device, which enable the doctor to suture and cut the tissue at the same time. This automatic suture-cutting device comes with a trigger, which makes the laparoscope operation even more simplified. With the help of this equipment, laparoscope hysterectomy can be finished in about an hour.
Other ' long leg ' apparatus
Due to making use of several wounds less than one centimeter, the apparatus all need to be thin and long. So the scissors, tweezers, and needle-holding devices, all become long-leg apparatus, which increased difficulty of the operation, but can all be abbreviated under the skillful doctors.
Undergo an operation easily. Recover and go home happily
Due to the huge traditional operation wound and intolerable the post OP pain, patient often undergo operation with ' mood of being separate forever from one’s family '. Lots of people would rather hesitate again and again, until being beyond cure. Nowadays, with laroscope operations, small wound, minimal pain and short recovery time, patient no longer fear for operation. The most important is that the golden time of treatment won’t be delay.
Applications of laparoscope in human body
Mrs. Lin experienced menstruation disorder due to uterine fibromyoma. She often felt abdominal distention and pain, especially after meal. She went to gastro-enterology to have an examination and unexpectedly found gallstone via ultrasound. Doctor suggested a laparoscope cholecystectomy. She had heard that several abdominal diseases can be solved with laparoscope at the same time, she discussed the possibility of having cholecystectomy and hysterectomy at the same time. The general surgeon then got in touch with the GYN doctors to confirm the feasibility of the operation. Mrs. Lin also expected to restore her hand hyperhydrosis, which affects her a lot. With the sympathetic nerve block skill of endoscope, she came and asked doctor if all the annoying problems can be fixed through single operation. We did admire Mrs. Lin’s courage. However, since the uterus, gallbladder, and appendiex are all intra-abdominal organs, diseases related to those organs can be solved through three to four small wounds. Thoracic laparoscope was used to treat hand hyperhydrosis. Although one could continue the thoracic treatment right after abdominal operation, this will increase the anesthesia time as well as the methods of anesthesia. We suggest her to have hand hyperhydrosis operations after abdominal operation. Mrs. Lin accepted our suggestion and completed hyperhydrosis endoscope operation in three months later.
The use of laparoscope in gynecology and obstetrics has lasted for a long time. In 1970’s, use of laparoscope in tubal sterilization was in great amount. In early 80’s, German laparoscope master issued thousands of cases of laparoscope operation of ovary and oviduct. But due to imperfect image and coagulation system, development of laparoscope operation was quite slow. Until year 1989 France issued the first case of laparoscope cholecystectomy, and then American Dr. Henry issued the first laparoscope hysterectomy. With the improvement of image, thermodynamics, and coagulation system, suddenly laparoscope seemed to have magic power. This causes a great revolution on surgery and gynecology operation techniques. In gynecology and obstetrics operations, more than 80% of laparotomies have been replaced by this small wounds technology. 90% of 20-centimeter laparotomy cholecystectomy wound can be replaced with 3-centimeter laparoscope cholecystectomy wound. Unfortunately, due to lack of acquisition and understanding of medical information in our country, we will now illustrate the medical achievements of laparoscope. Hope everyone can understand the applications of laparoscope, and then receive the best, and the most advanced medical treatment in near future.
Laparoscope cholecystectomy
The most common cause of cholecystectomy is cholelithiasis. Cholelithiasis patient considered operation dangerous due to the 20-centimeter traditional wound, complications and discomfort after the surgery. Moreover, result of internal medicine and lithostomy treatment are limited with relapse rate of nearly 50%. For this reason, laparoscope cholecystectomy issued in year 1987 was appreciated by many surgeons and patients. Nowaday, over 90% of cholecystectomy can be done with laparoscope through wounds that less than one centimeter.
Operation methods:
Make four wounds with one and two centimeter respectively in upper abdomen, then put the laparoscope into the wound that located in belly button, then put tweezers and electric coagulating apparatus into the other three wounds respectively. Operation procedures are as the following:
1. Use tweezers to pull gallbladder, in this way, Carlow’s triangular area can be visualized.
2. Use the laparoscope clip to cut the gallbladder
3. Cut the gallbladder arteries after isolation and coagulation
4. Separate the gallbladder and liver, and coagulated any bleeding vessels
5. Resect gallbladder and water irrigated the abdominal cavity
Result:
Under treatment of an experienced doctor, operation time is less than one hour. Two to four days are needed for hospital staying. With all these advantages, this is an operation worth being promoted. Except in cases of dreadful physical conditions and serious pelvic adhesion, almost all cholecystectomy can make use of laparoscope.
Laparoscope appendectomy
The greatest advantage of laparoscope appendectomy is the inspection of pelvic and abdominal cavity during the operation. With right lower abdominal pain, appendicitis is easily been diagnostic. But the non-typical appendicitis often lets the doctor hesitate in carry on an operation. By use of laparoscope, these problems can be avoided. Laparoscope can inspect other possible abdominal diseases during the operation. This makes laparoscope the best diagnosis and treatment tool. The total length of these three 1-centimeter wounds adds up to about same size of mini laparotomy, however, total pain of small wounds is less than a big wound. Therefore, the recovery period after a laparoscope operation is shorter than a mini laparotomy. Besides, laparoscope can inspect the whole abdominal and pelvic area, which can not be done with mini laparotomy.
Laparoscope Hearnia repair
This is still a controversial operation at present. Compared to a conventional operation which does not entering the abdominal cavity, the laparoscope might cause tissue adhesion. But as to a recurrent hernia, the laparoscope operation is still the best choice.
Laparoscope usage in the urinary system
Varicocele ligation, localization of cryptorchidism, and resection of pelvic lymph nodes of prostate cancer, all of these can be done with a laparoscope. In addition, there are some reports related to kidney fixation and nephrectomy. Among all these operations, varicocele ligation is the most common. During laparoscope procedures, vision was enlarged 10 to 25 times, clearly distinguishing the artery and vein of inner spermatic cord. During operation, laparoscope enters abdominal cavity and ligatures both sides of varix at the same time. The result is pretty good. However, in the case of external varicocele, laparoscope has no role. For this reason, the value of laparoscope operation is still under evaluation.
Hand hyperhydrosis treatment with endoscope
For traditional hand hyperhydrosis treatment, a wound more than 10 centimeters in the chest area is unavoidable. With resects of partial ribs and thoracic vertebra transverse process, operation time is very long, post op pain is extreme, and complications are common. Thoracoscope enters from second intercostal space and finds second sympathetic nerves in thorax, then damaged the ganglion with electric burning apparatus or laser. The same processes go to the opposite side. This operation takes only 30 to 60 minutes by an experienced endoscope doctor, and patient can leave the hospital on the next day. So compared to the past operation method, we may say that these two methods are as far apart as heaven and earth.
Thorax disease treatment by endoscope
This kind of treatment includes spontaneous pneumothorax, benign lungs disease, malignant lungs disease, and pleura disease. The most common use is spontaneous pneumothrox. There are varies size of alveolus in patient’s lungs, those alveolus cause ‘air leakage’ in lungs. Insert laparoscope into the intersection of the fifth intercostal space and back armpit line, with the use of electric burning apparatus or automatic suturing devices to achieve the repair purpose. The success rate of this method is as high as 90%. The more important thing is that this kind of operation skill makes the originally highly invasive thorax operation simple and effective.
With the above introduction, one may realizes that laparoscope operation has initiated a historical great revolution in the operation skill of general surgery and gynecology and obstetrics silently. The past operation skill with ‘huge wound’ and ‘complicated process’ has been phased out and been gradually replaced by laparoscope with minimal invading method. Consequently, in U.S.A. laparoscope cholecystectomy has already accounted for more than 95%; in some cities in German, the laparoscope operation has replaced more than 80% of the traditional operations as well. Compared to American and European countries, our laparoscope operation technique are sophisticated as well. For this reason, we believe people in our country can enjoy the greatest invention of this modern medical science in the near future.
Notification before laparoscope operation
The greatest progress in gynecology and obstetrics operations in recent 10 years is the replacement of conventional laparotomy by small wounds laparoscope operation. As laparoscope is fairly new, when the doctor proposes the laparoscope operation to patients, they often think that swallow the laparoscope into the abdomen, just like ‘swallow a gastroscope’. Some patients even doubt if a huge tumor really can be removed via several small wounds. Of course, some people have already strolled in many hospitals, believing in the principle of ‘get best buy by shopping around’, and showing the determined for receiving laparoscope operation. It’s obvious that most of patients do not know much about the laparoscope, but have extremely high appraisal and expectation on it.
Accurate diagnosis determined the success rate of an operation
The Chinese old saying ‘a workman wants to do his work well, must first sharpen his tools’, which means the detailed pre-OP examination is surely required. Adequate pre-op evaluation lets operator, anesthesiologist, and nurse make correct reactions. Pre-OP evaluation is different according to patient’s need, this includes intra venous pyelography, colono fiberscopy, and even computerized tomography scan.
I. Pelvic vagina examination: This is important to woman’s pelvic disease as woman’s uterus and ovary are all hidden inside of the pelvic cavity, and cannot be diagnosed with the naked eye. GYN doctors use both hands to palpate pelvic cavity and can be able to feel enlarged uterus and ovary. Function of the interior examination is truly like human’s eye, so it’s the basic examination before an operation.
II. Ultrasound diagnosis: Because of ultrasound’s popularization and practicality, ultrasound diagnosis is considered as one of basic examination in gynecology and obstetrics at present. To the patient with fibroid, ultrasound can conclude the position and size of myoma; however, we do not propose a laparoscope operation for size of myoma exceeding 16 weeks fetus. The reason is that time and cost are relatively high and benefit is limited when compared to the conventional operation. Therefore, we do not encourage using the laparoscope to carry on such operation. Ultrasound plays crucial role in ovarian tumor because type of ovary tumor decides operation methods. Ultrasound diagnosis in ovarian tumor has very high accuracy, with specificity 95.6% for benign ovary tumor, and 73% for malignant tumor. So ultrasound diagnosis should be one of the routine examinations before an operation.
III. Intra venous pyelography, colon-fiberscopy, computerized tomography scan: For the possible malignant tumor in pelvic cavity, it’s required to see whether the tumor has invaded other tissue or lymph nodes. One can utilize the colon-fiberscope to understand whether the cancer cell has invaded the rectum, and intra venous pyelography to show whether the ureter has been compressed by the tumor. Not only malignant tumor needed those examinations, patient with serious endometriosis also needed. Endometriosis itself is benign, but clinically behaves like malignant tumor which will invade its surrounding tissue.
Who is not suitable for laparoscope operation?
Because of the great breakthrough of instrument and technology of laparoscope operation in recent years, patients unsuitable for laparoscope operation become fewer and fewer. The listed below are some unsuitable conditions of laparoscope operation:
I. The physical and psychological unsuitable for anesthesia: Most laparoscope operations use general anesthesia. Patients apt to have unexpected mishap due to general anesthesia, such as: hypertension and myocardial infarction, are not suitable for the laparoscope operation.
II. One with cardiovascular and lung disease: Because the laparoscope uses the carbon dioxide as the medium, and peritoneum and intestines surface have ability to absorb carbon dioxide. Anyone with cardiovascular and lung disease will aggravate the heart and lungs burden, therefore is not suitable for a laparoscope operation.
III. Patient with diaphragm or the abdominal hernia: Abdomen pressures of 15 mm. of mercury columns will makes the hernia more aggregated. In more severe cases, high abdominal pressure makes intestines stuck in hernia, causing the intestines blockage and necrosis. Moreover, diaphragm hernia will influence patient's heart and lungs circulation.
IV. Patient with a large amount of internal bleeding: Generally speaking, the large amount of internal bleeding(1000 or more than of 2000 cc ) will often cause the decline of the blood pressure and endanger anesthesia process. In addition, large mount of internal bleeding makes operation relatively difficult to carry on. Therefore in the critical situation, stop bleeding quickly through laparotomy is the most important thing. In this circumstances, laparoscope is not appropriate.
V. Patient with ileus: In situation of ileus, intestines became inflated due to blockage. When using laparoscope, it might injure the intestines by mistake. Therefore, patient with ileus is unsuitable for the laparoscope.
Pre-OP preparations
You can undergo an operation promptly after registering in the operating room on the same day, and free to go home after having 1 to 2 hours rest in recovery room after the operation. However, with a higher complexity operation, the recovery time will be slightly longer. In this case, the doctor will tell you to undergo an operation a day after you register in the hospital..
I. Pre-operation blood routine, electrocardiogram, and chest X-rays: The main purposes of those examinations are to understand the patient's health condition, to reduce the complication of anesthesia, and to see whether the patient has coagulation disorder which may cause major bleeding during an operation. Electrocardiogram and chest X-rays can examine patient's heart and lungs to see whether this patient is suitable for laparoscope operation.
II. Pre-operation fasting: To prevent food and gastric juice from flowing back to trachea and block the breath during the anesthesia period, patients are usually required to fast for more than eight hours (include water, food ). Therefore, fasting is required since 12 o’clock midnight the night before operation. But for daily medication such as hypertension, diabetes and anti-epilepsy, patients should take them on time and notify the nurse.
III. Skin Preparation: For a simple laparoscope operation, there’s no need to shave pubic area; but for a complicated operation which may require laparotomy, the step of hair-shaving is essential. Nevertheless no matter the laparoscope operation is complicated or not, skin’s cleanness is very important. Therefore one should use the soap to clean the body completely, especially the belly button. For concealment of the operation wounds, the first and biggest wound (one centimeter long) is usually locates in the belly button. Consequently, a person who negliant hygiene of belly button tend to have infection after the operation. Although there’s no need of an “extremely long shower” the night before the operation but it does help to reduce post-operation infection by a well self cleaning.
IV. Inform consent: Inform consent must be sign before the operation. It’s essential for you have a thought discussion with doctor about disease treating plan, success rate of the operation, and complications of the operation. This is to prevent post –op accusation of not getting the problems solved ' once and for all ', or resecting ' too much 'during the operation. Meanwhile, as the laparoscope operation is newly developed in recent years, you should inquire whether the fee is covered in the general insurance before the operation.
V. Confirm doctor's experience: Laparoscope is an extremely new operation method. Two-dimensional space rather than three-dimensional space, electric knife, laser, and water knife, all are un-existent in the past. Hence, enough training plus experience guarantee the operation’s harmony and smooth; otherwise complications may occur easily. Inquiring your relatives or friends working in the hospital to choose the best doctor before the operation will guarantee operation safety. Finally you can also ask your doctor about his experience in laparoscope. If you find out that there is possibility of becoming ' the experiment target ', you can cancel the operation at once.
VI. Pre-OP waiting: Hospital arranges operation priorities due to complexity of operations. Generally speaking, older patients, children, and patient with internal illness have priorities. As to the patient with common physical strength, they might feel difficult to endure the waiting time. Listening to the music or reading some books will help kill those times.
' The good beginning is half of success ', carefully selecting the experienced doctor, with well understanding of pre-OP and post –OP procedures are the guarantee to successful treatment.
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| Publisher |
Prof. Chyi-Long Lee |
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