Minimally invasive surgery
Surgery through the keyhole
In our hospital, a large number of minimally invasive procedures are performed.
Almost all procedures, especially in the abdominal area, are successfully performed laparoscopically and video-assisted. The main advantage for the patient is the reduction of the trauma necessary for surgical access. Smaller incisions are possible, resulting in less pain for the patient and a shorter stay in hospital.
Of course, all operations are still performed conventionally, i.e. open surgery, as certain situations and findings cannot be successfully treated with the "keyhole technique". This means that treatment is tailored to the individual patient and situation.
A basic prerequisite for the success of minimally invasive parathyroid surgery is an exact preoperative localization diagnosis of the enlarged parathyroid gland (sestamibiscintigraphy, ultrasound, CT or NMR). Furthermore, there should be no large nodular goiter and no previous surgery or radiation should have taken place in the neck area. A suspected malignant disease of the parathyroid or thyroid gland is also a contraindication for the endoscopic surgical technique. The ideal candidate for minimally invasive video-assisted parathyroid or thyroid surgery is therefore a patient with a solitary adenoma of the parathyroid or thyroid gland.
In the endoscopic surgical technique, an approximately 1.5 centimeter long skin incision is made above the jugular fossa. Under video camera assistance, fine instruments are used to bluntly open up the space between the thyroid gland and the vascular nerve sheath and to visit the enlarged parathyroid gland. The vessels are severed between ligatures or metal clips and the epithelial body is retrieved. The vocal cord nerve can be precisely identified due to the optical magnification. A struma node can be removed in a similar way using this minimal surgical approach.
The intraoperative rapid determination of parathyroid hormone levels is a basic prerequisite for the successful performance of the endoscopic operation; if successful, the parathyroid hormone level must drop to normal within ten minutes after removal of the diseased parathyroid gland.
The advantages of the minimally invasive surgical technique are certainly better cosmetic results as well as a lower postoperative pain load and a faster convalescence of the patients. It is estimated that possibly 15 to 20 percent of all parathyroid and thyroid operations can be performed minimally invasively if the above mentioned criteria are observed. However, conventional methods still retain their value for the treatment of those patients in particular, in whom an exact further localization of the parathyroid glands is not possible, in the presence of a multiple gland disease, when a second operation is necessary or in the presence of a large goiter.
Removal of the adrenal gland is necessary for all hormone-active tumors of the adrenal gland (e.g. Conn's disease, Cushing's disease, pheochromocytoma) as well as for all non-hormone-active tumors that are larger than three centimeters or show a growth tendency. Nowadays, this operation can usually be performed laparoscopically.
Which examinations are necessary?
- Blood and urine determination of the adrenal hormones
- Blood grouping
- Ultrasound examination
- Computer tomography, possibly magnetic resonance examination
- good blood pressure adjustment
Bei der Laparoskopischen Gallenblasenentfernung handelt es sich um den "Golden Standard" bei der Behandlung der Gallensteinerkrankung. Hier kann auch eine mehr oder weniger ausgeprägte Entzündung der Gallenblase vorliegen.
Welche Untersuchungen sind erforderlich?
- Blutabnahme zur Bestimmung der Leber- und Gallenwegswerte sowie der Bauchspeicheldrüsenwerte
- Ultraschalluntersuchung (Sonografie)
Technik der laparoskopischen Gallenblasenoperation:
Die Bauchhöhle wird mit Kohlendioxidgas aufgeblasen. Über eine am Nabel eingebrachte Kamera wird die Bauchhöhle am Fernsehmonitor eingestellt. Über weitere drei kleine Schnitte (0,5 bis 1,5 Zentimeter) werden die Instrumente im rechten Oberbauch eingeführt und die Gallenblase wird auf diese Weise entfernt.
Stationärer Aufenthalt: zirka zwei bis fünf Tage
According to the latest surgical knowledge, both open surgery and laparoscopic appendectomy can be used with the same safety and a comparable result ("out-come") in cases of appendicitis.
Advantages for laparoscopic appendectomy are seen especially in the clarification of chronic lower abdominal pain in men and women and in the diagnostic clarification of lower abdominal pain in women of childbearing age and in overweight patients.
Which preliminary examinations are necessary?
- Blood test
- Ultrasound examination
- possibly gynecological examination
Inpatient stay: about four to five days
In principle, every inguinal hernia should be operated. In our clinic, all methods for the treatment of inguinal hernia, including recurrent hernia, are available and can be applied individually.
- Open surgical method according to Shouldice
- The hernia sac is removed through an incision in the groin area and the hernia gap is closed by special sutures which strengthen the abdominal wall by doubling it.
- Open surgical method with insertion of a plastic mesh (so-called Lichtenstein operation)
- The abdominal wall is strengthened tension-free by inserting a body-compatible plastic net.
- Abdominal mirror method with mesh inlay
- The inguinal hernia is closed by three small incisions from the abdominal cavity under camera view through a plastic mesh insert.
Which examinations are necessary?
- Usual preparation for surgery
- Ultrasound examination (groin and testicles)
In-patient stay: approximately two to five days
According to the latest surgical knowledge, both open surgery and laparoscopic appendectomy can be used with the same safety and a comparable result ("out-come") in cases of appendicitis. For selected patients with certain diseases, laparoscopic surgical procedures can also be used.
Here, too, the advantages of laparoscopic surgery come into play. No large incisions are necessary, painfulness is reduced and patients recover more quickly and can therefore leave the hospital more quickly.