Advancement of minimally invasive surgical techniques ("key hole surgery") was rapid and enormous during the last ten years, and included all fields of surgery. This development represents the most important progress in general surgery during the last years.

Thus, almost all procedures, especially those in the abdominal cavity, may be performed successfully via laparoscopy and video assistance.  Trauma at the abdominal wall  is part of the surgical procedure, but can be significantly reduced by laparoscopy, thereby providing the major benefit for the patient. Laparoscopy allows smaller skin incisions, thereby causing less pain for the patient and reducing hospital length of stay.

Obviously, it is still possible to perform all procedures as before, which means via open surgery. This option is important since certain cases and findings cannot be treated successfully via  "key hole surgery". We provide an individual therapy which is adjusted to the needs of the individual patient and to the particular characteristics of his disease.

We perform a variety of on minimally invasive procedures in our hospital.

Activities

please check also minimally invasive surgery for pulmonary diseases (thoracoscopy) in Thoracic surgery

Minimally invasive thyroid and parathyroid surgery     

If a minimally invasive procedure at the parathyroid gland is to be successful it is essential to localize the enlarged parathyroid gland exactly before surgery (using Sestamibi`s scintigraphy, ultrasound, CT or NMR). Furthermore, the patient should not present with a large knotty struma and should not have had a preceding surgery or cervical  radiation therapy. Endoscopic surgical procedures are also not indicated if a malignant disease of the thyroid or parathyroid gland is suspected. Consequently, patients who present with a solitary adenoma of the parathyroid or thyroid gland will be ideal candidates for minimally invasive parathyroid or thyroid  surgery.

For endoscopic surgical techniques we do a skin incision just above the jugulum with a length of 1.5 cm. Using small instruments and a video camera we bluntly open the cavity between the thyroid gland and the vessel/nerve sheath., and we are identifying the enlarged parathyroid gland.  Vessels are cut through between ligatures or metal clips and we harvest the epithelial body. Optical magnification allows a precise identification of the vocal cord nerve.. In the same way we can use such a minimally invasive access to remove a thyroid knot.

If this endoscopic surgery is to be successful it is essential to determine parathomone concentrations during surgery via a fast assay. In the case of success parathormone concentrations have to come down to normal levels as soon as ten minutes after removal of the diseased parathyroid gland.

Assured benefits of minimally invasive operative techniques include improved cosmetic results, less postoperative pain and an accelerated patient anastasis. If the criteria above are followed, approximately 15 to 20% of all thyroid and parathyroid diseases can be treated by minimally invasive surgery.  Nevertheless, conventional techniques will remain of unrestricted value for treating especially those patients in whom it is not possible to localize the parathyroid gland exactly, who present with a multifocal disease, who have already had a preceding surgery or who present with a large struma.

Laparoscopic surgery for adrenal disease     

Removal of the adrenal gland is indicated with all hormone secreting tumors of the adrenal gland (e.g. in Crohn`s disease, Cushing`s disease, pheochromocytoma) and with non-hormone secreting tumors of which the diameter is more than three centimeters or which were found to grow. Today, corresponding surgery can be mostly performed via  laparoscopy.

Which type of examinations are necessary?

• Concentration measurements of adrenal hormones in blood and urine
• Blood type determination
• Ultrasound examination
• Computerized tomography, eventually nuclear magnetic resonance tomography
• Sufficient control of blood pressure 

Technique of laparoscopic surgery for adrenal diseases:

Using a small paraumbilical incision we introduce a special camera into the abdominal cavity which has been inflated with carbon dioxide gas. Subsequently, we introduce small instruments through four further cuts into the abdominal cavity. Then, we perform the surgical procedure at the adrenal gland and remove it.

Hospital length of stay: about one to two weeks

Laparoscopic surgery for gall bladder diseases     

Laparoscopic surgery is the gold standard for treating a variety of gall stone diseases. They may also include a more or less pronounced inflammation of the gall bladder.

Which examinations are necessary?

• Blood samples to determine laboratory values of hepatic, biliary and pancreatic function 
• Ultrasound examinations (sonography)
• Gastroscopy

Technique of laparoscopic surgery for gall bladder diseases:

We inflate the abdominal cavity with carbon dioxide gas. Then we insert a camera through a paraumbilical incision and visualize the abdominal cavity on a TV monitor. Using three further cuts (0.5 to 1.5 cm) we introduce the instruments into the right upper abdomen. Subsequently, the gall bladder is removed in this way.

Hospital length of stay: about two to five days

Laparoscopic appendectomy     

If there is an appendicitis we can do a conventional appendectomy (open surgery) or an endoscopic appendectomy (laparoscopy). Most recent surgical knowledge tells us that both procedures are comparable with respect to safety  and prognosis (outcome). There are some advantages for laparoscopic appendectomy, if one wants to clarify chronic pain in the lower abdomen in male and female patients, or in pre-menopausal women, or if the patient is overweight.

Which type of examinations are necessary?

• Blood tests
• Ultra sound examinations
• eventually a gynaecological examination in women

Hospital length of stay: about four to five days

Repair of inguinal hernias     

Each inguinal hernia should always be repaired. Our hospital provides all methods for repair of inguinal hernias, also for recurrent disease, and we use these techniques optionally and individually.

Open surgical repair (procedure according to Shouldice):

Using a skin incision in the groin region we remove the hernia sack and we close the hernia gap by special sutures which reinforce the abdominal wall by sheathing.

Open surgical repair with insertion of a synthetic net (so-called Lichtenstein`s procedure).

For this type of repair we insert a synthetic net which is compatible with your body and  which reinforces the abdominal wall without tension.

Laparoscopic repair with net insertion:

Using three little cuts  we enter the abdomen, insert a camera for visualization, and we close the inguinal hernia from the inside by inserting a synthetic net through.

Which type of examinations are necessary?

• standard preoperative preparations
• Ultrasound examinations (groin and testicles)

Hospital length of stay: about two to five days

Laparoscopic adhesiolysis in the abdomen and laparoscopic surgery for gastrointestinal diseases     

To perform surgery in the abdominal cavity and at the small and large bowel, traditional methods require an abdominal incision which is more or less extensive. In addition, laparoscopic surgical procedures can be used in selected patients with certain diseases.

Also these patients will then profit from the benefits of laparoscopic surgery. Large incisions are no longer necessary, thereby painfulness is being reduced, and patients will recover faster and may also leave the hospital sooner.

Contact

	0049-(0)89-7276-224
	0049-(0)89-7276-233
	chirurgie.muenchen@martha-maria.de
	Krankenhaus Martha-Maria München Chirurgische Klinik Wolfratshauser Straße 109 D-81479 München Germany