Advanced Laparoscopic Surgery

Laparoscopic surgery is a minimally invasive procedure that uses a laparoscope to view internal body structures and organs. A laparoscope is a thin tube with a light and a camera. It is inserted into the body through small incisions called trocars. Images from the laparoscope may be sent to a video monitor. Thin surgical instruments are inserted through the trocars during the surgery.

Laparoscopic surgery has several advantages over traditional, open surgery. Laparoscopic surgery is less invasive and requires only small incisions. It is associated with less pain, bleeding, complications, and scarring. Additionally, less invasive surgery methods tend to require a shorter hospital stay and have a quicker recovery time. In some cases, surgeries may be performed as outpatient procedures.


Some condition and treatments we perform laparoscopically:

Click on the procedure title for enhanced details including pictures and video animations. Please be advised that some material may be considered graphic. No information conveyed on this website should be construed as a medical diagnosis and in all cases a personal consultation with a surgeon is required.

Laparoscopic-Hernia-Surgery advance-surgery-2
For additional information, videos and brochure downloads on our treatments please click on the links below the section

Laparoscopic Hernia Repair
(Hiatal ,Inguinal, Ventral, Umbilical, Epigastric & Spiegelian)

A hernia is the protrusion of an organ or the fascia of an organ through the wall of the cavity that normally contains it. There are different kinds of hernia, each requiring a specific management or treatment. Dr. Atwa and Paracha are the foremost Hernia specialists in the Metro New York Area. Please click the title above to visit our detailed Hernia Education Center.

Cholecystectomy (Gallbladder Removal)

The gallbladder is a small organ that aids mainly in fat digestion and concentrates bile produced by the liver. In humans, the loss of the gallbladder is usually easily tolerated. When the amount of bile and chemicals inside the gallbladder are imbalanced, gallstones may develop and irritate the lining of the bladder, causing heartburn, abdominal pain, nausea and vomiting. Gallstones are often treated with surgery to remove the gallbladder, which is not necessary for proper body functioning.

Cholecystectomy is the surgical removal of the gallbladder. Laparoscopic Cholecystectomy does not require the abdominal muscles to be cut, resulting in less pain, quicker healing, improved cosmetic results, and fewer complications. Most patients can be discharged on the same day of surgery or on the following day. Typically, patients may return to work within a week.

gallbaldder-pain laparoscopic-cholecystectom cholecystectomy

Brochure Downloads:
Gallbladder Removal Colecistectomia

Heller Myotomy for Achalasia

Achalasia is rare condition that causes difficulty swallowing as a result of the lower esophageal sphincter muscles being unable to relax. We correct this through a procedure called heller myotomy, which cuts the sphincter muscles that join the esophagus and stomach. This limits the activity of the muscle and allows food to pass more easily into the stomach. this surgery is often combined with partial fundoplication to reduce the incidence of postoperative acid reflux


Nissen Fundoplication for Acid Reflux

Gastroesophageal reflux disease (GERD) is a digestive disorder that is caused by gastric acid flowing from the stomach into the esophagus. If left untreated, esophageal ulcers, esophageal bleeding, narrowing of the esophagus (peptic stricture) and even cancer may occur. A hiatal hernia may be associated with GERD. Heartburn is the most common symptom of GERD. Severe heartburn may also be caused by a hiatal hernia. Nissen fundoplication is a surgical procedure to treat (GERD) and hiatus hernia. Para-esophageal hernias are hernias in which part of the stomach bulges into the chest. During this surgery, Drs Atwa and Paracha recreate the valve between the stomach and the esophagus, this prevents reflux into the esophagus and improves symptoms.

Laparoscopic Adrenalectomy

Adrenalectomy is the surgical removal of one or both (bilateral Adrenalectomy) adrenal glands. It is usually advised for patients with tumors of the adrenal glands. The adrenal glands produce several important hormones and chemicals,

Although laparoscopic adrenal gland removal has many benefits, it may not be appropriate for some patients. Obtain a thorough medical evaluation by a surgeon qualified in laparoscopic adrenal gland removal in consultation with your primary care physician or endocrinologist to find out if the technique is appropriate for you.


Gastrectomy is most often done to treat stomach cancer. It is currently the only way to cure stomach cancer. The use of chemotherapy and radiation after surgery may help improve survival. Even if the cancer is too advanced to be cured, Gastrectomy can help to prevent bleeding, obstruction, and pain. In addition to treating stomach cancer, this surgery may also be done to treat: Ulcer disease, Bleeding, Inflammation, Benign tumors in the stomach.


A vagotomy is performed when acid production in the stomach cannot be reduced by other means. A vagotomy is a surgical procedure that involves partial resection of the vagus nerves. The purpose of the procedure is to disable the acid-producing capacity of the stomach. It is used when ulcers in the stomach and duodenum do not respond to medication and changes in diet. It is an appropriate surgery when there are ulcer complications, such as obstruction of digestive flow, bleeding, or perforation. It is often performed in conjunction with another gastrointestinal surgery, such as partial gastrectomy.


This procedure is the surgical removal of the vermiform appendix. This procedure is normally performed as an emergency procedure, when the patient is suffering from acute appendicitis. In rare case, it may be performed for tumors of the appendix, chronic right lower quadrant pain or several months after an episode of perforated appendicitis (Interval Appendectomy)

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Brochure Downloads:




Splenectomy is the surgical removal of the spleen. The spleen filters blood to remove bacteria, parasites, and other organisms that can cause infection. It also removes old and damaged blood cells. You may need to be treated by having a Splenectomy if you have: Trauma to the spleen, Spleen rupture due to tumor, infection, inflammatory condition, or medicines, Enlargement of the spleen (splenomegaly), Certain blood disorders such as Immune thrombocytopenic purpura, Hereditary Spherocytosis, Sickle cell disease; Myelofibrosis (abnormal formation of fibrous tissue in the bone marrow), damage in the blood vessels of the spleen, Leukemia or lymphoma, Diseased spleen, due to disorders like HIV infection ,Tumor or abscess in the spleen or Liver disease. Splenectomy is occasionally included in removal of other cancers adjacent to the spleen, such as the stomach, colon, adrenal gland, or pancreas.

Small Bowel Resection

The small bowel, or small intestine, carries out food digestion (breaking down and absorbing nutrients). Resection to remove part of your small bowel may be recommended when your small bowel is blocked or diseased. A small bowel obstruction, or a blockage in the intestine caused by scar tissue or congenital (from birth) deformities, bleeding, infection, or is caused by scar tissue or congenital (from birth) deformities. Other surgical conditions of the small bowel are bleeding, infection, ulcers caused by inflammation of the small intestine, Crohn's disease, Cancer, Carcinoid tumor, Injuries to the small intestine or its vessels, Meckel's diverticulum, Noncancerous (benign) tumors or Precancerous polyps (nodes). Small cuts are made to remove the diseased segment. If there is enough healthy small intestine remaining, your surgeon will sew or staple the healthy ends of the small intestine back together. Most patients have this done. If you have a severe infection in the abdomen or do not have enough healthy small intestine to reconnect, your surgeon will make an opening on the abdominal wall and skin, called a stoma, and your small intestine will be attached to the outer wall of your abdominal wall. Stool will go through the stoma into a drainage bag outside your body. This is called an ileostomy. The ileostomy may either be short-term or permanent.

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Repair of perforated ulcer

If an ulcer continues to grow so that it creates a hole in the stomach or intestinal wall, it is called a perforated ulcer. Surgery for a perforated ulcer is a life saving procedure that typically involves the surgeon sewing up the hole. Depending on the size and location of the perforation, other techniques may be required such as partial gastrectomy (removal of part of the stomach) or a Pyloroplasty, where surgery widens the last part of the stomach.


Diagnostic Laparoscopy

Diagnostic laparoscopy is a procedure that allows a health care provider to look directly at the contents of a patient's abdomen or pelvis, including the fallopian tubes, ovaries, uterus, stomach, small bowel, large bowel, appendix, diaphragm, liver, spleen, and gallbladder. The examination helps identify the cause of pain in the abdomen and pelvic area. It is done after other, noninvasive tests. Laparoscopy may detect or diagnose the following conditions: Appendicitis, Cancer, such as ovarian cancer, Ectopic pregnancy, Endometriosis, Inflammation of the gallbladder (cholecystitis) or Pelvic inflammatory disease, adhesions (scar tissue), hernias, . The procedure may also be done instead of open surgery after an accident to see if there is any injury to the abdomen. Also, biopsies of diseased organs can be performed.

How the Test is Performed

The procedure is usually done in the hospital or outpatient surgical center under general anesthesia. A surgeon makes a small cut below the belly button (navel) and inserts a needle into the area. Carbon dioxide gas is passed into the area to help move the abdominal wall and any organs out of the way, creating a larger space to work in. This helps the surgeon see the area better. A tube is placed through the cut in your abdominal area. A tiny video camera (laparoscope) goes through this tube and is used to see the inside of your pelvis and abdomen. Additional small cuts may be made if other instruments are needed to get a better view of certain organs. After the exam, the laparoscope and instruments are removed, and the cuts are closed.


An esophagogastroduodenoscopy,or EGD, is the introduction of a flexible tube with a camera at the end, or endoscope, down the mouth, through the esophagus, stomach and into the duodenum.

Common indications are:

  • Diagnostic evaluation for signs or symptoms suggestive of upper GI disease (eg, dyspepsia, dysphagia, noncardiac chest pain, recurrent vomiting)
  • Surveillance for upper GI cancer in high-risk settings (eg, Barrett esophagus, polyposis syndromes)
  • Biopsy for known or suggested upper GI disease (eg, malabsorption syndromes, neoplasms, infections)
  • Therapeutic intervention (eg, retrieval of foreign bodies, control of hemorrhage, dilatation or stenting of stricture, ablation of neoplasms, gastrostomy placement)
  • Preoperatively for bariatric surgery, or for bariatric patient with upper abdominal symptoms.


Brochure Download:
AGAPatientBrochure UpperGI Preparacion para la Endoscopia de tracto intestinal Superior

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Colon resection

A Colectomy, or Colon resection, is a surgical procedure to remove either part of or the entire colon (large intestine). A colon resection may be performed to treat the following colon conditions: Colon cancer, Diverticulitis, Large bowel obstruction, Gastrointestinal bleeding, Inflammatory bowel disease, Intestinal polyps which cannot be removal with a colonoscopy. While the patient is under general anesthesia, an incision is made in the abdomen and the diseased part of the colon is located. The diseased part of the colon will be removed, and the healthy colon sewn back together. In more extensive operations, a colostomy may be performed in which a surgical opening is made through the abdomen to provide a path for elimination. A colostomy may be created as a temporary measure to allow more time for the colon to heal. Laparoscopic colon resection requires three to four small incisions instead of one large one. Typically, most partial colon resections can be handled with this technique.

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Liver biopsy

A liver biopsy is a diagnostic procedure used to examine liver tissue and determine the cause of any abnormalities. This procedure is often performed after another test, such as a blood test, indicates a problem within the liver. A liver biopsy can diagnose alcoholic liver disease, hemochromatosis, hepatitis B and C and liver cancer. During laparoscopy, the liver surface is examined and small tumors not seen during CT scans or other imaging modalities may be diagnosed. The use of ultrasound during laparoscopy is the most sensitive test to diagnose lesions in the liver. Laparoscopic liver biopsy is a simple procedure that is done on an outpatient basis.


Lymph node biopsy

A lymph node biopsy is the removal of lymph node tissue for examination under a microscope. Lymph nodes are small glands that make white blood cells (lymphocytes), which fight infection. Lymph nodes act as filters that trap germs that cause infection. Cancer can spread to lymph nodes. A lymph node biopsy is done in an operating room in a hospital, or at an outpatient surgical facility.


Laparoscopic Common bile duct exploration (LCBDE)

The CBD is a tube connecting the liver, gallbladder, and pancreas to the small intestine that helps deliver bile to aid in digestion. If a stone or obstruction is blocking the CBD, bile can back up into the liver causing jaundice. Jaundice is when the skin and white of the eyes become yellow.

The CBD might become infected and require emergency surgery if the stone or blockage is not removed.

A CBD exploration is the opening of the duct to evacuate a stone that is causing a blockage and jaundice. It is usually performed in conjunction with a Cholecystectomy (gall bladder removal) to prevent further stone from passing into the CBD. A tube is left after surgery to drain bile into a bag, which will be removed several weeks after surgery.

Common bile ductWhen is it used?

If a stone or obstruction is blocking the CBD, bile can back up into the liver causing jaundice. Jaundice is when the skin and white of the eyes become yellow.

The CBD might become infected and require emergency surgery if the stone or blockage is not removed. This procedure can be done during the removal of the gall bladder.

Common bile duct exploration and stone extraction is typically problematic, tedious, and is accomplished via three surgical options:

1. Open, which is an invasive procedure requiring a longer period of hospitalization and recovery.

2. Endoscopic Retrograde Cholangio-Pancreatography (ERCP), a second procedure that requires an endoscopic specialist (often not available in smaller hospitals), with a 10% complication risk that includes pancreatitis and a 1.0% mortality rate. Patients who develop post ERCP pancreatitis can expect extended hospital stays of 48-94 days. (Waknine, Yael. Gut, Dec. 2003)

3. Laparoscopic Common Bile Duct Exploration (LCBDE) includes either (a) transcystic or (b) choledochotomy procedures and is a minimally invasive operation with the lowest associated morbidity & mortality. No second operation is required and the patient's diseased gall bladder is removed during the same procedure. LCBDE provides for quick recovery, a short hospital stay (may even be performed in the ambulatory surgery setting), and has virtually no risk of pancreatitis.

Lysis of adhesions

Adhesions are bands of scar tissue that can form in your abdomen and pelvis, usually following previous open abdominal or pelvic surgeries such as hysterectomies, etc. Adhesions can cause organs and surrounding tissue to be twisted, pulled out of place or stuck together. Adhesiolysis (ad-he-zee-oh-LEYE-sis): This is a procedure that is performed laparoscopically. The surgeon uses instruments to cut or burn away the adhesions. A special gel is inserted at the end of the procedure to prevent further adhesion formation. This can be performed as outpatient.


Gastrostomy Feeding tube insertion

Gastrostomy feeding tube insertion is the placement of a feeding tube through the skin and stomach wall, directly into the stomach. A jejunostomy feeding tube is similar, but is inserted into the small bowel.

Feeding tubes are put in for different reasons. They may be needed for a short while or permanently. This procedure may be recommended for:

  • Patients who cannot swallow correctly because of a stroke or cancer
  • Patients who cannot take enough food by mouth to stay healthy
  • Patients who often aspirated food and develop pneumonias
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Partial Pancreas Resection

The pancreas is an organ that helps in digestion, as well as help in the metabolism of carbohydrates by secreting hormones such as insulin.

A laparoscopic distal pancreatectomy is the removal of the tail of the pancreas because of benign or malignant tumors or cysts or chronic pancreatitis. The spleen is usually also removed. It is performed through several small incisions in the abdomen. The patient will usually stay several days in the hospital.