Advanced Laparoscopic

What is Laparoscopic Surgery?

Laparoscopic or “minimally invasive” surgery is a specialized technique of performing surgery. In the past, this technique was commonly used for gynecologic surgery and for gall bladder surgery. Over the last 10 years the use of this technique has expanded into intestinal surgery.

In traditional “open” surgery the surgeon uses a single incision to enter into the abdomen. Laparoscopic surgery uses several 0.5-1cm incisions. Each incision is called a “port.”  At each port a tubular instrument known as a trochar is inserted.  Specialized instruments and a special camera known as a laparoscope are passed through the trochars during the procedure.

At the beginning of the procedure, the abdomen is inflated with carbon dioxide gas to provide a working and viewing space for the surgeon. The laparoscope transmits images from the abdominal cavity to high-resolution video monitors in the operating room.

During the operation the surgeon watches detailed images of the abdomen on the monitor. This system allows the surgeon to perform the same operations as traditional surgery but with smaller incisions.  Compared to traditional open surgery, patients often experience less pain, a shorter recovery, and less scarring with laparoscopic surgery.  Dr. Howard performs all of his bariatric operations laparoscopically and most of his general surgery operations laparoscopically in both The Woodlands and Conroe, TX facilities.

Common Laparoscopic Surgeries

Dr. Howard’s surgical expertise extends beyond weight loss surgery. In his general surgery practice, he performs many other procedures laparoscopically including:

Hernia Surgery

  • Inguinal   (a bulge in the groin)
  • Ventral/Incisional   (a bulge in the abdominal wall , many times present at old incision sites)
  • Femoral   (a bulge in femoral area)
  • Umbilical   (a bulge at the belly button)
  • Internal Hernia   (found in some patients after previous intestinal surgery)
  • Hiatal Hernia (defect in the diaphragm)


  • Cholecystectomy   (removal of the gall bladder)
  • Common Bile Duct Exploration   (examination of the duct between the liver and the bowel)
  • Liver Biopsy


  • Nissen Fundoplication   (treatment for Gastroesophageal Reflux Disease – GERD)
  • Paraesophageal Hernia Repair   (where the stomach as moved from the abdomen into the chest)
  • Gastrectomy   (removal of part or all of the stomach for cancer or other disease)
  • Gastrojejunostomy   (connecting the stomach and small bowel together)
  • TIF - Total Incisionless Fundoplication - see below


  • Lysis of Adhesions   (removal of scar tissue from previous operations)
  • Small Bowel Resection/Bypass   (removal of intestines or bypassing areas of disease)
  • Colectomy   (Removal of part or all of the colon for cancer or other colon diseases)
  • Appendectomy   (removal of the appendix)
  • Diagnostic Laparoscopy for Acute and Chronic Abdominal Pain

Solid Organ Surgery

  • Splenectomy  (removal of spleen)
  • Adrenalectomy  (removal or biopsy of the adrenal glands)
  • Distal Pancreatectomy (removal of part of the pancreas)

Single Incision 

  • Single incision cholecystectomy (removal of the gallbladder through a single incision in the belly button leaving virtually no scar)

Total Incisionless Fundoplication (TIF)

  • A procedure for GERD (gastroesophageal reflux) that is done completely with out an incision. 

See video: