Laparoscopy

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Laparoscopy

Laparoscopic surgery, also called minimally invasive surgery (MIS), bandaid surgery, keyhole surgery, or pinhole surgery is a modern surgical technique in which operations in the abdomen are performed through small incisions (usually 0.5-1.5 cm) as compared to larger incisions needed in traditional surgical procedures. Laparoscopic surgery includes operations within the abdominal or pelvic cavities, whereas keyhole surgery performed on the thoracic or chest cavity is called thoracoscopic surgery. Laparoscopic and thoracoscopic surgery belong to the broader field of endoscopy.

The key element in laparoscopic surgery is the use of a laparoscope: a telescopic rod lens system, that is usually connected to a video camera (single chip or three chip). Also attached is a fiber optic cable system connected to a 'cold' light source (halogen or xenon), to illuminate the operative field, inserted through a 5 mm or 10 mm cannula or Trocar to view the operative field. The abdomen is usually insufflated with carbon dioxide gas to create a working and viewing space.

The abdomen is essentially blown up like a balloon (insufflated), elevating the abdominal wall above the internal organs like a dome. The gas used is CO2, which is common to the human body and can be absorbed by tissue and removed by the respiratory system. It is also non-flammable, which is important because electrosurgical devices are commonly used in laparoscopic procedures.

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History

It is difficult to credit one individual with the pioneering of laparoscopic approach. In 1902 Georg Kelling, of Dresden, Saxony, performed the first laparoscopic procedure in dogs and in 1910 Hans Christian Jacobaeus of Sweden reported the first laparoscopic operation in humans.

Advantages

There are a number of advantages to the patient with laparoscopic surgery versus an open procedure. These include:

* reduced blood loss, which reduces the risk of needing a blood transfusion.
* smaller incision, which reduces pain and shortens recovery time.
* less pain, leading to less pain medication needed.
* Although procedure times are usually slightly longer, hospital stay is less, and often with a same day discharge which leads to a faster return to everyday living.
* reduced exposure of internal organs to possible external contaminants thereby reduced risk of acquiring infections.
* can be used in Gamete intrafallopian transfer (GIFT) surgery to put the eggs back into the fallopian tubes.

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Risks

Some of the risks are briefly described below:

* The most significant risks are from trocar injuries to either blood vessels or small or large bowel. The risk of such injuries is increased in patients who are obese or have a history of prior abdominal surgery. The initial trocar is typically inserted blindly. While these injuries are rare, significant complications can occur.

* Some patients have sustained electrical burns unseen by surgeons who are working with electrodes that leak current into surrounding tissue. The resulting injuries can result in perforated organs and lead to peritonitis.

* Coagulation disorders and dense adhesions (scar tissue) from previous abdominal surgery may pose added risk for laparoscopic surgery and are considered relative contra-indications for this approach.

* Patients can often have trouble walking after surgery for a few days.

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Robotics and technology

The process of minimally invasive surgery has been augmented by specialized tools for decades. However, in recent years, electronic tools have been developed to aid surgeons. Some of the features include:

* Visual magnification - use of a large viewing screen improves visibility
* Stabilization - Electromechanical damping of vibrations, due to machinery or shaky human hands
* Simulators - use of specialized virtual reality training tools to improve physicians' proficiency in surgery
* Reduced number of incisions

Robotic surgery has been touted as a solution to underdeveloped nations, whereby a single central hospital can operate several remote machines at distant locations. The potential for robotic surgery has had strong military interest as well, with the intention of providing mobile medical care while keeping trained doctors safe from battle.

Laproscopy