Laparoscopic surgery

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Cholecystectomy as seen through a laparoscope

Laparoscopic surgery, also called keyhole surgery (when natural body openings are not used), bandaid surgery, or minimally invasive surgery (MIS), is a surgical technique. Medically, laparoscopic surgery refers only to operations within the abdomen or pelvic cavity. Laparoscopic surgery belongs to the field of endoscopy. It consists of a Hopkins rod lens system, that is usually connected to a videocamera (single chip or three chip), a fibre 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 canula to view the operative field. Additional 5- 10 mm thin instruments can be introduced by the surgeon through side ports. Rather than a 20 cm cut as in traditional cholecystectomy, two to five cuts of 5-15 mm will be sufficient to perform a laparoscopic removal of a gallbladder. The abdomen is usually insufflated with carbon dioxide gas to create a working and viewing space.

It is difficult to credit one individual with the pioneering of laparoscopic approach. In 1902 Georg Kelling of Dresden performed the first laparoscopic procedure in dogs and in 1910 Jacobaeus of Sweden reported the first laparoscopic operation in humans. In the ensuing several decades, numerous individuals refined and popularized the approach further for laparoscopy. It was not until 1985 when, with the advent of a new and specialized computer chip television camera by Circon Corporation, the approach was broadened in scope to include surgical resection of organs such as gall bladder. The introduction of computer chip television camera was a seminal event in the field of laparoscopy. This innovation in technology provided the means to project a magnified view of the operative field onto a monitor, and at the same time freed both the operating surgoen's hands, thereby facilitating performance of complex laparoscopic procedures. Prior to its conception, laparoscopy was a surgical approach with very limited application and used mainly for purposes of diagnosis and performance of simple procedures.

Conceptually, the laparoscopic approach is intended to minimise post-operative pain and speed up recovery times, while maintaining an enhanced visual field for surgeons. Due to improved patient outcomes, in the last two decades, laparoscopic surgery has been adopted by various surgical sub-specialties including gastrointestinal surgery, gyneacologic surgery and urology. Based on numerous prospective randomized controlled trials, the approach has proven to be beneficial in reducing post-operative morbidites such as wound infections and incisional hernias (especially in morbidly obese patients), and is now deemed safe when applied to surgery for cancers such as cancer of colon.

In some cases the pain caused by the carbon dioxide left in the peritoneal cavity at the termination of the procedure is severe and painkillers may not be very effective. The restricted vision, difficult handling of the instruments (hand-eye coordination), lack of tactile perception and the limited working area can increase the possibility of damage to surrounding organs and vessels, either accidentally or through the difficulty of procedures. For these reasons, minimally invasive surgery has emerged as a competitive new sub-specialty within various fields of surgery. Surgical residents who wish to focus on this area of surgery, gain additional training during one or two years of fellowship after completing their basic surgical residency.

The first transatlantic surgery (Lindbergh Operation) ever performed was a laparoscopic gallbladder removal.

1 Risks
2 Robotics and technology
3 See also
4 References

[edit] Risks

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. Many patients with existing pulmonary disorders may not tolerate pneumoperitoneum (gas in the abdominal cavity), resulting in a need for conversion to open surgery after the initial attempt at laparoscopic approach. 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.

[edit] 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 (example).
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 the battle.