surgery also referred to
as minimally invasive surgery describes
the performance of surgical procedures
with the assistance of a video camera
and several thin instruments. During
the surgical procedure, small incisions
of up to half an inch are made and
plastic tubes called ports are placed
through these incisions. The camera
and the instruments are then introduced
through the ports which allow access
to the inside of the patient.
surgery, also called minimally
invasive surgery (MIS), bandaid surgery,
or keyhole surgery, is a modern surgical
technique in which operations in the abdomen
(Abdomen is Latin for belly) are performed
through small incisions (usually 0.5 - 1.5
cm) as compared to larger incisions needed
in traditional surgical procedures. Medically,
laparoscopic surgery refers only to operations
within the abdomen or pelvic cavity. Laparoscopic
surgery belongs to the 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 videocamera (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
to view the operative field. The abdomen
is usually insufflated with carbon dioxide
gas to create a working and viewing space.
Additional 5- 10 mm thin instruments can
be introduced by the surgeon through trocars
(hollow sheaths). Rather than a 20 cm incision
as in traditional cholecystectomy, four
incisions of 0.5-1.5 cm will be sufficient
to perform a laparoscopic removal of a gallbladder.
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, the approach was broadened in scope
to include surgical resection of organs
such as gall bladder. The first successful
laparoscopic removal of gall bladder in
humans was reported in 1987 in France. 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
surgeon'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.
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, gynecologic 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.
restricted vision, the difficulty in handling
of the instruments (hand-eye coordination),
the lack of tactile perception and the limited
working area are factors which add to the
technical complexity of this surgical approach.
For these reasons, minimally invasive surgery
has emerged as a highly 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.
first transatlantic surgery (Lindbergh Operation)
ever performed was a laparoscopic gallbladder
There are a number of advantages to the
patient with laparoscopic surgery versus
an open procedure. These include:
time in the operating room, which equals
a shorter time under anesthesia.
reduced blood loss, which equals less
risk of needing a blood transfusion.
smaller incision, which equal less pain
and shorter recovery time.
less pain, which equals less pain medication
shorter hospital stay, which equals a
faster return to everyday living.
reduced exposure of internal organs to
possible external contaminants therebey
reduced risk of acquiring infections.
The expert advisers said that laparoscopic
surgery may increase the chance of completely
removing the cancer. They also said it offers
an improved chance of the cancer not returning.
The healthy tissue that is removed with
the cancer is examined after surgery to
check that all of the cancer has been removed.
Eight studies of laparoscopic surgery and
open surgery showed that the rate of not
removing all of the cancer was similar.
Two studies showed that this occurred more
often with open surgery, and one study showed
that it occurred more often with laparoscopic
Out of just over 1400 men treated with laparoscopic
surgery, the cancer was not fully removed
in 1 in 5 patients. Out of just over 22,000
men treated with open surgery, nearly 1
on 4 had some cancer that was not removed.
Some of the risks are briefly described
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
Not all of the gas introduced into the
abdominal cavity is removed through
the incisions during surgery. The gas
moves around in the body, usually ending
up in the shoulders. For an appendectomy,
the right shoulder can be particularly
painful. Bubbles of gas can also move
to near the solar plexus when lying
down, causing considerable pain when
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.
This is a laparoscopic robotic surgery machine
developed by Intuitive Surgical.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
magnification - use of a large viewing
screen improves visibility
Stabilization - Electromechanical damping
of vibrations, due to machinery or shaky
Simulators - use of specialized virtual
reality training tools to improve physicians'
proficiency in surgery (example).
Reduced number of incisions
Patients may have chemical burns due
to Mastisol Liquid Adhesive that is
used to keep the bandages in place.
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.
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