Katana VentraIP

Laparoscopy

Laparoscopy (from Ancient Greek λαπάρα (lapára) 'flank, side', and σκοπέω (skopéō) 'to see') is an operation performed in the abdomen or pelvis using small incisions (usually 0.5–1.5 cm) with the aid of a camera. The laparoscope aids diagnosis or therapeutic interventions with a few small cuts in the abdomen.[1]

Laparoscopic surgery, also called minimally invasive procedure, bandaid surgery, or keyhole surgery, is a modern surgical technique. There are a number of advantages to the patient with laparoscopic surgery versus an exploratory laparotomy. These include reduced pain due to smaller incisions, reduced hemorrhaging, and shorter recovery time. The key element is the use of a laparoscope, a long fiber optic cable system that allows viewing of the affected area by snaking the cable from a more distant, but more easily accessible location.


Laparoscopic surgery includes operations within the abdominal or pelvic cavities, whereas keyhole surgery performed on the thoracic or chest cavity is called thoracoscopic surgery. Specific surgical instruments used in laparoscopic surgery include obstetrical forceps, scissors, probes, dissectors, hooks, and retractors. Laparoscopic and thoracoscopic surgery belong to the broader field of endoscopy. The first laparoscopic procedure was performed by German surgeon Georg Kelling in 1901.

Reduced , which reduces the chance of needing a blood transfusion.[12][13]

hemorrhaging

Smaller incision, which reduces pain and shortens recovery time, as well as resulting in less post-operative scarring.[14][15]

[13]

Less pain, leading to less needed.[16][15]

pain medication

Use of regional anesthesia (with the recommendation of using a ) for laparoscopic surgery, as opposed to general anesthesia required for many non-laparoscopic procedures, can produce fewer complications and quicker recovery.[17]

combined spinal and epidural anaesthesia

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.[18]

[14]

Reduced exposure of internal organs to possible external contaminants, thereby reduced risk of acquiring infections.

[8]

The major problems during laparoscopic surgery are related to the cardiopulmonary effect of pneumoperitoneum, systemic carbon dioxide absorption, venous gas embolism, unintentional injuries to intra-abdominal structures and patient positioning.

[4]

The most significant risks are from injuries during insertion into the abdominal cavity, as the trocar is typically inserted blindly. Injuries include abdominal wall hematoma, umbilical hernias, umbilical wound infection, and penetration of blood vessels or small or large bowel.[26] The risk of such injuries is increased in patients who have a low body mass index[27] or have a history of prior abdominal surgery. While these injuries are rare, significant complications can occur, and they are primarily related to the umbilical insertion site. Vascular injuries can result in hemorrhage that may be life-threatening. Injuries to the bowel can cause a delayed peritonitis. It is very important that these injuries be recognized as early as possible.[28]

trocar

In laparoscopic procedures there is a risk of port site metastases, especially in patients with peritoneal carcinomatosis. This incidence of iatrogenic dissemination of cancer might be reduced with special measures as trocar site protection and midline placement of trocars.[29]

oncologic

Some patients have sustained electrical burns unseen by surgeons who are working with that leak current into surrounding tissue. The resulting injuries can result in perforated organs and can also lead to peritonitis.[30]

electrodes

About 20% of patients undergo during surgery and peritoneal trauma due to increased exposure to cold, dry gases during insufflation. The use of surgical humidification therapy, which is the use of heated and humidified CO2 for insufflation, has been shown to reduce this risk.[31]

hypothermia

Not all of the CO
2
introduced into the abdominal cavity is removed through the incisions during surgery. Gas tends to rise, and when a pocket of CO2 rises in the abdomen, it pushes against the (the muscle that separates the abdominal from the thoracic cavities and facilitates breathing), and can exert pressure on the phrenic nerve. This produces a sensation of pain that may extend to the patient's shoulders in about 80% of women for example. In all cases, the pain is transient, as the body tissues will absorb the CO2 and eliminate it through respiration.[32]

diaphragm

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.

Coagulation

formation is a risk associated with both laparoscopic and open surgery and remains a significant, unresolved problem.[33] Adhesions are fibrous deposits that connect tissue to organ post surgery. Generally, they occur in 50-100% of all abdominal surgeries,[33] with the risk of developing adhesions the same for both procedures.[34][35] Complications of adhesions include chronic pelvic pain, bowel obstruction, and female infertility. In particular, small bowel obstruction poses the most significant problem.[34] The use of surgical humidification therapy during laparoscopic surgery may minimise the incidence of adhesion formation.[36] Other techniques to reduce adhesion formation include the use of physical barriers such as films or gels, or broad-coverage fluid agents to separate tissues during healing following surgery.[34]

Intra-abdominal adhesion

The gas used to make space and the smoke generated during surgical procedures can leak into the operating room through or around access devices as well as instruments. The gas plume can pollute the airspace shared by the operating team and patient with particles and potentially pathogens, including viral particles.[38]

[37]

Some of the risks are briefly described below:

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 training tools to improve physicians' proficiency in surgery[39]

virtual reality

Reduced number of incisions

[40]

In recent years, electronic tools have been developed to aid surgeons. Some of the features include:


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 a strong military interest as well, with the intention of providing mobile medical care while keeping trained doctors safe from battle.


In January 2022, a robot performed the first ever successful laparoscopic surgery without the help of a human. The robot performed the surgery on the soft tissue of a pig. It succeeded at intestinal anastomosis, a procedure that involves connecting two ends of an intestine. The robot, named the Smart Tissue Autonomous Robot (STAR), was designed by a team of Johns Hopkins University researchers.[41]

Non-robotic hand-guided assistance systems[edit]

There are also user-friendly nonrobotic assistance systems that are single-hand guided devices with a high potential to save time and money. These assistance devices are not bound by the restrictions of common medical robotic systems. The systems enhance the manual possibilities of the surgeon and his/her team, regarding the need of replacing static holding force during the intervention.[42]


With laparoscopy providing tissue diagnosis and helping to achieve the final diagnosis without any significant complication and less operative time, it can be safely concluded that diagnostic laparoscopy is a safe, quick, and effective adjunct to non‑surgical diagnostic modalities, for establishing a conclusive diagnosis, but whether it will replace imaging studies as a primary modality for diagnosis needs more evidence.[43]

 – Medical procedure

Arthroscopic surgery

 – Surgical technique that limits size of surgical incisions needed

Invasiveness of surgical procedures

 – Surgical procedure

Laparotomy

 – medical speciality

Natural orifice translumenal endoscopic surgery

 – A surgical procedure

Percutaneous

Revision weight loss surgery

Single port laparoscopy

Feder, Barnaby J. (17 March 2006). "". The New York Times.

Surgical Device Poses a Rare but Serious Peril