Keyhole surgery?
During laparoscopic or minimal access surgery surgeons gain access to the abdominal cavity through small keyhole incisions instead of the classic big incision. Through these small incisions trocars are placed that are thin tubes equipped with a valve system, about the size of a pen. Using a special insufflator device attached to one of the trochars, the abdominal cavity is inflated with carbon dioxide gas to a certain pressure to create a working space. At the end of the surgery or the gas is released from the abdomen.
The valve system is necessary to prevent leakage of the gas from the abdomen during surgery. A specialized, long tube-shaped video camera, called the laparoscope is placed into the abdomen through one of the trocars and the image of the abdominal cavity is viewed on high-definition screens. The surgical instruments that are used during laparoscopic surgery are specifically engineered for this purpose and they all had a long shaft, a handle and a tip that will go through the trocars.
The surgeon must rely on the image transmitted through the laparoscope to the video screen to assess intra-abdominal problems, and perform entire operations using the laparoscopic instruments without actually seeing the operative field directly. He does not have the ability to directly palpate structures with his hand during surgery.
Despite these limitations, most operations can be done laparoscopically safely and with excellent results.
What is the benefit of minimal access surgery?
The obvious benefits include significantly less postoperative pain and faster recovery. But there is a whole list of additional advantages, such as earlier ambulation following surgery, less frequent development of deep venous thrombosis and postoperative pneumonia, less wound complications, less postoperative hernia formation.
Certain areas of the abdominal cavity can be visualized with much greater precision and with much easier access than during open surgery. The operating technique requires skill set that is different from the open surgical routine and requires specific training. Sometimes this technology is compared to video games and he is referred to as the surgical technique of the new generation of surgeons.
Open Incision
Laparoscopic incisions
How long has laparoscopic surgery been around?
The fundamentals of laparoscopy were laid down in the 1950s primarily by gynecologists and urologists. The first documented laparoscopic cholecystectomy (gallbladder removal) was performed in Germany in 1985 by Dr. Eric Mühe. The laparoscopic cholecystectomy was further popularized by surgeons from France. By the late 1980s with the development of 3 CCD chip video cameras the video laparoscope became a reality and the technique was ready for widespread use.
But the impact of this technology was completely unexpected and it practically revolutionized general surgery. In a matter of 2-3 years laparoscopic cholecystectomy became the standard operation for gallbladder removal and the operation that previously required 3-5 days of hospital stay became day surgery.
Innovative surgeons quickly realized the potentials of the minimal access surgery and developed the technique for many other surgical procedures, such as appendectomy, various hernia repairs and even more complex surgeries that require cutting and reattaching different segments of the gastrointestinal tract. The medical industry continues to develop amazing instruments that help surgeons perform surgeries faster and safer and they continue to breakdown boundaries and perform operations that were previously considered inconceivable.
Having said that, not every surgery should be done laparoscopically and it should remain the surgeon's decision whether the laparoscopic technique is appropriate to deal with any particular problem.
The Commonwealth Weight Loss Center offers a whole range of laparoscopic procedures from the most basic interventions to very complex, advanced laparoscopic surgeries. Dr. Sandor completed the prestigious minimally invasive surgical fellowship at the University of Massachusetts Medical School and since his training he continued to study and keep his knowledge up-to-date on the most recent technologies.
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