Understanding Laparoscopic Procedures
When a patient is confronted with the necessity of having a surgical procedure, a surgeon may suggest that laparoscopic procedures are preferable to previous modes of surgical intervention. Of course, many patients still do not understand what laparoscopy entails or how different laparoscopic procedures may be of benefit to them.
On the other hand, surgeons will suggest that laparoscopic procedures have definitely changed the face of surgery, in a positive direction, over the years.
When did laparoscopic surgery originate?
With the initial laparoscopic surgery on dogs, in 1902, by George Kelling, of Dresden, Saxony, it became apparent that this method of surgery would also be beneficial to human beings. Thus in the year 1910, Hans Christian Jacobaeus of Sweden performed the first laparoscopic procedure on a human being. (1)
Gradually laparoscopic procedures have continued to evolve over time. During the following years, the initial laparoscopic procedures on human beings were primarily diagnostic and gynecologic in nature.
The introduction of the computer chip television camera enabled surgeons to have a magnified view of the operative area, on a monitor and thus it freed their hands as well, allowing more complex procedures to be carried out. In 1990, the laparoscopic chip applier, with twenty automatically advancing clips, was introduced. Until that time, only a single clip had been used. This made laparoscopic surgery, the preferable method for gallbladder surgery. (2)
What is laparoscopic surgery?
Laparoscopic surgery is commonly referred to as minimally invasive surgery, band-aid surgery or key-hole surgery, because it is performed through an incision of .5-1.5 cm. It is generally used for surgery, in either the pelvic cavity or the abdomen. Key-hole surgery involves the thoracic or chest cavity. (3)
What is a laparoscope?
A laparoscope is a telescopic lens system, connected to a video camera or a digital laparoscope, with a charge-coupled device. A fiber optic system gives a cold light source, needed for visualization. CO2 is used to enlarge the operative area. (4)
How is laparoscopic surgery performed?
For gallbladder surgery, using four incisions, 5-10 mm instruments are inserted through tubes, directly into the abdominal cavity. The bile is then suctioned out and the gallbladder is removed, through a 1 cm incision, at the navel. For other kinds of surgery, that involve the bowel or kidney, a larger incision may be needed to remove an organ or part of it. This may also require a hand-assist, where a hand is inserted into the body cavity. (5)
When is laparoscopic surgery used?
Laparoscopic surgery is currently being used for gastrointestinal and gynecologic surgery, as well as urology. It is also used for surgery involving morbid obesity and cancer of the colon. It is the preferred method of treatment for Gamete intra-fallopian transfer. (6)
What are the advantages of laparoscopic surgery?
Some of the advantages to laparoscopic surgery may include the following:
Minimal length of stay in hospital
Same day discharge
Minimum amount of post-operative pain
Shorter recovery time
Reduction in post-op infections
Reduced likelihood of hemorrhage
Less pain medication is required
Reduction of exposure and contamination of organs
Decreased likelihood of post-op hernias
Less scarring of tissue (7)
What are the risks involved in laparoscopic procedures?
Any kind of surgery involves a certain degree of risk and uncertainty, as until there is actual surgical intervention, a surgeon does not know exactly what he or she will find with a laparoscope. There may be times when an organ or a part of an organ has to be removed through a larger incision.
Other risks related to laparoscope procedures may include the following:
Possible injury to blood vessels or organs
Hypothermia from cold gases
Complications related to pulmonary disorders
Phrenic nerve pain in shoulder area, if the CO2 is not absorbed properly
Problems related to coagulation disorders
Difficulty walking for several days (8)
While laparoscopic procedures involve a degree of risk, this still appears to be the surgical method preferred by surgeons and patients. Thus, in the future, we should expect to see more technological advances that will change the face of surgery even further, for the benefit of humankind.