Laparoscopic surgery

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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.

--> A laparoscope 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.

This approach, pioneered by Dr. Camran Nezhat, is intended to minimise operative blood loss and post-operative pain, and speeds up recovery times. However, in some cases the pain caused by the carbon dioxide leaving the body is severe and painkillers have little or no effect. 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.

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

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.

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 shakey human hands
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.

References

[Surgical Device Poses a Rare but Serious Peril] from the New York Times (Registration required)
[Intuitive Surgical] - Developer of robotic surgery machines.

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