What is laparoscopic surgery, or minimally invasive surgery?
Laparoscopic surgery, also called minimally invasive surgery, is a surgical technique that has been used for over twenty years to perform operations on the thoracic cavity (thoracoscopic surgery) and in the abdomen (laparoscopic surgery).
Using laparoscopic surgery does not mean rejecting traditional open surgery, as they are based on the same cultural and scientific principles .
Laparoscopic surgery is a minimally invasive type of surgery, or better a less invasive one, performed with a sophisticated medical instrument that enables the surgeon to make small incisions into the abdominal cavity, as opposed to the larger incisions needed in laparotomy.
How does laparoscopic surgery work?
Under physiological conditions, the abdomen is a cavity where it is not possible to place fiber optics/cameras. Therefore at the beginning of the procedure, the abdomen needs to be inflated with carbon dioxide gas, to provide a working and viewing space for the surgeon, also called pneumoperitoneum.
Trocars are deployed as means of introduction for optic fibres and other laparoscopic instruments. .
Laparoscopy is performed by introducing a fibre optic endoscope in the abdominal cavity. The endoscope has a micro camera head attached to it, which is connected to video monitors. The camera takes and transmits images from within the abdomen allowing the surgeon to have a clear vision of the abdominal cavity.
When performing laparoscopic surgery, the surgeon has reduced palpatory and tactile perception, as he/she must use tools to interact with organs, but he/she gains a much better view of the abdominal cavity, thanks to the micro-camera which can magnify images from within the endo-abdominal cavity by 4 to 6 times.
During the procedure the surgeon cannot feel or touch the patient’s organs directly with his/her hands nor with traditional medical instruments. He/she cannot directly manipulate intestinal loops, stretch or divaricate. Such motions are very important tools in traditional open surgery, but can also cause micro surgical traumas and slow down the post-op recovery.
Many studies have indicated that patients undergoing laparoscopic surgery often experience less pain and a shorter recovery compared to traditional open surgery (including a faster return to their normal eating habits, shorter hospital stay and a quicker discharge). Thus postoperative risks for cardiopulmonary or infectious complications are significantly reduced, according to statistics.
Moreover the pressure the pneumoperitoneum transmits to the organs facilitates spontaneous haemostasis in the blood vessels damaged during surgery. Also, the visual magnification of the abdominal cavity provides an enhanced visual field for the surgeon and enables him/her to be far more accurate.
Countless studies have shown that, compared to traditional surgery, laparoscopic surgery reduces intra-operative blood and liquid losses, as well as body heat loss, preventing the coagulation process from being altered.
Risks and contrindications
Laparoscopic surgery cannot be performed on all patients: there are both absolute and relative risks.
Absolute contraindications exist for patients suffering from serious cardiovascular and pulmonary diseases: in this case the risk factor can vary from one patient to the other and can be assessed by different specialists such as the cardiologist, pulmonologist, anaesthesiologists and the surgeon.
Relative contraindications are exclusively assessed by the surgeon and exist for patients that have already undergone one or more abdomen surgeries. In such cases do not hesitate to ask your surgeon any question, so as to better tackle and solve your health problems.
PNEUMOPERITONEUM IN LAPAROSCOPIC SURGERY
It is created by insufflating aseptic carbon dioxide (CO2) to elevate the abdominal wall above the internal organs obtaining a working and viewing space. It marks the beginning of any laparoscopic procedure, as it maintains enhanced visual exposure of the operative field during surgery.
LAPAROSCOPIC IMAGING SYSTEM
It consists of a fibre optic endoscope, a camera head, two cables to transmit cold light and images, a microprocessor, a light source and video monitors. Laparoscopes that are most commonly used have a diameter of 3-5-10 mm and can provide both 2D and 3D imaging.
They are the gateways that connect the inside of the abdominal cavity to the outside without leading to significant changes in pressure. They enable the surgeon to introduce the necessary surgical instruments into the cavity. The most commonly used trocars range from 0,5- 1 cm to 12- 15 mm in diameter. They include a valve for carbon dioxide insufflation and/or desufflation.
LAPAROSCOPIC SURGICAL INSTRUMENTS
They may differ from traditional surgical instruments both in size and shape, but their aim is the same, since they allow the surgeon to perform the same operations as in traditional surgery.