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March 2010
Laparoscopic Surgery Unveiled
Dr Arun Prasad
Access to body cavities in order to undertake surgical procedures by means other than making a large cut has been a technique waiting for its time. Laparoscopic surgical techniques are being applied to a growing number of surgical procedures

The word laparoscopy has its roots in Greek, and means examination of the abdomen with a scope (endoscope). If the procedure is done in the chest it is known as thoracoscopy. An endoscope in the bladder is cystoscopy, the one in the uterus is hysteroscopy, and so on.

Although laparoscopy has been used for many years by gynaecologists to evaluate pelvic pathology, most surgeons did not recognise its value until laparoscopic gall bladder operation was done. Since that time, the applications of laparoscopic instruments and techniques have greatly improved, and new uses are being developed rapidly.

How Is It Done?
During laparoscopic surgery, we make a small half inch cut in the skin at the belly button. Then a cannula (thin tube) is introduced in between the muscle fibres without cutting any of the muscle. Through the cannula, the laparoscope is inserted into the patient’s body.

The scope is equipped with a tiny camera and light source, that allow it to send images through a fibre-optic cord to a television monitor. The television monitor shows a high resolution magnified image. Watching the monitor, the surgeon can perform the procedure. While looking inside the patient, further half inch or quarter inch diameter cannulas are put in, depending upon the procedure: like say, one more for a diagnostic laparoscopy, two more for groin hernia repairs and three more for a laparoscopic gall bladder operation. Instruments are introduced through the cannulas and the operation is performed exactly as one would have done the same procedure in an open operation. All fundamentals of surgery are strictly followed during laparoscopic surgery.

Latest in Technology

With the advancement of technology, the engineers and manufacturers have responded with telescopes of smaller diameter like 5 mm and 3 mm as opposed to the ‘conventional’ laparoscopic 10 mm telescopes. Also instruments are being developed of 3 mm diameter. This advancement is known as mini/micro/needloscopic laparoscopic surgery.

Instruments have been developed to do this procedure through just a single hole in the belly button making it a more cosmetically appealing option. This is known as SILS ( Single Incision Laparoscopicc Surgery).

13 Advantages of a Keyhole Surgery
The most common question asked is whether laparoscopic surgery is another cosmetic operation, the benefit of which is restricted to the bikini wearing public! There are many more advantages of this procedure and cosmesis is just an added benefit:
  1. There is no cutting of the muscles as the holes are made in between the fibres.
  2. The pain is minimal like one would have after a skin cut.
  3. Less chance of hospital acquired infections.
  4. Fewer post-operative chest complications.
  5. Early return to work.
  6. No residual weakness.
  7. Minimal risk of incisional hernias. During hernia operations, the already weak muscles are not cut, unlike in open surgery.
  8. Less disturbing to physiology.
  9. Exploratory ‘open and close ‘ look into the tummy operations are avoided. The same information is gained on diagnostic laparoscopy as a ‘day case’ patient with one, or maximum two, holes.
  10. Avoidance of large cuts and rib removals in the case of thoracoscopic surgery.
  11. In the case of diagnostic laparoscopy, quick information is gained and the entire procedure can be recorded on video. Further opinion can also be taken from other surgeons in case of a diagnostic dilemma.
  12. Despite small holes, there is no compromise in the field of vision. Much more of the ‘insides’ can be seen than is possible in an open surgery. Unlike the ‘mini-incision’ operations, here the entire tummy can be visualised ensuring no abnormal anatomy or pathology to be missed.
  13. Advanced surgeries like weight loss (bariatric) surgery, cancer surgery etc can also be done by this technique and the advantages of a magnified vision is tremendous.
Dr Arun Prasad, Senior Consultant - Minimal Access Surgery at Indraprastha Apollo Hospitals, New Delhi

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