Laparoscopic surgery which has a history of over 100
years is widely used today for pelvic and abdominal surgery. In this minimally
invasive procedure the cavity is visualized via a camera inserted in to the body
cavity.
The first
laparoscopic surgery has taken place early in the last century and it was done
on a dog. It was about decade later the first performance on a human was
carried out. First laparoscopic surgery was done without inflating any air into
the abdominal cavity. Later filtered atmospheric air was used for this and in
1920 s co2 was first used. At the beginning the abdominal cavity was visualized
directly with lenses. Then various lens systems were introduced. However video
laparoscopy came into practice in 1980s. With the widespread application of
the compact cameras, both laparoscopist and assistants could simultaneously
view the operative field on a video screen. By the end of the decade,
video-laparoscopy had become standard and operative laparoscopy became widely
accepted as a safe and effective surgical approach. A major step forward in the
development of laparoscopy was the development of a safer laparoscopic lighting
system in the 1950s. Up until that time, intra-abdominal light was produced by
a small electric light bulb at the distal tip of the laparoscope. The development of this technology shows the great
thinking pattern of human being.
These were widely used in Gynaecology decades
before it was used in general surgery. During the last 35 years, gynecologic laparoscopy has evolved from a
limited surgical procedure used only for diagnosis and tubal ligations to a major
surgical tool used to treat many gynecologic conditions. For many procedures,
such as removal of an ectopic pregnancy, treatment of endometriosis, or ovarian
cystectomy, laparoscopy has become the treatment of choice.
The use of laparoscopy in general surgery widely came
into practice in last 3 decades. But since then it has become
versatile. Today it is used for diagnostic and therapeutic purposes in general
surgery.
The procedure itself draws interest as it needs
special skill and great practice than the open surgery. The basic
principle of laparoscopy is simple. A working space within the abdominal cavity
is initially established. This is usually accomplished by insufflating the
peritoneal cavity with carbon dioxide to a pressure of 10 to 15 mm Hg. The
laparoscope is inserted into the abdomen with a trocar and hollow sheath
containing a side port for continuous carbon dioxide insufflation, as well as
valves and gaskets to allow the insertion and removal of the laparoscope
without allowing the carbon dioxide to escape. In an operation, accessory
trocars are inserted to introduce laparoscopic instruments to the Abdomen.
The laparoscopic instruments are of two categories. They are equipments for access and exposure
and hand instruments for the actual operative procedure. These include the
screen, the light source, the insufflater, fibro optic cable, the camera,
veress needle, Trocars and other hand instruments needed for the actual procedure.
These are graspers, scissors, needle holders and retractors, but all the
instruments are long and narrow, and have small jaws that allow the
introduction and use of the instruments through trocars. A unique instrument in
Laparoscopic surgery is a "clip applicator".
There are a number of advantages to the patient with
laparoscopic surgery than an open procedure. They include Reduced hemorrhaging, so the incidence of blood transfusion is less, smaller incision, which reduces
pain and shortens recovery time and reduce post-operative scarring. There is less
pain so less analgesia is needed;
hospital stay is less, and often with a same day discharge. Reduced exposure of
internal organs to possible external contaminants thereby reduced risk of
acquiring infections.
At the same time there are some risks associated with
laparoscopic surgery. They include trauma due to trocar to major blood vessels
and major organs and the problems due to co2 insufflation .Also I
increased intra-abdominal pressures associated with laparoscopy increase
anesthesia-related risks such as aspiration and increased difficulty in
ventilation.
However this technology evolves
everyday and becomes more and more versatile. In recent years robot surgery and
single incision laparoscopy has been introduced of which the robotic surgery is having
the largest impact on clinical care
