About Laparoscopic Surgery
Minimally Invasive Surgery, some people refer to this simply as MIS, is a broad term for any procedure performed with small incisions (or sometimes no incisions at all).
Laparoscopic Surgery refers to MIS in the abdominal cavity. A telescope and long, fine caliber instruments are inserted into the abdomen to see and perform the surgery. The incisions used are 5 to 10 mm in size. These incisions heal quickly after surgery, resulting in small “keyhole” scars. Sometimes, even finer instruments are used (2 to 3 mm) in what we call Needlescopic Surgery. This results in “pinhole” scars that are hardly discernable.
The same technique is called Thoracoscopic Surgery when used in the thoracic cavity (to approach the esophagus, for example) or Endoscopic Surgery when used elsewhere (for example in the neck for Endoscopic Thyroid Surgery).
Almost any conventional operation can be done laparoscopically. This can something simple, like the removal or a gallbladder or appendix, to something very complex, like the resection of the stomach for cancer. Some of the complicated operations can be technically demanding, and a good outcome depends on the skill and experience of the surgeon. In general, we believe that, under our hands, the laparoscopic options gives a better result. Occasionally however, laparoscopic surgery is contraindicated in certain patients, and some operations may be too difficult to offer any substantial benefit over conventional open surgery.
The only absolute contraindications are an unstable patient (for example, someone who is bleeding actively from trauma) or a patient who is unfit for general anaesthesia (since GS is always required for laparoscopy). In certain patients, the contraindications are relative and have to be evaluated individually. These patients include those who have severe heart or lung disease, have previous abdominal surgery, bowel obstruction or bleeding problems.
In general, we try to not to do elective surgery during pregnancy. In those cases where we must, we try to delay the operation until the second trimester, or until fetal viability, or till after delivery. If surgery is absolutely essential, laparoscopic surgery is as safe as open surgery, and even offers certain advantages. However, great care has to be taken with surgery and anaesthesia as the dangers are real: about 12% risk of miscarriage in the first trimester, 5 to 8% risk or preterm labour in the second trimester and 30% risk of preterm labour in the third trimester.
Since only “keyhole” incisions are used, the post operative functional recovery is rapid. Most patients are discharged from hospital faster and return to work earlier. There is less wound pain and the cosmetic outcome is excellent. In the long term, there are fewer problems with post-surgery bowel adhesions. There is also recent evidence to suggest that the reduced disturbance to the immune system during laparoscopy results in better survival after cancer resection when compared to open surgery. This is because the minimal insults allow the body to fight off circulating cancer cells more effectively.
Laparoscopic surgery is technically more difficult than conventional open surgery. Moreover, as some of these procedures have only evolved in the last few years, not all surgeons are trained to perform them. Surgeon related errors can occur. Finally, laparoscopic surgery often takes longer to perform and may cost more in terms of equipment used – although this is not always so!
Links to specific laparoscopic procedures: