Minimally-Invasive Laparoscopic Surgery Overview

surgeons operating using laparoscopic instruments

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Laparoscopic surgery, also referred to minimally invasive surgery (MIS), involves the use of a thin, tubular device called a laparoscope which is inserted through a keyhole incision into the abdomen or pelvis to perform operations that used to require large incisions.

Because the procedure involves smaller wounds, recovery times tend to be shorter with less pain. Modern laparoscopy was first employed in the late 1940s to perform hysterectomies but only came into its own in the 1970s and 1980s when the first laparoscopes were patented for widespread use.

Today, laparoscopy is routinely performed to treat a wide range of medical conditions. When the keyhole surgical technique is applied to the chest cavity, it is referred to as thoracoscopic surgery.​​

What Is a Laparoscope?

Key to the development of minimally invasive surgery was the laparoscope itself. The laparoscope is a long, rigid fiber-optic instrument which is inserted into the body to view internal organs and structures.

Older models are equipped with a telescopic lens connected to a video camera, while newer ones have a miniature digital camera mounted at the end of the tube. A light source is provided using either an LED, halogen, xenon or solar light bulb.

Laparoscopic instruments are usually made of high-quality stainless steel. The narrow tubular scope can range in size from as little as three millimeters (0.12 inches) to more than 10 millimeters (0.4 inches) in diameter. A variety of attachments and other instruments mounted on the ends of long, narrow tubes are also available to perform precision surgery, which are inserted through different incisions. Instruments such as scissors, forceps, graspers, needle drivers (used to hold surgical needles while suturing a wound) and electrocautery are often used.

How Laparoscopic Surgery Is Performed

Laparoscopic surgery is carried out entirely on the inside of the body. Instead of making a long, open incision, laparoscopic surgery requires one or multiple small incisions (usually a quarter to a half inch in length) through which scopes are inserted. The surgery itself is guided by closeup video imaging which is viewed externally on a monitor.

In order to provide the surgeon with more room to operate, the cavity will typically be inflated with pressurized carbon dioxide (CO2), which is both non-flammable and readily absorbed into the body.

Laparoscopy is a technically complicated surgery that requires excellent hand-eye coordination and an almost intuitive ability to navigate delicate internal structures. Surgical residents who decide to pursue the subspecialty must undergo a one- to two-year fellowship after completing their basic surgical residency.

Advantages and Disadvantages

However minimally invasive a laparoscopic surgery may be, there are limitations and risks that accompany any surgical procedure. The advantages of laparoscopic surgery include:

  • Less bleeding and typically less need for a blood transfusion.
  • Smaller incision and shorter recovery time.
  • Less pain and less need for pain medications.
  • Reduced risk of contamination compared to open surgery.
  • Typically lower cost due to shorter hospitalization.

The disadvantages of laparoscopic surgery include:

  • The lack of ability to touch (palpate) tissue, especially important when investigating cancer.
  • Possible damage to internal tissues due to lack of tactile perception.
  • Difficulty in seeing "the whole picture" that an open procedure can provide.
  • It may be difficult to perform in persons with prior surgeries and excessive scar tissue.
  • Possible adverse reactions to abdominal CO2 inflation (including hypothermia and pain).
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  • Katkouda N. Advanced Laparoscopic Surgery: Techniques and Tips (Second Ed.) New York, New York: Springer Publishing; 2011.