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Bruce E. Freedman, M.D., F.A.C.S.
Breast Surgery
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LAPAROSCOPIC SURGERY
Contributed by:
Marelyn Medina, MD
Rio Grande Regional Hospital (McAllen, TX)
SLS Public Relations Committee

The second millennium has brought with it a new era of modern surgery. The creation of video surgery is as revolutionary to this century as the development of anesthesia and sterile technique was to the last one. With ten years of solid experience behind them, surgeons can now confidently approach almost every part of the human body with cameras and video monitors. First they make a small cut in the skin and then introduce a harmless gas, such as carbon dioxide, into the body cavity to expand it and create a large working space. Through additional small cuts, a rod shaped telescope, attached to a camera, and other long and narrow surgical instruments are placed into the newly formed space. By this means, under high magnification diseased organs are able to be examined with minimal trauma to the patient . Instead of making a large cut into the skin and underlying muscles, surgeons are now able to make small entry ports into the area of interest and perform all the major maneuvers previously done when a large opening was present.

Almost every organ in the human body has become accessible to the surgeon's camera and scalpel. Gall stones can now be removed with the gallbladder by laparoscopic surgery in over 90% of patients presenting with this disorder. Instead of months of bed rest and limited activities, which was associated with the old method of removing the gallbladder, patients can now usually resume their normal activities in several weeks.

Many other organs can now also be approached in a similar manner. These include the stomach, intestines, pancreas and spleen, kidneys and all the females organs. More recently operations have also been developed for diseases of the bladder and the prostate in men.

As new surgical instruments and better cameras and video display systems are developed, the frontiers for laparoscopic surgery will expand even further. Hopefully, in time the cost of this impressive technology should decrease - allowing surgeons in all corners of the Global community to practice it.

The advantages of this method of operating are several. First, since the overall trauma to the skin and muscles is reduced, post operative pain is less - allowing patients to get out of bed sooner. They are often able then to walk and move around within a few short hours following their operations.

The second advantage is a reduced infection rate. This is because delicate tissues are not exposed to the air of the operating room over long periods of time - as they are when the body is wide open in traditional operations. Video magnification also offers surgeons better exposure of the diseased organ and its surrounding vessels and nerves. As a result, delicate maneuvers can be performed to protect these vital structures during the removal or repair of target organs.

The disadvantages of laparoscopy include the expensive equipment involved in performing it. Not all hospital operating rooms can afford to offer it because of cost containment. The other major issue is the need for surgeons to take special training in performing the many operations that are available by this means. Even surgeons that are brilliant in open techniques need special training to transfer their excellent surgical skills to the video monitor and display.

The need for additional training is because laparoscopic surgeons leave the familiar territory of a three dimensional operating field to working on a two dimensional flat video display. The shift is a critical one, and requires some degree of practice moving around long laparoscopic instruments while handling delicate tissues. Despite these temporary disadvantages, with the proper training, surgeons are able to adapt to this means of operating.

Finally, laparoscopy cannot always be performed on everyone. Some patients with many prior operations may have so much scar tissue within the body that a safe operation cannot be done. In time, what disadvantages exist may be overcome with continued laparoscopic research and development. The future is still wide open for this new and revolutionary way of performing surgery. As new generations of surgeons come into training with solid computer and video skills established since childhood - only time will tell what wonderful innovations lie in store for all of us!

 
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