Laparoscopic surgery

By – Sushila Gedam
BSC Endoscopy and Laparoscopy Tech. (SAHS)

DMMC, Nagpur
Abstract
Aim – To describe Laparoscopic surgery, it’s current applications and highlight
the accepted procedures across various fields.

Material & Methods- Diversified search throughout the internet with major
input from article resources on PubMed

Keywords: Laparoscopy, Endoscopy, Gastrectomy, Pancreatic surgery, Rectal

resection, Appendectomy, Gastric cancer, Cholecystectomy, Colon resection,
Esophagectomy, laparoscopic surgery, Endoscopic surgery

Introduction
Endoscopy, which derives from the Greek words "endo" and "skopein," refers
to "watching the inner voids of the human body." Hippocrates II, the chief
representative of the Kos school, described using a speculum to examine the
rectum. Albukasim who was a physician from Arab, was the first human to
make use of light that was reflected to watch the insides of body. In front of
vulva, he put up a glass mirror, reflecting light into the vaginal vault.

In 1806 Philipp-Bozzini (1773-1809), a physician who was from Frankfurt,

published a report on the light conductor he had, which was a device made up
of a single optic part that had light part and some mechanical equipment that
was lined the body orifice. Because he represents the transition from
antiquated to modern medicine, Bozzini was important when it came to
development of modern endoscopy. As a result, he developed a device for the
rectum , oral cavity, and vagina.

Invention of diagnostic laparoscopy was in the era of 1960s that led to the
creation of laparoscopic surgery. Beginning in 1980s, invention of laparoscopic
surgery by Semm & Muehe, two of its founders, transformed it from a
diagnostic to a surgical treatment. Since then, it has grown in popularity across
a variety of indications. Many organ systems now use this method as the gold
standard, with the reproductive (especially gynaecological) and digestive
systems being among of the most popular (as for cholecystectomy).

The fact that Antonin Desormeaux (1815–1894) was the first person to operate
Bozzini's made light conductor in a clinical context has led many to refer to him
as the "father of endoscopy." Edoscopes with electrical illumination didn't
appear until Thomas Alva Edison created the light bulb in 1879.

In his PhD thesis, gastroenterologist Georg Kelling concentrated on the

anatomy and physiology of the digestive system. Kelling was the first to
develop the procedure using this information and his research on the
insufflation of air within the abdomen. At the conclusionof his lecture in 1901,
Kelling performed the first laparoscopy; he named the process
"coelioscopy."He used a Nitze cystoscope to look into a dog whose body had
been inhaled with filtered air to examine the abdominal cavity. One could
argue that this discovery gave rise to laparoscopy.Laparothoracoscopy was a
term used by Swedish doctor Hans-Christian Jacobaeus (1879–1937) while
performing the first endoscopic examination of the chest and abdomen of a
human. Bertram M. Bernheim (1880–1958) performed the first laparoscopy in
the United States.

In the years 1911–1987, following Phillipe Mouret’s successful completion of

the first laparoscopic cholecystectomy, this procedure was considered the gold
standard.

Laparoscopic surgery is now safe and practicable in a variety of medical

specialties thanks to significant advancements in the surgical education and in
surgical tools, imaging technology, surgical procedures.

In a new era of surgery that involves little intervention, laparoscopy is just one
of many cutting-edge techniques. Simply put, many difficult issues required
wide incisions to reach a very focused area. The same location is accessible by
minimally invasive surgery without a significant incision. Procedures in
minimally invasive surgery restricted to the abdomen are referred to as
laparoscopic surgery.

A surgeon operating on a patient while assisted by nurses.

Small puncture holes are all that are needed during laparoscopic surgery to
insert different operating tools.

Gynecologists who were performing tubal ligations with a small telescope put
through the umbilicus obtained early expertise with laparoscopy (belly button).
Technology advanced to the point that TV screens could display the images in
the late 1980s.

Over the past 10 to 20 years, laparoscopic surgery has undergone significant

development. Nowadays, difficult treatments can be carried out
laparoscopically with fewer complications, a quicker recovery, and smaller
scars than with open surgery.

This review highlights the accepted practises and compiles studies on

laparoscopic surgery from many domains.

Discussion
The belly (tummy) and pelvis can be accessed from the inside via a surgical
procedure called laparoscopy, which eliminates the need for large skin
incisions in the body.

Keyhole surgery also known as minimally invasive surgery are other names for
the same procedure.

Large incisions can be avoided while performing laparoscopy because the

surgeon utilizes a tool that is called a laparoscope. This little tube sends
pictures from the pelvic region or abdomen to a TV screen. It also has a light
source and a camera. Over the past few years, laparoscopic surgery has grown
steadily, evolving from an invasive diagnostic tool towards an effective tool for
surgically treating benign or malignant disease. It is a little tube that transmits
images of the pelvis or abdomen to a television monitor. It has a camera and a
light source. The expanding uses of laparoscopic surgery have been made
possible by continued training, experience, advancements in imaging
technology, and the development of laparoscopic tools.

Laparoscopic surgery has become more common in clinical settings recently.

The development of pneumoperitoneum is a crucial component of
laparoscopic surgery, and carbon dioxide is frequently utilised for insufflation.
This pneumoperitoneum poses serious risks to the healthy cardiopulmonary
system. In order to prevent the negative effects of pneumoperitoneum, every
laparoscopic surgeon should be aware of its implications.

Although there are specific circumstances, such as obesity, pregnancy, and

prior abdominal surgery, where laparoscopic surgery may not be appropriate,
there are no absolute contraindications.

Diagnostic laparoscopy made its debut in one of the surgical department of a

country that as developing in 1972. This method's creators wanted to expedite
diagnosis, lessen patient suffering, and maximise bed occupancy in a busy
teaching hospital where routine tests like x-rays took too long to conduct.
3,200 diagnostic laparoscopies were performed on individuals purposefully
between 1980 and 1990 while they were under local anaesthesia; there were
no fatalities, a 0.09% complication rate, an 84% rate of diagnosis, and 74%
received histology biopsies intended for a wide range of diseases. When 3,200
patients are included, the equipment costs 30 INR each patient. The function
of diagnostic laparoscopy has changed as a result of the development of
noninvasive diagnostic tools including ultrasonography, magnetic resonance
imaging , and computed tomography (US, MRI, CT) used in conjunction with
target biopsies. A video camera and a pneumoperitoneum insufflator have
been available to clinicians since 1990. Abdominal TB, cancer, acute abdomen,
and abdominal trauma are all evaluated by diagnostic laparoscopy for liver and
peritoneal pathology. Especially in situations of acute appendicitis, it
frequently serves as a precursor to laparoscopic treatment of the underlying
pathology.

Laparoscopies are increasingly frequently performed to examine specific

symptoms and diagnose a wide range of disorders. They could be utilised, for
instance:

The female upper genital system, that includes the womb,ovaries, and ,
fallopian tubes, gets infected with germs in a condition known as pelvic
inflammatory disease (PID).
When endometrium, the lining of the womb, is found in tiny fragments outside
the womb, the condition is called endometriosis..

An extrauterine pregnancy is referred to as an ectopic pregnancy.

A fluid-filled sac called an ovarian cyst develops on a woman's ovary.

Fibroids are benign tumours that develop in or near the uterus (uterus)

The infertility of women

A kid who is born without one or both testicles in the scrotum has
undescended testicles, a frequent childhood ailment.

An unpleasant enlargement of the appendix is known as appendicitis (a small

pouch connected to the large intestine)

Abdomen or pelvis pain that is not explained.

The rigorous adherence to long-standing, accepted surgical principles,

appropriate staff training in laparoscopic techniques, and high-quality tools are
the cornerstones of effective laparoscopic surgery.

When compared to open surgery, numerous laparoscopic treatments have

consistently reduced stress to the abdominal wall. The most obvious benefits
of laparoscopic surgery are quicker recovery, acute hospital stays, and fast
tracking to normal activity. A variety of applications, including
cholecystectomy, fundoplication, and adrenalectomy, have demonstrated the
effectiveness, lower occurrence of wound infections, and decreased
perioperative morbidity of minimal invasive operations. Laparoscopic
procedures are regarded as the golden standard for surgical intervention
without the involvement of randomised controlled research to support them.
Laparoscopic procedures take longer than open procedures. Due to experience
and the learning curve, the duration has shortened over time. There is no
proof that open surgery is more effective than laparoscopic surgery when it
comes to oncological short- and long-term outcomes.

It was occasionally challenging to interpret the data from reviews or meta-

analyses. Various laparoscopic procedures were combined for one purpose,
such as incisional hernia repair. Heterogeneity in the compared experiments
was brought on by the use of various mesh and fixation kinds. Bias as a
methodological limitation has a high likelihood of occurring.

It was challenging to prove that laparoscopy was preferable to other

procedures including key-hole surgery, NOTES, and robotic surgery. The main
barriers to adoption of these procedures, particularly for robotic surgery, were
cost and effort.

It was unable to conduct randomised controlled studies in some areas of

laparoscopic surgery. Because, for instance, the sample size calculation to
obtain a particular power is vast to undertake such a study in ordinary surgical
practise, there is a lack of sufficient data. There is a need for randomised
controlled research and standardisation because it was challenging to compare
outcomes that were tracked from case reports or cohort series. Particularly in
technically challenging procedures like laparoscopic gastric, esophageal
surgery and pancreatic surgery this is required.

Conclusion
The safety and viability of laparoscopic surgical treatments have significantly
risen due to advancements in surgical training, tools, imaging, and surgical
techniques.