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Minimally Invasive Abdominal Surgery

We often hear the term laser surgery used to describe operations that are done through small incisions. This term got its start in the early days of laparoscopic surgery, when surgeons we experimenting with laser scalpels and somehow the two, laparoscopic surgery and laser surgery, became associated as being the same thing. Studies have subsequently shown that laser energy carries no advantage over more conventional types of energy in surgery, except in very specialized cases, and now nearly all laparoscopic surgery is performed without the need for or use of lasers.

Laparoscopy describes the use of a slender telescope, really a rigid lens system, attached to a bright light source, to peer into the abdominal cavity during surgical procedures. The use of the laparoscopic dates back several decades, and is well known to many patients who are at an age when they might remember undergoing for example, tubal ligation by this technique, long before the explosion of so called minimally invasive surgery. The revolution in this type of surgery came when camera and computer technology allowed the development of a video system which would attach to the laparoscope so that the surgeon, the assistant, and in fact all the personnel in the operating room could observe the same image on video monitors next to the operating table. It wasn't long before techniques used in laparoscopic surgery were adopted for use in the chest, leading to the development of Thoracoscopic Surgery, or VATS (Video Assisted Thoracic Surgery). Orthopedic applications, such as joint surgery, called arthroscopy, have also been developed during this minimally invasive era.

The initial step in laparoscopic surgery is to achieve general anesthesia, so that the patient is completely unconscious and relaxed. Next comes insufflation of the abdomen, by which a space for the surgeon to work in is created. Carbon dioxide gas is blown into the abdominal cavity through a small needle, usually passed through a tiny incision in the umbilicus, until a cave is created around the internal organs. Trocars come next. These are small diameter tubes which are passed through the skin and abdominal wall into the space made by the gas. A trocar has a valve on it to keep the gas from escaping. Depending on the type of procedure to be performed, anywhere from two to seven or eight trocar might be needed. They range from 2 millimeters to 12 millimeters in diameter or from 1/16 inch to 1/2 inch, usually.

With the trocars in proper position, long handled instruments are passed into the abdomen. While watching on TV, the surgical team can then perform the operation in an almost identical way the same operation used to be performed using incisions big enough to place one or both of the surgeon's hands into the abdomen. Many specialized instruments have been developed over the years to make these operations possible, including long handled scissors, graspers, dissectors, clip appliers, stapling devices, even plastic bags that can be inserted through the tubes to extract things like a ruptured appendix, which might cause an infection if it were to come in contact with the muscles or skin of the abdominal wall as it is removed through one of these small trocar openings. In some cases the surgeon completes the operation through these tiny incisions and then makes a small incision to remove an organ such as the spleen, which is too large to come out through a half inch incision. Studies have shown, however, that even if a larger incision is needed to remove the specimen, the patient still accrues the benefit of the minimally invasive technique, with less pain, shorter recovery, abbreviated hospital stay, and quicker return to normal activity.