Laparoscopic Surgery

Laparoscopic Surgery: an introduction

The term laparoscopy describes an array of techniques, instruments and equipment which allow surgery to be performed through small incisions. The objectives are to minimise the problems, pain and complications associated with the opening, closure and persistence of conventional access scars.

Laparoscopy has been used as a technique in abdominal, gynaecological and thoracic surgery for many years, but interest in the scope of the subject grew dramatically at the end of the 1980’s with the development of modern instrumentation, fibre optic and video techniques, and the safe demonstration of complex procedures such as gall bladder surgery.

The bottom line is that laparoscopy is simply a tool for the conduct of safe and efficient surgery, and not an end in itself. The excitement and possibilities of the new technologies has led to experimentation across the entire spectrum of surgical interventions.

In some situations, laparscopic techniques have demonstrated considerable benefits over conventional surgery, and have become established in mainstream practices. These include:
-gall bladder surgery
-hiatus hernia surgery
-ovarian and many forms of gynaecological surgery
-adrenal surgery
-thoracic and lung surgery
-arthroscopy (examination of joint cavities)
-sinus surgery

In other circumstances, such as inguinal hernia surgery the overall long term risk/benefit ratio compared with conventional and well tried and tested techniques is uncertain, and longer term follow up and surveillance will be needed.

In certain circumstances, technology is being applied on an experimental basis, and is unlikely to offer significant advantages or less risk compared with established techniques. This may be the case in laparoscopic approaches to the thyroid and parathyroid, for example.

In all cases, the application of laparoscopic techniques is governed by the specific circumstances of the individual patient, the condition under treatment, and the skill and experience of the particular surgeon or team of surgeons and their supporting team. Surgeons will always reserve the right to convert to open or “conventional” access methods where appropriate on technical and safety grounds.

Considerations of safety and long term outcomes and complication rates must always take precedence over short term factors in the selection of any surgical technique. Apparent short term benefits, such as early return to work, must be balanced against risks and complications, some of which may be unquantifiable at this stage in the evolution of the technologies.

Text provided by Mr David Rew, Copyright 2003

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