Laparoscopic surgery, also called minimally invasive surgery (MIS), or keyhole surgery, is a modern surgical technique in which operations are performed through small incisions (usually 0.5–1.5 cm) elsewhere in the body.
Laparoscopy [from Ancient Greek λαπάρα (lapara), meaning ‘flank, side’, and σκοπώ (skopo), meaning ‘to see’] is an operation performed in the abdomen or pelvis through small incisions with the aid of a camera.
The key element in laparoscopic surgery is the use of a laparoscope, a long fiber optic cable system which allows viewing of the affected area by snaking the cable from a more distant, but more easily accessible location.
There are a number of advantages to the patient with laparoscopic surgery versus an open procedure. These include:
- Reduced hemorrhaging, which reduces the chance of needing a blood transfusion.
- Smaller incision, which reduces pain and shortens recovery time, as well as resulting in less post-operative scarring.
- Less pain, leading to less pain medication
- Although procedure times are usually slightly longer, hospital stay is less, and often with a same day discharge which leads to a faster return to everyday living.
- Reduced exposure of internal organs to possible external contaminants thereby reduced risk of acquiring infections.
- There are more indications for laparoscopic surgery in gastrointestinal emergencies as the field develops
History of Laparoscopy
It is difficult to credit one individual with the pioneering of the laparoscopic approach. In 1901, Georg Kelling of Dresden, Germany, performed the first laparoscopic procedure in dogs, and in 1910, Hans Christian Jacobaeus of Sweden performed the first laparoscopic operation in humans.
In the ensuing several decades, numerous individuals refined and popularized the approach further for laparoscopy. The advent of computer chip-based television cameras was a seminal event in the field of laparoscopy. This technological innovation provided the means to project a magnified view of the operative field onto a monitor and, at the same time, freed both the operating surgeon’s hands, thereby facilitating performance of complex laparoscopic procedures. Prior to its conception, laparoscopy was a surgical approach with very few applications, mainly for purposes of diagnosis and performance of simple procedures in gynecologic applications.
The first publication on modern diagnostic laparoscopy by Raoul Palmer appeared in 1947, followed by the publication of Hans Frangenheim and Kurt Semm. Hans Lindermann and Kurt Semm practiced CO2 hysteroscopy during the mid-1970s.
In 1972, Clarke invented, published, patented, presented, and recorded on film laparoscopic surgery, with instruments marketed by the Ven Instrument Company of Buffalo, New York.
In 1975, Tarasconi, from the Department of Ob-Gyn of the University of Passo Fundo Medical School (Passo Fundo, RS, Brazil), started his experience with organ resection by laparoscopy (Salpingectomy), first reported in the Third AAGL Meeting, Hyatt Regency Atlanta, November 1976 and later published in The Journal of Reproductive Medicine in 1981. This laparoscopic surgical procedure was the first laparoscopic organ resection reported in medical literature.
In 1981, Semm, from the gynecological clinic of Kiel University, Germany, performed the first laparoscopic appendectomy. Following his lecture on laparoscopic appendectomy, the president of the German Surgical Society wrote to the Board of Directors of the German Gynecological Society suggesting suspension of Semm from medical practice. Subsequently, Semm submitted a paper on laparoscopic appendectomy to the American Journal of Obstetrics and Gynecology, at first rejected as unacceptable for publication on the grounds that the technique reported on was “unethical,” but finally published in the journal Endoscopy. Semm established several standard procedures that were regularly performed, such as ovarian cyst enucleation, myomectomy, treatment of ectopic pregnancy and finally laparoscopic-assisted vaginal hysterectomy (nowadays termed as cervical intra-fascial Semm hysterectomy). He also developed a medical instrument company Wisap in Munich, Germany, which still produces various endoscopic instruments of high quality. In 1985, he constructed the pelvi-trainer = laparo-trainer, a practical surgical model whereby colleagues could practice laparoscopic techniques. Semm published over 1000 papers in various journals. He also produced over 30 endoscopic films and more than 20,000 colored slides to teach and inform interested colleagues about his technique. His first atlas, More Details on Pelviscopy and Hysteroscopy was published in 1976, a slide atlas on pelviscopy, hysteroscopy, and fetoscopy in 1979, and his books on gynecological endoscopic surgery in German, English, and many other languages in 1984, 1987, and 2002.
Prior to 1990, the only specialty performing laparoscopy on a widespread basis was gynecology, mostly for relatively short, simple procedures such as a diagnostic laparoscopy or tubal ligation.
However, most general surgeons did not recognize its value till the successful performance of laparoscopic cholecystectomy by Philippe Mouret (1987) and Francois Dubois and Jacques Perisant (1988). The subsequent enthusiasm and world wide acceptance of this procedure with its advantages of minimal patients discomfort, short hospital stay and excellent cosmetic results has revolutionized the management of gall stones disease.
The speed of adoption and popularity of laparoscopic cholecystectomy is without precedence in modern surgical history. This has resulted in therapeutic and diagnostic laparoscopy being attempted in almost every field of surgery to substitute open surgical procedures. The list is endless. The success of laparoscopic cholecystectomy has stimulated interest in minimally invasive surgery and various centers are performing other surgical procedures like
- diagnostic laparoscopy
- appendicectomy
- splenectomy
- nephrectomy
- hernia repair
- adrenal gland surgery
- vagotomy
- fundoplication
- Heller’s oesophagomyotomy
- small and large bowel resection
- stomach surgery
- anti-reflux surgery
- surgical oncology
- obesity surgery.
Establishment of laparoscopic surgery unit involves costly and high technology modern equipments which are constantly under revision and upgrading. It needs a specially trained team with skills different from that of open surgery. It cannot be used in all cases and even in the most expert hands there is a percentage of cases that will be converted to open surgery.