This paper will define laparoscopy in general, how a laparoscopic surgery is performed, the different types of laparoscopic instruments and the benefits and risks associated with undergoing a laparoscopic surgical procedure. Laparoscopic surgery has evolved rapidly in the last twenty years and as the field advances there are constant new innovations. Laparoscopy, also known as minimally invasive surgery or videoscopic surgery is an operation performed in the abdomen or pelvis through small incisions with the aid of a camera.
There are two types of laparoscope that can be used: a telescopic rod lens system, which is usually connected to a video camera, or a digital laparoscope where a miniature digital video camera is placed at the end of the laparoscope, eliminating the rod lens system. Laparoscopic surgery has allowed surgeons to perform the same procedures as in traditional open surgery, using small incisions instead of large abdominal incisions. A camera and a number of additional laparoscopic instruments are inserted into the peritoneal cavity through the abdominal wall.
The vast majority of laparoscopic procedures are led by the establishment of a pneumoperitoneum. Pneumoperitoneum is classically achieved by means of CO2 insufflation by a Verses needle or similar trocar. Generally, this is performed in the periumbilical region. The left upper quadrant site is considered as an alternate access entry if there are any adhesions periumbilically, umbilical hernias or after three failed attempts at insufflations. Once a pneumoperitoneum has been established the camera transmits an image of the organs inside the abdomen onto a television monitor.
In this kind of surgery, the video camera serves as the surgeon’s eyes, allowing him to perform certain surgical operations with ease. There are several different types of laparoscopic instruments. Laparoscopic instruments are made of durable materials and usually high quality stainless steel. Instruments all have a very narrow shaft so that they can fit inside laparoscopic incisions. Sizes typically range from 3 mm, 5 mm and 10 mm sizes. A variety of tips are available for manipulating the tissue and handle styles may allow ergonomic rotating, grasping and locking abilities in a precise fashion.
Common instruments used during laparoscopic procedures include a: laparoscope, needle driver for suturing, trocar, bowel grasper and surgical mesh. Surgical scopes are among the oldest forms of medical instrument, with some of the earliest examples on record dating back to 70AD. Initially consisting of simple hollow tubes, over time these rudimentary devices were adapted to include magnifying lenses and illumination, eventually evolving into the sophisticated surgical scopes used today.
Once the image has been digitized, it may undergo additional processing, with some systems offering features such as filtering, noise reduction, color adjustment and image enhancement. The resulting video feed is then sent to a monitor, where it can be viewed by the surgeon and the rest of the surgical team. Needle drivers, or needle holders, are used to grasp and manipulate needles to enable free-hand suturing of wounds or surgical incisions within the body during laparoscopic procedures. Laparoscopic needle drivers typically comprise a long narrow shaft, with a handle at one end and a set of hinged jaws at the other.
The shaft is made of surgical steel with an outer layer of non-conductive plastic or silicone. Jaws are generally made of tungsten carbide and may have additional coatings applied to improve grip. Along with the probe, scalpel, and cannula the trocar is one of the oldest implements used by medical practitioners. A trocar is a pen-shaped instrument with a sharp triangular point at one end, typically used inside a hollow tube, known as a cannula or sleeve, to create an opening into the body through which the sleeve may be introduced, to provide an access port during surgery.
Today, a very wide range of precision-engineered laparoscopic trocars exists, with instruments available in a variety of lengths and diameters, and with many different styles of tip. Most modern trocars comprise an outer housing assembly, a sleeve that fits inside the housing assembly and a piercing stylus which slots into the sleeve such that the tip protrudes from the lower end of the instrument. These instruments play an important role in laparoscopic surgery. Instruments such as scissors and graspers are introduced using surgical trocars.
Manipulating bowel graspers requires practice and skill because the tips of the graspers are small and pressure at the tips is magnified; too much pressure can lead to tissue damage and too little pressure can cause the tissue to slip out of grasp. Minimally invasive techniques can deprive surgeons of the tactile feedback, depth perception and hand-eye coordination available to them during open procedures, making it much more difficult to judge how much force to apply. Bowel tissue is considered to be among the most delicate in the human body, so it is essential that the grasping tip is able to offer a safe, secure
grip, without exerting excessive pressure. The advantage with using laparoscopic graspers is that they enable the surgeon to grasp and manipulate abdomen tissue with precision without having to cut open the abdomen. The graspers facilitate observation, excision, and biopsy procedures. Mesh-like structures, woven from the suture materials of the day or formed from organic materials such as animal tendons, have been used in surgical repairs for more than a century. However, it was not until the development of synthetic polymer mesh that such techniques were widely adopted.
Meshes can be categorized in terms of weight, pore size, material, fiber type and flexibility. Heavyweight meshes tend to form a dense scar plate and are best suited to applications where mechanical stability is a factor. Lightweight meshes are formed from thin fibers and are designed to flex with normal physiological movement. The mesh itself only provides minimal support. It is your own tissue that is ultimately responsible for the repair. Advanced hand-access devices are also used during a laparoscopic surgery.
These devices allow surgeons to place a hand inside the patient’s abdomen and to perform the different hand functions that were only possible in open surgeries before. The development of this device has also led to the development of other advanced surgical procedures such as the distal pancreatectomy, the liver resection and the Whipple operation. These kinds of surgical methods were not possible with traditional laparoscopic techniques that existed before advanced hand devices were developed.
Patients who undergo a laparoscopic surgical procedure are not allowed to drink at least eight hours before the procedure. The surgery is commonly done with the use of general anesthesia, so patients can stay awake if they were injected with spinal or local anesthetics. After the procedure, the surgeons close the abdominal incisions they made using a few stitches. With any surgical procedure there are associated risks and benefits. Laparoscopic surgery is popular among patients because of the small incisions that it entails.
Its deviation from traditionally large incisions allows patients to experience quicker recovery times and shorter hospital stays. Since smaller incisions are made all throughout their operation, they also experience less internal scarring and less pain than traditional operations usually cause. Most people who choose laparoscopic surgery are also pleased about its capacity to produce much smaller scars. There are numerous complications associated with laparoscopic surgery. The process of peritoneal access has a complication rate in its own right.
Those with significant mortality rates include bleeding from the abdominal wall and injury to the large vessels of the pelvis and aorta as well as damage to both intra-peritoneal viscera and the genitourinary tract. More general complications include wound dehiscence, hernia formation and local infection. References http://www. medicinenet. com/laparoscopy/article. htm http://www. webmd. com/infertility-and-reproduction/guide/laparoscopic-surgery-for-endometriosis http://en. wikipedia. org/wiki/Laparoscopic_surgery.