12 - Laparoscopic surgery

Summary

Introduction

Laparoscopic surgery is a method of performing intra–abdominal operations through small incisions (typically less than 2 cm). It has developed at a rapid rate since the late 1980s. At least initially, this was largely because of technological advances that allowed good–quality video cameras to be made small enough to be held easily in the hand.

Using a miniaturised video camera and specialised instruments inserted through these small incisions, the surgeon can now do operations that previously needed much larger incisions. The advantages of this are not merely cosmetic; usually, the patient's recovery is quicker, and sometimes dramatically so. For example, after laparoscopic cholecystectomy, patients typically stay in hospital for less than 24 h, whereas after open cholecystectomy, a stay of almost a week is usual.

The same technological advances that have allowed laparoscopic surgery to develop, have also allowed minimal–access surgery to develop in other areas, such as thoracic surgery and surgery of the paranasal sinuses.

Setting up for laparoscopic operations

General layout of instruments

There is a lot of individual variation in the way surgeons arrange their instruments for most operations, and this particularly applies to laparoscopic operations. However, the general principles are described below.

There are six lines (i.e. cords, cables and tubes) that have one end on the operating table, and the other end attached to an unsterile object nearby. The six lines are the light cord, the camera and diathermy cables, and tubing for the gas, irrigation and suction.