Introduction:
New methods are continuously being introduced in procedures such as laparoscopic surgeries are ever-evolving with the help of science. Being minimally invasive, these techniques have some drawbacks, such as poor designs of the instruments, controlling the operating system with the help of pedals, fixed ports for the instruments, and the screen location. These drawbacks restrict the movement of the surgeon leading to exhaustion, aches, and pain. Many new surgical methodologies, instruments, and other devices are being developed that would help surgeons deal with the challenges faced while performing the surgery.
What Is Laparoscopic Surgery?
Laparoscopy is a type of minimally invasive surgical procedure that is done with the help of a keyhole instead of a large incision. It is also known as keyhole surgery. Laparoscopic surgery is carried out with the help of an instrument known as a laparoscope. A laparoscope is a small instrument that is shaped like a tube with a light source and a camera attached at one end. The camera captures images of the internal organs which are related to a monitor outside. The first laparoscopic surgery was conducted in the year 1987 by Philippe Mouret. Laparoscopic surgery is preferred since it leads to a speedy recovery, lesser pain, less scarring, and a reduced hospital stay.
What Are the Recent Laparoscopic Techniques?
The significant and recent types of laparoscopic techniques are discussed below.
Laparoscopic Appendectomy - Appendectomy conducted with the help of laparoscopy has become quite popular due to improved results, faster recovery, and reduced hospital stay. With the development of single-incision laparoscopic appendectomy (SILA), and multi-channel glove ports, certain complicated endoscopic operations can be performed. There are two approaches to single-incision laparoscopic appendectomy:
- Intracorporeal Laparoscopic Appendectomy (ICLA) - A 10-millimeter port above the umbilicus is used to allow air or gas in the abdominal space, along with the placement of two five-millimeter ports beyond the midline. This parallel placement of the instruments requires appropriate skill and knowledge. Several studies have shown positive results with this approach for appendectomy.
- Extracorporeal Laparoscopic Appendectomy (ECLA) - It is a video-assisted appendectomy that includes all the steps of intracorporeal laparoscopic appendectomy. Additionally, the appendix is removed through a ten-millimeter port made in the area around the right side of the hip bone. The remaining procedure is the same as an open appendectomy.
Natural Orifice Transluminal Endoscopic Surgery (NOTES) - It is one of the recent advancements in laparoscopic surgery. In this surgery, access to the abdominal cavity is gained through natural holes without the need for any incision. The procedure is done with the prevailing endoscopic techniques with the use of instruments in the peritoneal cavity. Internal access is gained through an endoscope through the body’s natural orifice, such as the mouth, anus, vagina, or urethra. The hybrid NOTES method is a combination of the natural orifice transluminal endoscopic surgery with a direct transcutaneous entry, with the help of various laparoscopic instruments. Entry into the peritoneal cavity is carried out through several routes, such as transgastric, trans colonic, transvaginal, transesophageal, and transvesical routes. However, the stomach is the most preferred route in natural orifice transluminal endoscopic surgery. The vagina is used in women for access to the abdominal cavity with certain limitations. Transanal endoscopic microsurgery is carried out through a fractal approach. All these procedures require meticulous access and closure care. Appendectomy performed with the help of natural orifice transluminal endoscopic surgery leads to a shorter hospital stay, lesser scar formation, less pain, and reduced hospital stay. The rate of complications following the procedure is also less. Various other surgeries can be performed with the help of natural orifice transluminal endoscopic surgery as it avoids incisions on the abdominal wall.
Single-Incision Laparoscopic Surgery - As the name suggests, this procedure makes a single incision, thus reducing the port count. This has led to many advantages, such as lesser scar formation, reduced pain or discomfort, speedy recovery, and reduced port-associated complications. Although a few clinical trials are doubtful of any other benefit apart from cosmetics. However, single-incision splenectomy is becoming quite popular due to reduced operative time and less blood loss. Conventional multiport laparoscopic splenectomy is considered the gold standard for spleen removal, with the use of multiple incisions.
Laparoscopic Cholecystectomy - This procedure is used for surgically removing the gallbladder. This procedure requires making four incisions in the abdominal area for the insertion of the instruments. Advanced skills are required for conducting this procedure. However, bile duct injury is higher than the open surgical procedure. Nevertheless, laparoscopic cholecystectomy is preferred to remove the gallbladder due to lesser hospital stay, lesser pain and discomfort, and quick recovery.
Laparoscopic Bariatric Surgery - Various bariatric surgeries such as intestinal bypass, vertical banded gastroplasty, and laparoscopic adjustable gastric banding are used to manage obesity. For the past few years, laparoscopic sleeve gastrectomy has become the procedure of choice for weight loss. A few recent procedures include laparoscopic Roux-en-Y gastric bypass, one anastomosis gastric bypass, and laparoscopic adjustable gastric banding. Of these procedures, the laparoscopic adjustable gastric banding procedure is the most common procedure.
Laparoscopic Anti-reflux Surgery - Laparoscopic surgeries are used in treating gastroesophageal reflux (GERD). Various laparoscopic anti-reflux surgeries include Dor fundoplication, Touple fundoplication, and Nissen fundoplication. Laparoscopic Nissen fundoplication is the surgery of choice in chronic GERD.
Laparoscopic Cancer Resection - Laparoscopic gastrectomy is the treatment of choice for individuals with early-stage stomach cancer. Laparoscopy-assisted distal gastrectomy with extracorporeal anastomosis is one of the recent laparoscopic surgeries. Procedures like NOTES and SILS are found promising for the treatment of colorectal cancer.
Laparoscopic Pancreatic Surgery - Procedures like laparoscopic distal pancreatic resection are a popular choice in pancreatic surgery.
Laparoscopic Hepatic Surgery - Laparoscopic liver resection has been found to be at an edge as compared to open surgery due to reduced postoperative complications. More research is required to find out the outcomes of such surgeries.
Robot-Assisted Laparoscopic Surgery - Robot-assisted laparoscopic surgery has overcome the cons of conventional laparoscopic surgery. Prostatectomy and hysterectomy were the two common procedures that were robot-assisted. Recently it has also been used in surgeries like nephrectomy, adrenalectomy, pyeloplasty, ureteroureterostomy, and bladder diverticulectomy with ureteric reimplantation.
Conclusion:
Laparoscopic surgery is a surgery that is minimally invasive and is effective in treating almost any kind of abdominal surgery. Recently many new forms of the preferred surgery have come to light. Advanced laparoscopic surgery includes hepatectomy, pancreatectomy, urology, and gynecology. Recent techniques such as NOTES, SILS, and RALS have become quite popular and promising. However, further research is required to assess their competence in the field of surgery.
