Laparoscopic surgery or minimal access surgery (MAS) is a rapidly advancing field within surgery and has the potential to greatly reduce the anatomical, physiological and pathological consequences of surgery to patients by having a positive impact on both postoperative pain and on length of inpatient stay. Many surgical and gynaecological procedures are now regularly performed using a laparoscopic approach. Below is a list of examples of the uses of therapeutic laparoscopy.
Scope of laparoscopic surgery
General surgery examples: diagnostic laparoscopy, appendicectomy, cholecystectomy, hernia repair, Nissen's fundoplication, repair of perforated duodenal ulcer, splenectomy, colectomy.
Gynaecology examples: oophrectomy, hysterectomy, tubal surgery, treatment of ectopic pregnancy, treatment of infertility.
Others: minimal access urology.
When deciding whether to perform a laparoscopic or open procedure there is rarely one method that is absolutely preferable over the other. It is always important to consider the fact that laparoscopic procedures may be technically more difficult, necessitate a higher level of experience and expertise, as well as requiring the availability of laparoscopic equipment and theatre staff familiar with the instruments. Without all of these factors the potential risks may outweigh any potential benefits.
Advantages and disadvantages of laparoscopy
In addition to considering the advantages and disadvantages of a laparoscopic procedure it is also very important to be aware that there are some absolute and relative contraindications to laparoscopy.
Basic equipment for laparoscopy (Figure 164)
(1) Monitor, (2) Light source, (3) Insufflator, (4) Camera, (5) Diathermy, (6) Suction and irrigation.
This can be hazardous, and careless port insertion can lead to injury of viscera such as the bowel, bladder or potentially the aorta or the vena cava.