Physicians:

What’s New in Laparoscopy?

Historically, most surgery has been performed through large incisions. This was necessary so that the surgeon could insert both of his hands and any other instrumentation that may be used to perform the particular procedure.

Laparoscopy involves very small incisions through which instruments and cameras are inserted through the skin. Microlaparoscopy is a new technique that allows for surgery to be performed through even smaller incisions.

While the actual techniques are basically the same, newer, smaller instruments allow for smaller incisions. A small scope is introduced into the abdominal (stomach) cavity. The scope is then connected to a camera which displays its picture on television monitors located within the operating room. Magnification and good lighting allow a surgeon to view organs, spaces and tissues etc., as good as, and usually better than, with the naked eye.

The actual "scope" and surgical instruments have decreased in size from the standard 10mm in diameter to 2-3mm in diameter. Microfibers, better computer chips, and better camera lenses all contribute to better visualization with shrinking scope size. To put this into perspective, these instruments are just barely larger than needles used with syringes to give injections. Smaller instruments allow for smaller incisions, less pain, and quicker recovery.

An obvious benefit is the lack of scar when using these instruments. The incisions are so small that they do not require sutures, only a dot bandaid.

Currently, microlaparoscopy can be utilized in surgery for the removal of the gallbladder and appendix. It is very useful as a tool for making a diagnosis of certain abdominal conditions.

For instance, a scope can be inserted into the “stomach cavity” with the intent of looking for abnormalities and/or to take a small piece of tissue (biopsy) for further evaluation outside of the body. If biopsy or direct visualization is required in making a final diagnosis, these very small instruments can be used as opposed to “big incisions”.

A common surgical procedure "cholecystectomy" involves removal of the gallbladder. As little as 10 years ago this would have likely involved an incision anywhere from 6-12 inches in length. A typical microlaparoscopic cholecytectomy would involve 3 "needle sticks" and a 1cm incision at the umbilicus that is basically used to remove the actual gallbladder. Ten years ago the patient would have been admitted to the hospital for at least several days as recovery was much more difficult and prolonged. This generally included several days without eating and a drainage tube that passed through the nose into the stomach. Needless to say the incisional pain and the long scar that was left behind are undesirable.

Today, most gallbladder surgery is performed as an outpatient procedure. This means the patient goes home the same day as the procedure is performed.

Laparoscopy has rapidly developed and has become a specialty within the field of surgery. Removal of the appendix, gallbladder, spleen, large bowel, small bowels, and adrenal gland are routinely performed. Hernia repair, reflux surgery, “weight loss surgery”, and chest (lung) procedures are other examples.

Many of these procedures have now been converted to “same-day” or “outpatient” status meaning you go home the same day! As equipment and technology continues to evolve, more procedures will likely include the use of laparoscopic and microlaparoscopic techniques and instrumentation.

Mark Medley, M.D. is fellowship trained in Laparoscopic Surgery and is a Fellow of the American College of Surgeons. He is in private practice and is a partner in Wilmington Surgical Associates.