Laparoscopy is an operation performed in the abdomen or pelvis using small incisions (usually 0.5–1.5 cm) with the aid of a camera. The laparoscope aids diagnosis or therapeutic interventions with a few small cuts in the abdomen.
Laparoscopic surgery, also called minimally invasive surgery (MIS), bandaid surgery, or keyhole surgery, is a modern surgical technique. There are a number of advantages to the patient with laparoscopic surgery versus the more common, open procedure. These include reduced pain due to smaller incisions, reduced hemorrhaging and shorter recovery time. The key element is the use of a laparoscope, a long fiber optic cable system which allows viewing of the affected area by snaking the cable from a more distant, but more easily accessible location.
Laparoscopic surgery includes operations within the abdominal or pelvic cavities, whereas keyhole surgery performed on the thoracic or chest cavity is called thoracoscopic surgery. Specific surgical instruments used in a laparoscopic surgery include forceps, scissors, probes, dissectors, hooks, and retractors. Laparoscopic and thoracoscopic surgery belong to the broader field of endoscopy. The first laparoscopic procedure was performed by German surgeon Georg Kelling in 1901.
There are two types of laparoscope:
- a telescopic rod lens system, usually connected to a video camera (single chip or three chip)
- a digital laparoscope where a miniature digital video camera is placed at the end of the laparoscope, eliminating the rod lens system
The mechanism mentioned in the second type is mainly used to improve the image quality of flexible endoscopes, replacing traditional fiberscopes. Nevertheless, laparoscopes are rigid endoscopes. The rigidity is required in clinical practice. The rod-lens based laparoscopes dominate overwhelmingly in practice, due to their fine optical resolution (50 µm typically, dependent on the aperture size used in the objective lens), and the image quality can be better than that of the digital camera if necessary. The second type of laparoscope is very rare in the laparoscope market and in hospitals.
Also attached is a fiber optic cable system connected to a “cold” light source (halogen or xenon), to illuminate the operative field, which is inserted through a 5 mm or 10 mm cannula or trocar. The abdomen is usually insufflated with carbon dioxide gas. This elevates the abdominal wall above the internal organs to create a working and viewing space. CO2 is used because it is common to the human body and can be absorbed by tissue and removed by the respiratory system. It is also non-flammable, which is important because electrosurgical devices are commonly used in laparoscopic procedures.
Laparoscopy Surgery isconsidered superior to open surgery because it ensures early recovery after surgery, decreased pain, better cosmesis,minimal scar on the abdomen, early return to work, no residual weakness and better surgical precision.
Laparoscopy Surgery is considered safe for people suffering with other medical problems like Diabetes, Hypertension, Kidney disorder or Obesity. Minimization of the trauma to the body by Minimal Access Surgery (MAS) causes minimal disturbance of normal physiology.
Laparoscopic Hernia Treatment
Hernia can be repaired by open technique or laparoscopically. Most hernias nowadays are repaired laparoscopically. Three to four small punctures are made, varying from 5 – 10 mm in size. Laparoscopic Surgery for Inguinal hernia is performed using TEP (Total Extra-peritoneal) or TAPP (Trans-abdominal Pre-Peritoneal) techniques. For Ventral / Incisional / Umbilical / Epigastric hernia, Laparoscopic Surgery is performed using IPOM (Intra-peritoneal onlay mesh), Hybrid or abdominal wall reconstruction techniques.
Mesh is usually indicated for most hernia cases to do a tension-free repair of the hernia defect. Use of mesh decreases the recurrence rate of hernia.Non-absorbable polypropylene or partially absorbable meshes are used in inguinal hernia repair and abdominal wall reconstruction. Special composite meshes (prevents mesh complications in contact with abdominal viscera) with fixation devices are used in ventral hernia repair, which adds extra cost to laparoscopy surgery.