By Dane Rucker

Surgery has been an essential treatment tool for as long as medicine has existed. Consequently, as doctors’ understanding of medicine improved, so did their surgical techniques. Now, after thousands of years of innovation, doctors have the capability to relieve pain, repair organs, and improve bodily function in a quick and effective manner. Despite all of their previous advances, surgical techniques continue to improve in order to minimize any negative effects on patients.

Surgical advancements aim to improve recovery times, decrease pain, reduce total number of hospital visits, and lower costs; these advancements have yielded operations superior to traditional surgery under many circumstances. Currently, one of the most popular and influential innovations is the development of minimally invasive, laparoscopic surgery.

Laparoscopic surgery relies on small cameras, no wider than a pinky finger, called laparoscopes. The now-popular procedure was introduced in the early 20th century by the Swedish surgeon Hans Christian Jacobaeus.1 Over the following decades, the procedure was further refined, and by 1990, surgeons around the world were performing the technique.2

The procedure begins with an incision, measuring as small as one tenth of an inch, close to the target area. The size and number of cuts depend on the procedure.3 For example, the removal of the gall bladder requires only one incision as small as a third of an inch. For more complicated procedures, such as cardiac surgery, there can be multiple incisions as long as three or four inches.

A laparoscope attached to the end of a long tube, known as an “arm,” is inserted through the primary incision into the body cavity. Additional surgical instruments are placed inside the area of operation. As the laparoscope moves through the body, it relays images onto a screen that allows the surgeon to visualize the instruments’ movement. The surgeon can then perform a modified version of the traditional, open, surgery.4 This technique also enables the surgeon to have a magnified view of the internal organs, which often translates to a more accurate procedure.5

Laparoscopic surgery has numerous advantages over a traditional approach. Smaller incisions allow the body to recover more quickly and with less pain, permitting a shorter hospital stay. The minimally invasive technique also lowers the risk of permanent scarring, intense blood loss, and a hefty hospital bill.6 

Like most advancements in technology, this innovative surgical procedure also comes with some disadvantages. Many doctors who were already trained in their respective fields must now adapt to these changing techniques. This requires that they spend time perfecting their skills in these surgeries.

Furthermore, the initial costs of implementing laparoscopic surgery are higher than continuing traditional surgical methods because it requires expensive equipment and individualized training. The burden of these costs may be unappealing to certain hospitals, preventing them from offering laparoscopic surgery as an option.12

Patients also often request laparoscopic surgeries because of the advantages that accompany this technique. Yet, under some circumstances the surgery may require an increased visual field only available with traditional surgery. For example, certain types of thoracic surgery and tumor removal operations are better-suited for a traditional approach, because it can be beneficial for surgeons to examine the surrounding physiology to completely address the problem. Patients who request laparoscopic surgery could be increasing their operating time, turning a simple procedure into a more difficult and dangerous one.11  Many other factors including age, general health, and medical history are also considered when determining the best surgical approach.

The emergence of laparoscopic techniques is altering the field of surgery. For example, thoracic surgeons from the University of Cincinnati estimated that only 10% of all lung cancer operations in the United States in 2007 were performed using minimally invasive techniques.  Today, up to 40% of all lung cancer patients receive minimally invasive surgery.9 

With an increase in the use of laparoscopic surgery, new technologies are being implemented to further improve the quality of this technique. For instance, robotic surgery is emerging as an innovative facet of minimally invasive surgery. Similar to laparoscopic surgery, robotic surgery utilizes three or four small incisions. However, rather than controlling the instruments directly, the surgeon uses a remotely controlled robot. This enables the surgeon to make small, precise movements that he or she would not be able to manage without the use of the nimble robot.2,10 Robotic surgeries are developing as the newest technique for tumor removal because of the technology’s ability to cut out tumors with minimal damage to neighboring tissues.8

There is a growing consensus that minimally invasive surgeries have many benefits over a traditional approach. While there are risks associated with laparoscopic surgery, the benefits of higher efficiency surgery and shorter recovery times are promising. The evolution of surgical techniques will be exciting to monitor as surgeons continue to develop more effective ways to perform procedures on their patients. ∎

References:

1. Mandal, Ananya. “Laparoscopic Surgery History.” News-Medical.net. N.p., 19 May 2010. Web. 05 Mar. 2015.
2. Litynksi GS.(1999, August 23). Endoscopic surgery: the history, the pioneers. World J Surg. pp 745-53.
3. Vinocur, Charles D. “What Is “Minimally Invasive” Surgery?” Kids Health. N.p., 01 May 2012.
4. Agha, Riaz, and Gordon Muir. “Does Laparoscopic Surgery Spell the End of the Open Surgeon?” Journal of the Royal Society of Medicine. The Royal Society of Medicine,
5. The University of Chicago Medical Center. (n.d.). Benefits of minimally invasive procedures.
6. Green, M. (2014, February 4). Drexel Medicine: Benefits of minimally-invasive gynecologic surgery [Video file].
7. ”Laparoscopic vs. Open Approach.” Valley Health.
8. Griffin, R. M. (2008, August 12). Surgery lite: Understanding endoscopic surgery.
9. University of Cincinnati. (2007, July 2). Surgeons Say Minimally Invasive Lung Surgery Should Be Standard Care. ScienceDaily.
10. Liou, Louis. “Robotic Surgery: MedlinePlus Medical Encyclopedia.” U.S National Library of Medicine. U.S. National Library of Medicine, 7 May 2013.
11. The University of Chicago Medicine. (n.d.). Minimally invasive surgery for lung, mediastinal and pleural diseases.
12. Allaf, Mohamad. “Robotic Surgery: Minimally Invasive, Better Than Ever.” Hopkins Medicine. JHM Publications, 16 Oct. 2014.

Leave a Reply

Your email address will not be published. Required fields are marked *