Laparoscopic surgery is a surgical technique in which short, narrow tubes (trochars) are inserted into the abdomen through small (less than one centimeter) incisions. Through these trochars, long, narrow instruments are inserted. The surgeon uses these instruments to manipulate, cut, and sew tissue and can perform wide variety of procedures with the help of camera & monitor .

Laparoscopic surgery, also called minimal invasive surgery, or keyhole surgery, is a modern surgical technique. There are a number of advantages to the patient with laparoscopic surgery versus an exploratory laparotomy.

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 laparoscopic surgery include Obstrecticts scissors, probes, dissectors, hooks, and retractors. Laparoscopic and thoracoscopic surgery belong to the broader field of endoscope .

Gallbladder

Rather than a minimum 20 cm incision as in traditional (open) cholecystectomy four incisions of 0.5–1.0 cm, or more recently, a single incision of 1.5–2.0 cm,will be sufficient to perform a laparoscopic removal of a GB . Since the gallbladder is similar to a small balloon that stores and releases bile, it can usually be removed from the abdomen by suctioning out the bile and then removing the deflated gallbladder through the 1 cm incision at the patient's navel. The length of postoperative stay in the hospital is minimal, and same-day discharges is safe for most patients.

Colon & kidney

In certain advanced laparoscopic procedures, where the specimen removed is too large to pull through a trocar site (as is done with gallbladders), an incision larger than 10 mm must be made. The most common of these procedures are removal of all or part of the colon (Colectomy) or removal of the kidney (Nephrectomy) Some surgeons perform these procedures completely laparoscopically, making the larger incision toward the end of the procedure for specimen removal, or, in the case of a colectomy, and other major procedures.

Many other surgeons feel that since they will have to make a larger incision for specimen removal anyway, they might as well use this incision to have their hand in the operative field during the procedure to aid as a retractor, dissector, and to be able to feel differing tissue densities (palpate), as they would in open surgery. This technique is called hand-assist laparoscopy.

Since they will still be working with scopes and other laparoscopic instruments, CO2 will have to be maintained in the patient's abdomen, so a device known as a hand access port (a sleeve with a seal that allows passage of the hand) must be used. Surgeons who choose this hand-assist technique feel it reduces operative time significantly versus the straight laparoscopic approach.

Based on numerous prospective randomised controlled trials and approach has proven to be beneficial in reducing post-operative morbidities such as wound infections and incisional hernias especially in morbidly obese patients), and is now deemed safe when applied to surgery for cancers such as cancer of colon.
Laparoscopic Instruments:

Advantages

There are a number of advantages to the patient with laparoscopic surgery versus an open procedure.
* Reduced haemorrhage which reduces the chance of needing a blood transfusion.
* Smaller incision, which reduces pain and shortens recovery time, as well as resulting in less post-operative scarring.
* Use of regional anesthesia (with the recommendation of using a combined spinal and epidural anaesthesia) for laparoscopic surgery, as opposed to general anesthesia required for many non-laparoscopic procedures, can produce fewer complications and quicker recovery.

Disadvantages

While laparoscopic surgery is clearly advantageous in terms of patient outcomes, the procedure is more difficult from the surgeon's perspective when compared to conventional, open surgery:
* Laparoscopic surgery requires pneumoperitoneum for adequate visualization and operative manipulation.
* The surgeon has a limited range of motion at the surgical site, resulting in a loss of dexterity.
* Poor depth perception.
* Surgeons must use tools to interact with tissue rather than manipulate it directly with their hands.

* In January 2022, a robot performed the first ever successful laparoscopic surgery without the help of a human. The robot performed the surgery on the soft tissue of a pig. It succeeded at intestinal anastomosis, a procedure that involves connecting two ends of an intestine. The robot, named the Smart Tissue Autonomous Robot (STAR), was designed by a team of Johns Hopkins University researchers.

Dr Mohammad Iqbal Adil

MBBS. FRCSEd U.K. FRCSI ( Ireland)
Consultant General, Breast , Colorectal and Minimal Invasive Surgeon
Evercare Hospital , Hayat Memorial Hospital & Bahria Orchard Hospital Lahore
Pakistan

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