The idea of minimally invasive surgery is not novel. The use of tubes and dilators in medicine began in the early days of the civilizations in Mesopotamia and ancient Greece.
The beginnings of modern endoscopy date back to 1805, when Bozzini, a gynecologist from Frankfurt, used a candle as a light source to attempt to examine the vagina and female urethra through a thin tube.
In 1897 Nitze, a urologist from Berlin, in collaboration with Reinecke, an optician also from Berlin, and Leiter, a tool maker from Vienna, built the first cystoscope, with a lens system and platinum wire as the light source.
In 1901 Von Ott from St. Petersburg announced the first abdominal examination using a head mirror focusing on a dilator. A year later, Kelling, using a cystoscope and creating a pneumoperitoneum with filtered air, announced at a Hamburg conference the successful laparoscopy on a live dog.
In 1910, Jacobaeus, a surgeon from Stockholm, performed laparoscopy and thoracoscopy on a human using a cystoscope.
From 1920 to 1930, Kalk, the founder of the German School of Laparoscopy, designed many tools, promoted the spread of diagnostic laparoscopy in diseases of the liver and bile ducts, and paved the way for the development of surgical laparoscopy.
This was followed by the development of laparoscopy in gynecology by Palmer (France), Frangeheim and Semm (Germany), Steptoe (Great Britain) and Phillips (USA).
The evolution of fiber optics and the development of the lens system by the British physicist Hopkins in 1952, led to a rapid increase in the use of endoscopic and laparoscopic devices worldwide.
The sources of modern laparoscopic surgery can be found at the Kiel School in Germany under the direction of gynecologist Semm. This center developed and perfected most of the tools and introduced most of the laparoscopic gynecological procedures that are still performed today.
Although gynecologists have been using laparoscopy for several years, general surgery has been slow to follow suit. The first laparoscopically guided cholecystectomy was performed in an experimental model by Frimberger and colleagues in Germany in 1979. Semm and his team described the technique of laparoscopic appendectomy using a modified orthoscope and CO2 pneumoperitoneum in 1985.
A relatively recent technological development was the introduction of the computer chip camcorder in 1986, which sparked the development of laparoscopic surgery in its current form.
In 1987, Mouret in Lyon (France) was the first surgeon to perform a cholecystectomy on a human using specific laparoscopy equipment. The first published announcement of modern multiple intra-abdominal cholecystectomy was made by Dubois in Paris in 1989. Around the same time, the operation was performed by Perissat (in Bordeaux, France), Reddick (in Nashville, USA), Cuschieri and Nathanson (in Dundee, UK) and Berci (in Los Angeles, USA).
Since then, the application of laparoscopic techniques has spread rapidly in the various specialties of surgery. There is no doubt that many parameters of current equipment can and will be improved in the near future to facilitate this beneficial method of minimally invasive surgery.
Since the year 2000, the proliferation of robotic surgical systems has marked a new era in laparoscopic surgery, in which several of the limitations of classical laparoscopy are overcome.
What is laparoscopic surgery?
Laparoscopic Surgery is perhaps the most important development of General Surgery in the 20th century. The word laparoscopy comes from the ancient Greek words “laparo” which means belly and “scopy”, which means to see.
Thus, while open surgery is performed through large incisions in the abdomen so that there is direct vision of the patient’s organs, in laparoscopy the surgeon performs the operation through small incisions and magnifies the patient’s internal organs on a screen.
Laparoscopy is the examination of the peritoneal cavity with a telescope that is inserted into the abdomen through the abdominal wall after pneumoperitoneum formation.
Laparoscopic surgery is the performance of documented procedures in such a way that surgical injury during entry is smaller resulting in faster recovery of the patient.
The surgical maneuvers are performed outside the patient’s body through laparoscopic instruments that allow the tissue preparation movements into the narrow spaces of the peritoneal cavity or other extraperitoneal spaces, under direct vision through a video camera and a monitor.
The laparoscopic method requires long-term training and experience. Robotic surgery is an evolution of conventional laparoscopy, the latter, despite its many advantages, having some limitations. However, robotic surgery also requires a good knowledge of the principles of laparoscopic surgery and that is why we consider it appropriate to refer to them. The latter is a matter of debate as to whether young surgeons should be trained directly in robotic or laparoscopic surgery, or whether they should first acquire the skill of conventional “open” surgery. We adopt Ash Tewari’s view that “when you have learned to perform surgery, you know how to operate in any way: open, laparoscopic, robotic or through natural holes.”
The vision of intervention through observation was fulfilled thanks to the evolution of both science and technology, with the use of fiber optics and video technology. Creating a three-dimensional image further expands the scope and prospects of laparoscopic surgery.
Laparoscopic surgery provides significant benefits:
- Minimal surgical injury
- Quick recovery
- Minor blood loss
- Shorter hospitals stay
- Lower treatment costs
- Rapid return to work
- Image magnification by 10-15 times and better lighting
- Minimization of postoperative pain
- Almost elimination of postoperative complications related to the surgery, such as perforation, rupture, hernia, chronic pain, etc.
- Less respiratory and cardiovascular complications
- Lower possibilities for postoperative adhesions
- The surgical team is protected from passing on viral infections
- Easier to treat patients in serious conditions
Current applications of laparoscopic surgery have expanded to a wide range of operations, including both simple and specialized procedures, such as:
- Laparoscopic cholecystectomy and bile duct examination in combination with intraoperative cholangiography, intraoperative galloscopy and intraoperative ultrasound
- Laparoscopic appendectomy
- Laparoscopic treatment of hernia (inguinal hernia, femoral hernia, abdominal hernia, etc.)
- Laparoscopic treatment of gastroesophageal reflux with or without hiatal hernia and laparoscopic cardiomyotomy for the treatment of esophageal achalasia
- Laparoscopic colectomy for the treatment of benign diseases of the colon (diversion, polyps, ulcerative colitis, etc.), as well as colon cancer
- Laparoscopic treatment of morbid obesity with ring placement or other complex techniques (gastric bypass, etc.)
- Laparoscopic treatment of intestinal obstruction / adhesions
- Laparoscopic treatment of benign & malignant breast diseases
- Laparoscopic treatment of gynecological diseases (endometriosis, pelvic adhesions, ovarian cysts, uterine fibroids, ectopic pregnancy, etc.) as well as laparoscopic hysterectomy
- Laparoscopic oncology surgery for the staging or palliative treatment of cancer
- Laparoscopy in acute abdomen (peritonitis) and injury
- Diagnostic laparoscopy, most commonly for investigating abdominal pain, removing tissue or fluid for biopsy, etc.
- Laparoscopic pancreatectomy
- Laparoscopic gastrectomy
- Laparoscopic treatment of gastroduodenal ulcer
- Laparoscopic liver surgery
- Laparoscopic adrenalectomy
- Laparoscopic splenectomy
- Laparoscopic pelvic lymph node dissection