It’s only about two decades since the laparoscopic surgery was introduced with a cholecystectomy by the French surgeon called Philippe Mouret and since then by far the majority of the cholecystectomies are done laparoscopically compare to open surgery. In India laparoscopic surgery has been slower than many other countries in the west to adopt these minimal invasive surgery. Though now there are many best laparoscopic surgeon in Mumbai and other metropolitan cities of India. The range of operations using laparoscopy has now extended to a great deal, from simple surgical procedures such as herniorrhaphy and ovarian cystectomy to complex surgical operations including radical prostatectomy, nephrectomy, and adrenalectomy. Does the advancement and popularity of laparoscopic surgery means end to open surgery?.
Advantages of Laparoscopic surgery for patients
With respect to patients, laparoscopy is far more option as only small incisions are made compare to larger incisions done in open surgery. Smaller incision mean less pain, less blood loss and less discomfort. Patients recovers much faster and usually discharges from the hospital the next day. There is also fewer unwanted effects from analgesia because analgesia is required in small quantity. These advantages help to decrease the recovery period, and also lessening the risks of bone loss, muscle atrophy and urinary retention associated with lengthy bed rest and inactivity. Other advantages include early mobilization and finally patients prefer small scars to large ones, and laparoscopic surgery is likely to generate less postoperative anxiety related to self-image.
Laparoscopic surgery for Surgeons
In laparoscopic surgery, there is less direct contact between the patient and the laparoscopic surgeon and as a result there is far less risk of infection to surgeons and also vice versa. Though many surgeons do not like the separation between them and the patients as it hampers surgical judgment. Moreover, there are other perceptual difficulties. After the trocar is inserted, the trocar site serves as both a fulcrum and a steadying point. A small movement at the proximal end gives a large movement at the distal end.
In laparoscopic surgery images from 3-D structures are transmitted via the laparoscope onto a 2-D monitors, making it difficult for surgeons to judge depth and reducing the perceptual cues for identification of anatomical structures. Other difficulty in doing surgical operation is that the visual field is smaller than with open surgery, and the necessity to work with screen images demands special mental as well as physical skills. In laparoscopic dissection the limited range of motion from 4 to 6 degrees of freedom can hamper the ability to freely use medical instruments and structures. The necessity to use non-ergonomic instrument positions disrupts the surgeon’s hand-eye coordination, and the working positions of surgeon and assistant can be many time awkward.
In certain respects, open surgery is far better option than laparoscopic surgery. Surgical procedures performed laparoscopically are comparatively slower, especially when the setting-up time is included. Laparoscopic nephrectomy, for example, takes about three or four hours whereas open nephrectomy takes only about two hours. In case of emergency where immediate operation is to be performed, laparoscopic surgery will often be ruled out by the set-up time, the need to get access quickly and the likelihood that blood will obscure the visual field. Many laparoscopic surgical procedures demand a particular operational conformation; nevertheless, laparoscopic appendicectomy and duodenal ulcer closure are now standard procedures in many hospitals. Diagnostic laparoscopy has also helped substantially in management of the acute abdomen; and laparoscopic surgery has been found safe and effective in haemodynamically stable patients with abdominal trauma.
So does laparoscopic surgery means end of open surgery? Answer is No. The skills of open surgery will remain indispensable. But as the laparoscopic surgery have many advantages in the future many more operations would be performed laparoscopically.