Minimally Invasive Surgery: What are the techniques?
Laparoscopy
What is laparoscopy?
Laparoscopy, or laparoscopic surgery, is a minimally invasive surgical technique used for both the diagnosis and treatment of certain diseases. The number of incisions may vary depending on the objective, as surgical instruments must also be introduced for therapeutic purposes. The name comes from the laparoscope, a thin tube (approximately 5 to 10 mm in diameter) equipped with a lighting system and a fiber optic camera that transmits images to a monitor. This allows the surgeon to navigate inside the abdomen (or pelvis) and perform the operation. Laparoscopic surgery offers numerous advantages. While intervention times are not significantly different from traditional surgery and may require general anesthesia, laparoscopy enables much faster postoperative recovery, a reduced risk of complications, less intraoperative bleeding, and a smaller aesthetic and psychological impact. Many abdominal and pelvic operations can be performed laparoscopically.
Diagnostic Laparoscopy
Non-invasive procedures such as magnetic resonance imaging (MRI) and/or ultrasound are generally preferred for diagnosis. However, when these tools are inconclusive, diagnostic laparoscopy may be necessary, although it remains a surgical procedure.
It is commonly used to diagnose gynecological diseases:
- Pelvic inflammatory disease (acute or chronic inflammation affecting the female reproductive organs and adjacent structures).
- Endometriosis;
- Infertility;
- Ectopic pregnancy;
- Ovarian cysts;
- Uterine fibroids;
Other pathologies that may be examined include: cryptorchidism (undescended testicles); appendicitis (inflammation of the appendix); and abdominal and/or pelvic pain of unknown origin.
Furthermore, abdominal/pelvic organ tumors (liver, pancreas, kidneys, ovaries, common bile duct, and gallbladder) can be diagnosed. Diagnostic laparoscopy allows for biopsy (taking a small sample of cells for laboratory analysis). If necessary, the procedure can transition to therapeutic laparoscopy during the same session.
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Therapeutic Laparoscopy
During therapeutic laparoscopy, the surgeon can remove an inflamed appendix (appendectomy), gallbladder (cholecystectomy), a diseased section of the intestine (e.g., in Crohn's disease), adipose tissue (for weight reduction), tumors, ectopic pregnancies, fibroids, or even the uterus (hysterectomy). It can also be used for hernia repair (e.g., inguinal hernia), to control bleeding from a gastric ulcer, etc.
Endoscopy
Endoscopy involves direct observation of the interior of an organ or cavity using an optical instrument (a tube with lighting, connected to a camera and monitor). Access is through natural orifices or the abdominal wall (as in hysteroscopy and laparoscopy). Endoscopy, like laparoscopy, can be used for diagnosis, observation, treatment, and surgery. It's widely used in gynecology, often for conditions also treatable by laparoscopy but involving abdominal incisions.
Endoscopy is prevalent in otorhinolaryngology (endoscopic sinus surgery for nasal lesions affecting breathing, smell, or causing pain). In general and digestive surgery, it may be indicated for bariatric surgery. In neurosurgery, it can treat cerebral hemorrhage or stroke (CVA). The main advantage is its minimally invasive nature, resulting in a shorter postoperative period.
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Robotic Surgery
Robotic surgery is an advancement in minimally invasive techniques. A specialized surgeon uses a high-precision robotic system for enhanced visualization and surgical instrument manipulation beyond human capabilities. The surgical instrument is attached to the robot's arms, controlled by the specialist from a computer workstation. The robot mimics the surgeon's movements. Compared to traditional surgery, robotics enables smaller, more precise incisions, faster recovery, and less postoperative pain.
Compared to open surgery, robotic surgery offers advantages such as: less blood loss, less tissue damage, shorter and less painful recovery, lower infection risk, and smaller scars. Compared to laparoscopic surgery, robotics provides 3D instead of 2D visualization and greater freedom of movement for enhanced precision. Risks associated with general anesthesia and infection exist, but are lower due to the minimally invasive nature.
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