Minimally invasive surgery

Synonyms: keyhole surgery, laparoscopic surgery

This involves procedures performed by entering the skin via small incisions or by a body cavity, with two aims:

• To produce the least possible damage to structures.

• At the same time, to achieve the same result as if performed by open or more invasive surgery.

Specialist equipment is required, including fibre optics, camera and equipment with handles.

Background¹

The use of light-containing probes to view internal cavities has a long history. Philip Bozzini (1771-1809) a German-born urologist, was the earliest deviser of such equipment which was called the 'Lichtleiter' and was primarily used to examine the vaginal cavity. In 1877 Maximilian Carl-Friedrich Nitze produced the first workable cystoscope; this was also the first instrument with a mechanism to light the inside of an organ. In 1929 Heinz Kalk, a German gastroenterologist, used laparoscopy to diagnose hepatobiliary disease.

30 years later the automatic insufflator was invented and used to perform an appendectomy as part of a gynaecological procedure. However, it was not until the early 1980s that laparoscopic procedures began to be performed on a regular basis in the USA and, subsequently, the UK, leading to regulation regarding procedure and training aspects.

Recent advances include the use of robotic-assisted surgery²and single-point entry laparoscopy.³

Not all patients will be suitable for minimally invasive procedures. For example, raised body mass index, previous abdominal surgery leading to adhesions or other underlying medical conditions may affect the decision on whether to proceed towards more invasive surgery.

• Risks and complications of anaesthesia.

• Bleeding.

• Infection.

• Shoulder pain from CO₂ insufflation.

• Injury to organs; this may go unnoticed - eg, biliary tract damage.

• Thromboembolic disease.

• It may be necessary to proceed to open surgery if complications occur.

• Death.