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New technologies for advance laparoscopic surgery

In the arena medical science, laparoscopic surgery is highly beneficial for patients. There are many developments of new instruments and modernism in advanced laparoscopy technique for the treatment of abdominal ailments. Presently, most modern laparoscopic systems offer high image quality and the surgeons and their team can view the procedure on a separate video monitor. These systems provide excellent image and access to anatomical structures. New technologies may trounce numerous limitations of standard laparoscopic methods. Doctors are using advanced technologies to develop laparoscopic operations for the pancreas, liver and the bile duct.

In advance laparoscopic surgery, numerous new technologies have been developed, these include:

  1. Hand access devices
  2. Robotic surgery.
  3. Single-port laparoscopy (SPL)
  4. NOTES (Natural Orifice Transluminal Endoscopic Surgery)

1. Hand access devices: Surgeons performs many functions during operation that are difficult to replicate with laparoscopic instruments. The loss of the capability to place the hand into the abdomen during traditional laparoscopic surgery has restricted the use of laparoscopy for complicated abdominal gall bladder surgery and the pancreas, liver and bile duct. New laparoscopic hand-access devices enable the surgeon to place a hand into the abdomen during laparoscopic surgery and execute multiple functions with the hand that were earlier possible only during open surgery. Surgeons have utilized this new device to develop various laparoscopic pancreatic, liver and biliary procedures such as the Whipple operation, distal pancreatectomy and liver resection that were not possible formerly by standard laparoscopic practice.

2. Robot-assisted surgery: This surgery utilizes the Da Vinci computer robot system. Da Vinci system, highly advanced medical technique is a computer-assisted robotic system that expands a surgeon's ability to operate within the abdomen easily during laparoscopic surgery. Da Vinci system allows greater accuracy and better image in comparison to standard laparoscopic surgery.

The operations with the Da Vinci System are performed with no direct automatic connection between the surgeon and the patient. The surgeon is isolated from the patient, working a few feet from the operating table while seated at a computer console with a three-dimensional image of the operating area. The surgeon operates two masters that control the two mechanical arms on the robot. The mechanical arms are armed with specialized instruments with hand-like movements which carry out the surgery through tiny holes in the patient’s abdomen. The arms remove any hand vibration by the surgeon and offer motion scaling allowing tremendously precise movements within the patient.

3. Single-incision laparoscopic surgery: This novel surgery has only been practiced in a few centres around the world since last many years by expert laparoscopic surgeons. Single port surgery offers less invasive operation as compared to standard laparoscopic procedure and thus lessens post-operative pain, cut related complications, enables outstanding cosmetic results and quicker recovery. The aim of Single-incision laparoscopic cholecystectomy is to remove the gallbladder through a single incision, which is usually made near the umbilicus. SILC is performed with the patient under general anaesthesia.

There are two surgical approaches. In first approach, surgeon uses a single umbilical skin incision with skin flaps to insert ports through multiple fascial punctures. The other approach uses a specially designed device that allows multiple instruments to be passed through a single port placed in or near the umbilicus. A pneumoperitoneum is established and the gallbladder is retracted with a laparoscopic instrument (grasper) or by a transabdominal suture. The hilum of the gallbladder is dissected using endoscopic instruments. The cystic artery and cystic duct are clipped and divided, and the gallbladder is separated from the liver. At least one additional port in the epigastrium may be needed if a cholangiogram is performed or if the common bile duct is explored. The gallbladder is removed through the umbilical incision. Single-incision laparoscopic appendectomy was found to be technically useful for dealing with appendicitis in unusual anatomical locations.

4. NOTES (Natural Orifice Transluminal Endoscopic Surgery): Natural orifice transluminal endoscopic surgery (NOTES) is a promising field within gastrointestinal operations and interventional gastroenterology in which the doctor accesses the peritoneal cavity via a hollow viscus and performs diagnostic and therapeutic procedures. Natural Orifice Transluminal Endoscopic Surgery is a new method that requires no abdominal incision. It has been supported in a small number of centres for diagnostic and therapeutic procedures. This system utilizes the natural openings of the body, such as the mouth or vagina. In many departments, it has performed gallbladder resections. NOTES cholecystectomy is best suited for women who prefer no scar surgery.

Laparoscopic Surgeon Chennai
Dr. Jameel Akther

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E-mail: jameel27@gmail.com


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