Introduction

Famously called as Key-Hole surgery, the operation is done through small holes in your body. A telescope is inserted through the body which acts as the eye of the surgeon. He operates looking at the image in the monitor using thin long instruments through other small holes placed in the body.

It is the absence of long incisions on the body that makes the surgery almost painless and results in no scarring while achieving the same results as open surgery.

Applicability

This technique is applicable to all fields that deal with organs inside the abdomen, the most popular among them being gall bladder surgery (cholecystectomy). The other fields that are largely benefited are gastroenterology (hepato-biliary, pancreas, stomach, colon), oncosurgery (surgery for cancer), trauma and emergency surgery, endoscopic surgeries (MIPH for hemorrhoids, SEPS for varicose veins, VATS for chest surgeries etc.). Four major specialities that benefit in a major way by this state-of-the-art technique are Surgical Gastroenterology, Gynaecology, Urology and Pediatric Surgery.

Technique  Multiple small incisions are made and "trocars" (metal cylinders) introduced to gain access to the abdominal cavity, these are called "ports". A telescope is introduced first, it has a camera and acts as the eye of the surgeon it is attached to a fibre optic light source which provides illumination inside the abdominal cavity. The picture is relayed on to a monitor, which is seen by the ot team during operating. Gas (usually carbon di-oxide) is filled in the abdominal cavity to create enough space to visualize and to operate.

Instruments which are specially designed for laparoscopy are introduced next into the other ports, the sites of which are determined by the procedure to be performed. Surgery is done in a manner similar to its open counterpart. Presently with advancement in the field of surgical technology and instrumentation, the instruments which were initially meant for open surgery can be used for laparoscopic procedures, viz, electro-cautery, harmonic scalpel, staplers.

Many laparoscopic surgeries end with a specimen which needs to be extracted from the abdomen, this can be done using sterile plastic bags called "endo-bags" either through one of the ports or via a small incision (which is still considerably smaller than the one used for open surgery). An alternative method of extraction is "morcellation" wherein the tissues are grinded into small shreds and removed through one of the ports. Morcellation has a disadvantage in that it cannot provide tissue for histo-pathological examination.

Advantages

    * Less pain
    * Rapid recovery
    * Reduced scarring
    * Reduced duration of stay in hospital
    * Cost effective
    * Patient friendly
    * Magnification: hence better visualization

Future With further advancement and man`s quest for even better cosmesis, the trend is moving from minimally invasive to non invasive techniques, for minimal scarring to no scarring. LESS (Laparo Endoscopic Single Site surgery) or SILS (Single Incision Laparoscopic Surgery) use just one small incision, usually at the umbilicus to do the surgery. NOTES (Natural Orifice Trans Endoscopic Surgery) further improves in using naturally available orifices such as mouth, anus and vagina to perform abdominal surgery, thus providing a scarless surgery. These methods are very tough to master are not in common use as of now, but are supposed to gain popularity in the near future. 

 Laparoscopic surgery is in vogue and fast gaining momentum in the field of bariatric surgery (surgical treatment of obesity) and diabetes, the so called “Diabesity” . Operations like surgical bypass to reduce the absorption of fats and carbohydrates so as to cause loss of weight are quite popular means to reduce weight. Gastric banding, wherein an inflatable band is placed around the stomach to moderate the food intake as per the individuals choice. Certain procedures help in controlling and even curing diabetes, opening newer avenues in the treatment of the rampant disorder. All these when done through minimal access routes have caught the fancy of the patient and the doctor alike.