Minimally Invasive Surgery

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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.

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 surgery[2]and single-point entry laparoscopy.[3]

Advantages
Disadvantages
  • Less expensive.
  • Shorter duration of hospital stay.
  • Less trauma to the patient.
  • Less pain.
  • Less blood loss.
  • Smaller skin scars.
  • Becoming more common for major surgical procedures - eg, cardiac surgery.
  • Requires special equipment.
  • Specialist training is required.
  • Equipment is more expensive.
  • Some procedures, especially the latest ones, may take longer.
  • Some complications can be masked - eg, biliary peritonitis.

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.

Body system
Procedures performed
CardiacClosing atrial septal defects.
Coronary artery bypass graft ('off pump').
Repairing patent foramen ovale.
Valve surgery.[7]
GastrointestinalAppendicectomy.
Adrenalectomy.
Cholecystectomy.
Lymph node biopsy.
Splenectomy.
Hiatus hernia, umbilical and inguinal hernia repairs.
Colonic cancer.
Diverticular disease.
Inflammatory bowel disease.
Rectal prolapse.
Dividing adhesions.
GynaecologicalPolypectomy.
Sterilisation.
Endometrial ablation.
Fibroid removal.
NeurologicalRemoval of pituitary tumours.
Treatment of intracranial aneurysms.
Carotid angioplasty.
Radiosurgery for brain tumours.
OrthopaedicArthroscopy of joints.
Carpal tunnel release.
Pelvic fracture repair.
Rotator cuff repair.
OtorhinolaryngologyRemoval of nasal/sinus tumours.
Lymph node biopsy.
Respiratory/ThoracicLung surgery.
Recurrent pleural effusions.
UrologyBiopsy.
Removal of kidney and ureteric calculi.
Nephrectomy.[8]
VascularStenting carotid and renal arteries.
Repair of thoracic and abdominal aneurysms.[5]
Varicose veins.
  • 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.

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Original Author:
Dr Gurvinder Rull
Current Version:
Dr Laurence Knott
Peer Reviewer:
Prof Cathy Jackson
Document ID:
2457 (v23)
Last Checked:
14 January 2013
Next Review:
13 January 2018

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