Advances in Laparoscopic Surgery

Abstract

After a brief account of the origins of laparoscopy and of its development into an interventional technique thanks to technical improvement, the author gives a dynamic state of the art in laparoscopic surgery, beginning with a description of his original classification method for laparoscopic procedures according to their level of use. Before tackling the highly controversial issue of laparoscopic surgery for cancer, he reviews in detail the various operations successfully performed by laparoscopy for the treatment of nonmalignant abdominal disorders and acute syndromes, all the while checking their results against those obtained with their open counterparts. As the various procedures are described, the interest of the laparoscopic approach becomes clearly visible, based on the excellent view of the operative field that allows diagnostic accuracy, thus avoiding unnecessary operations, and precise dissection with minimal damage. However, the laparoscopic approach is highly dependent on the surgeon’s proficiency, itself depending on experience and therefore on the frequency of occurrence of the disorder, and on the progress in and availability of adequate equipments. The last chapter looks into the future of this ever-expanding approach and defines two great trends in its evolution, one accessible to the individual surgeon, the gradual adaptation of open procedures into laparoscopic ones, the other at the institutional level, in view of the huge financial support involved if high technologies are to be systematically integrated in this new surgery. What will the future be like?

Minimally Invasive Surgery

“…No one can say, but MIS is likely to form part of a general context of treatment with increased efficacy and even less invasiveness. These goals can be achieved when it becomes possible to explore the human body without "over-opening" its external envelope [46]. In combination with flexible endoscopy, radiography, ultrasound, and magnetic resonance imaging, laparoscopy will make this possible.…”

Safety of Laparoscopy in Patients with Ventriculoperitoneal Shunts

“…The gradual and slow evolution of laparoscopic surgery at its early stages was related to limitations of technology and the skepticism of the medical and surgical communities [20]. It was not surprising that the pioneers of laparoscopic surgery, Kurt Semm, a German gynecologist, who was the first to perform laparoscopic appendectomy in 1983, and the German surgeon Erich Muhe who was also the first to perform laparoscopic cholecystectomy by a 3-cm, directvision laparoscope of his own design, in 1986, were both suffered skepticism, criticism and experienced many examples of repression by the old guard of traditional surgery [20,21]. The most important technological advancement in laparoscopic surgery is the advent of a video laparoscope.…”

The History of Adolescent Medicine

“…The development of the vaginal cytologic smear by Papanicolaou in 1943 reduced the death rate from invasive cervical cancer in adults by 70% but also profoundly influenced the practice of adolescent health care by introducing routine preventative gynecologic care for sexually active adolescent girls (36). Laparoscopy, first used by gynecologists for adults as an interventional surgical technique in the 1960s and 1970s (37), greatly advanced our understanding of the pathophysiology of pelvic inflammatory disease in teens and provided an acceptable alternative to laparotomy for the evaluation of young women with chronic pelvic pain. The specific application of new microbiologic and recombinant techniques to routine screening for chlamydial and gonococcal cervical infections in adolescents has played a significant role in the rapid diagnosis and prevention of teenage pelvic inflammatory disease and its sequelae.…”