The development of minimal invasive operative techniques in the late 80’s has changed all surgical disciplines dramatically. It all started while I was training at the Technical University and I was lucky to be there when the first operations were carried out and to experience the almost explosive development in the years to come. At my training hospital,” Klinikum rechts der Isar” we performed the first laparoscopic cholecystectomy in Munich (and one of the first in Germany).
Minimal invasive techniques are used in all operative disciplines today, e.g. abdominal and thoracic surgery, gynecology, urology, neurosurgery, traumatology and orthopedic surgery. But was does minimal invasive surgery actually mean?
The main difference when compared with conventional surgery is the way of access to body cavities, joints or other operative sites. Instead of a huge cut e.g. through the abdominal wall or through the capsule of a joint only small incisions (ports) are used. Thin instruments are inserted through these incisions and the operative field is visualized by a small fiber optic device connected to a camera and a TV screen. With this type of access very little tissue is damaged and the injury caused by the operation is reduced to a minimum.
For the patients minimal invasive surgery has the following advantages:
In addition to minimal invasive technique I have had formal training in the conventional, open surgical procedures. This combination in training becomes essential when minimal invasive surgery reaches its limits and the operation has to be converted to an open procedure. Many of the younger surgeons today have not been trained adequately in the conventional techniques.
Laparoscopy is used more and more as an additional diagnostic tool to evaluate tumors of the abdomen or abdominal complaints of unknown origin. It enables us to differentiate gynecological conditions like endometriosis or ovarian cysts from diseases of the bowel like chronic appendicitis or other inflammatory diseases. Usually the problem can be solved in the same procedure.
Quite often we see patients with abdominal complaints that are attributed (after many frustrating examinations) to peritoneal adhesions. Unfortunately there is no reliable (non operative) investigation to visualize and prove adhesions. This leaves us with laparoscopy. During the laparoscopic examination adhesions can also be removed. Recent studies have shown that laparoscopic treatment of adhesions is significantly less traumatic than conventional surgical adhesiolysis and also carries a much lower risk of recurrent adhesions.