Minimally Invasive Surgery

Synonyms: Key hole surgery; laparoscopic surgery

This involves procedures performed by entering the skin via small incisions or by a body cavity with two aims:

• Produce the least possible damage to structures
• Whilst at the same time achieving the same result as if performed by open or more invasive surgery

It requires specialist equipment including fibreoptics, camera and equipment with handles.

The use of light containing probes to view internal cavities has a long history. Philipp Bozzini (1771-1809) was the earliest deviser of such equipment which was called the "Lichtleiter" and was primarily used to examine the vaginal cavity. This was then modified by John D. Fisher (1798 - 1850) and used for urological purposes. 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 1980's that laparoscopic procedures began to be performed on a regular basis in the United states and subsequently the United Kingdom leading to regulation regarding procedure and training aspects.

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 whether to proceed towards more invasive surgery.

• Risks and complications of anaesthesia
• Bleeding
• Infection
• Shoulder pain from CO₂ insufflation
• Injury to organs - may go unnoticed e.g. biliary tract damage
• Thromboembolic disease
• May need to proceed to open surgery if complications occur
• Death