LAPAROSCOPIC SURGERY

Laparoscopic surgery involves the insertion of a videoscope with an integrated camera into the abdominal cavity, along with other small instruments through small openings in the abdominal wall. The operating surgeon and assistants perform the procedure while viewing the abdominal cavity on one or more monitors in the operating room.

To carry out a laparoscopic procedure, space must be created within the abdomen to maneuver the instruments. This is why the abdominal cavity is filled with carbon dioxide (pneumoperitoneum) using a gas insufflator. General anesthesia is required, although some anesthesiology practices are successfully using regional anesthesia (spinal) with excellent results.

Initially utilized for diagnostic purposes, especially by gynecologists, laparoscopy quickly became widespread in general surgery after the first laparoscopic cholecystectomy performed by a French surgeon (Mouret, 1987). Laparoscopic cholecystectomy soon became the preferred procedure for gallbladder stones, and progressively, all general surgery procedures, including cancer surgeries, have been approached and standardized using this technique.

Industry advancements have led to the development of increasingly advanced and safer instruments, along with significant improvements in the quality of images provided by the cameras on monitors.

The benefits include faster postoperative recovery for patients due to the absence of large abdominal scars, lower rates of cardiorespiratory complications that can occur more easily in prolonged hospital stays with large wounds, less pain, and improved aesthetic outcomes. Thus, it is a less aggressive, “gentler” form of surgery that achieves the same results as traditional open surgery, including in cancer surgeries. The surgeon must have undergone a learning curve and possess the necessary skills to perform it.

Patients should be aware that laparoscopic surgery is not always possible. In some cases, an open approach may be simpler and quicker. Additionally, certain patient characteristics may contraindicate laparoscopic surgery (e.g., significant previous surgeries leading to many adhesions, tumors located too deep, significant cardiovascular conditions contraindicating pneumoperitoneum).

It is also important to know that especially for more complex surgeries, there is the possibility of converting from laparoscopic to open surgery if difficulties arise that compromise the safety of the procedure (e.g., uncontrollable bleeding, excessive adhesions, technical problems, poor visibility, patient instability, etc.).