Developments in Keyhole Surgery

01/08/2002

The advancements in minimally invasive surgery (MIS) have lead to a paradigm shift in many surgical specialties, where the standard procedures are changing from open to endoscopic surgery.

Especially the progress in video imaging, endoscope technology, and instrumentation helped to speed up the implementation of minimally invasive techniques. Within a few years, the standard procedures for gallbladder surgery shifted from open to minimally invasive methods, with rates as high as 95% for nissen fundoplication and 72 % for adhesiolysis.

Applications of laparoscopic techniques include many other procedures in the abdominal cavity, e.g. hernia repair, esophageal reflux surgery and colon surgery. Other procedures, e.g. pelviscopy in gynecology, blebectomy and lung biopsy in thoracic surgery, benefit from MIS as well. On the whole, excisional or albative procedures are relatively easy to adapt to endoscopic techniques, while reconstructive procedures remain a rather difficult task in MIS.

One of the main advantages of minimally invasive techniques is to be found in the reduction of trauma. Often, the trauma and pain of a procedure is not caused by the procedure itself, but rather by gaining access to the area where it should be performed.

The application of minimally invasive procedures to more complex surgeries, however, evokes the need for new technologies. So far, many procedures rather bridge the gap between open and completely endoscopic procedures, e.g. hand-assisted laparoscopy in general surgery.

One of the main fields of research includes the use of precision enhancement in MIS, often including robotic assistance for the surgeon. Robotics in surgery so far focus on surgical assistance, dexterity enhancement and image-guided therapy. One application of robotics can be found in “motion scaling”, enabling the surgeon to reduce gross hand movements to enhance precision and perform microscale tasks.

Nevertheless, MIS applications imply special challenges, e.g. the limited freedom of performance in the confined space and the confined range of the motion left for instruments. An other main issue to be addressed in future research is visualisation, especially the need for 3-D imaging and high resolution image display.

MEDICA.de, Source: JAMA. 2001;285:568-572

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