Laparoscopic Surgery: An Almost Scarless Approach

Abstract

Minimally invasive surgery is gaining popularity worldwide as it contributes to less postoperative pain, shorter hospital stay and reduced morbidity. Since laparoscopic cholecystectomy was first performed in the 80’s, a wide array of different types of laparoscopic surgery was performed and this has been extended to colorectal resection, where the first reported case of laparoscopic colorectal resection was made in 1991. Conventionally, a mini laparotomy is required to extract the specimen following laparoscopic colorectal resection, which may increase post-operative pain, wound infection, a bigger scar and other pain related morbidities. Thus, the use of natural orifice specimen extraction (NOSE) for the extraction of colorectal specimen is slowly gaining worldwide acceptance and evolving. Single Incision laparoscopic Surgery or Single Port Access Surgery is also gaining popularity as an alternative approach to NOSE and Natural Orifice Transluminal Endoscopic Surgery (NOTES) in order to provide an almost scarless surgery. Often at times, such procedures are complementary to one another. However, there is a significant cost implication due to the expensive disposable port and hand instruments but the main aim of having such procedures is the retrieval of resected surgical specimens through exploitation of natural body orifices such as the mouth, anus, vagina or urethra. In this chapter, we described a technique for retrieval of the colonic specimen via a natural orifice or transvaginal for a 78 year old lady who had sigmoid carcinoma and underwent a total laparoscopic high anterior resection, hence avoiding a mini-laparotomy for retrieval of the specimen. We also described various instrumentation and developments in Single Incision Laparoscopic Surgery, NOSE or NOTES, including the latest technique to make this surgery safe. This is concluded with a Health Technology Assessment (HTA) of this emerging technology in health care.