Laparoscopy and laparoscopic surgery

Abstract

Today, laparoscopy is an alternative technique for carrying out many operations that have traditionally required an open approach. The benefits of minimal access surgery have been well recorded, including lower post-operative morbidity, shorter duration of hospital stay and a shorter return to work. Advances in technology, specifically in fibre optics and video imaging, have made the relatively recent rapid progress in laparoscopic surgery possible. Operative laparoscopy, however, requires a high degree of technical skill and training. The use of small instruments and imaging systems that provide magnification allow for the high degree of precision that can be achieved with laparoscopic surgery. This is often difficult to obtain by a conventional laparotomy, as magnification is not available and the surgeon's hands and large instruments often obscure the operative field. It is this precision that has lead to advances in the treatment of conditions such as endometriosis, adhesions and in the field of reproductive surgery. It is unfortunate however that in reality very few major gynaecological procedures are performed laparoscopically. They are technically difficult and require the surgeon to master a whole new set of surgical skills and in effect to return to the bottom of the surgical learning curve. A wide range of simple laparoscopic procedures needs to be mastered to develop the hand eye coordination required to perform complex tasks. These procedures need to be performed on a regular basis to maintain skills and only when these skills can be regularly performed accurately can complex surgical tasks be carried out. As a result of this, most established gynaecologists have very little time and resources to be able to retrain in what is essentially a new surgical field, although most experts throughout the country agree that the vast majority of gynaecological surgery could safely and efficiently be performed laparoscopically.