Advances and Developments in Laparoscopic Surgery in India

Laparoscopic or keyhole surgery has made operations much less invasive, which benefits the patient in many ways. However, since it became mainstream procedure, the traditional laparoscopic techniques have encountered certain limitations, which are as follows -

In open surgery, the human hand is able to perform multitude of different movements and functions, which is not possible in laparoscopy since the opening is very small and the surgery is performed by inserting long instruments through the small opening.
Most instruments used in laparoscopic surgery are long an thin, making them poor substitutes for complex procedures.
The image provided by the laparoscope camera is two dimensional, which is a major drawback in certain surgeries where the surgeon needs much better depth of perception.
In open surgery, other organs not connected with the surgery can be retracted out of the way, whereas in laparoscopy, retraction of organs is difficult and it can be a challenge.
New Technologies and Advances in Laparoscopic Surgery

Fortunately, many new instruments have been developed and there have been innovations in techniques to overcome the limitations of traditional laparoscopic surgery. Two major advancements are introduction of hand access devices and robot-assisted surgery.

Hand Access Devices

The major drawback of laparoscopic instruments is that they cannot replicate the functions of the human hand. The surgeon is at a major disadvantage when he is unable to place his hand into the abdomen of the patient, especially while doing complex procedures on the bile duct, liver, or pancreas. However, now, hand access devices are available that enables the surgeon to insert his hand inside the abdomen and perform various functions that previously could be done only in open surgery. These hand access devices are now very useful in procedures like liver resection, distal pancreatectomy, and Whipple surgery.

Robot Assisted Surgery

A major breakthrough in laparoscopic surgery can be seen by the development of robotic system that assists the surgeon during laparoscopic surgery in different ways. The latest is called the Da Vinci System, which is computer-assisted robotic system that greatly enhances visualization and precision of the surgeon. Surgery with the Da Vinci System can be performed without direct mechanical connection between patient and surgeon.

The surgeon works from a computer console, seated a few feet away from the operating table. One of the major advantages of the system is its capability to provide three-dimensional imagery of the operating field. The system has two mechanical arms that are controlled by the surgeon by operating devices just like joysticks. These arms are not only able to replicate hand movements and functions but also perform certain movements that are not possible by the human wrists. Hence, the surgeon can be much more dexterous and precise. The arms also eliminate any risk of hand tremor and provide motion scaling.

In Germany studies have been conducted to evaluate the efficacy of the latest Da Vinci Xi surgical robot, which was approved by the FDA in April 2014. The study analyzed 2700 colorectal surgeries done with this system. It was found that conversion rates for rectal resections were much lower while using the system, compared to traditional laparoscopic procedures. Patients who underwent colon procedures with the system had to stay for much fewer days in the hospital, compared to patients who underwent the same surgery through traditional laparoscopic procedure. Further analysis of about 170,000 general surgeries showed that robotic assisted procedures resulted in much lesser complications compared to conventional laparoscopic procedures. The studies concluded that robotic approach was much safer, precise, and minimally invasive, especially in colorectal surgeries.