Laparoscopic surgery: Current status, issues and future developments

doi:10.1016/S1479-666X(05)80032-0

The Surgeon

Volume 3, Issue 3, June 2005, Pages 125-130, 132-133, 135-138

https://doi.org/10.1016/S1479-666X(05)80032-0 Get rights and content

Laparoscopic surgery has come a long way since its introduction two decades ago. In essence it represents a new era of technology-dependent surgical interventions, and to some extent its future progress depends on the growth of interventional technologies and devices (facilitative, enabling and additive). Laparoscopic surgery has had a significant impact on all surgical disciplines and is now firmly embedded in routine surgical practice. There remain, however, several outstanding issues that need to be addressed. These concern mainly quality assurance, training, resource allocation, assessment of competence and tiers of laparoscopic surgical practice in line with the changing situation facing the next generation of surgeons

References (76)

A Cuschieri et al.
Extracorporeal pneumoperitoneum access bubble for endoscopic surgery
Am J Surg
(1995)
CT Wu et al.
Laparoscopic donor nephrectomy: new combination of hand-assisted and standard approaches
Transplant Proc
(2004)
YS Alimi et al.
Laparoscopy-assisted abdominal aortic aneurysm endoaneurysmorraphy: early and mid-term results
J Vasc Surg
(2003)
JS Bender et al.
Increased laparoscopic experience does not lead to improved results with acute cholecystitis
Am J Surg
(2002)
BK Oelschlager et al.
The use of small intestine submucosa in the repair of paraesophageal hernias: initial observations of a new technique
Am J Surg
(2003)
AM Lacy et al.
Laparoscopy-assisted colectomy versus open colectomy for treatment of non-metastatic colon cancer: a randomised trial
Lancet
(2002)
C Troppmann et al.
Laparoscopic live donor nephrectomy: a risk factor for delayed function and rejection in pediatric kidney recipients? A UNOS analysis
Am J Transplant
(2005)
A Pietrabissa et al.
Localization of insulinoma by laparoscopic infragastric inspection of the pancreas and contact ultrasonography
Surg Oncol
(1993)
P Hauters et al.
Treatment of pancreatic pseudocysts by laparoscopic cystogastrostomy
Ann Chir
(2004)
RM Walsh et al.
Combined endoscopic/laparoscopic intragastric resection of gastric stromal tumors
J Gastrointest Surg
(2003)

S Miura et al.

Laparoscopy-assisted distal gastrectomy with systemic lymph node dissection: a critical reappraisal from the viewpoint of lymph node retrieval

J Am Coll Surg

(2004)

NT Nguyen et al.

Minimally invasive Ivor Lewis esophagectomy

Ann Thorac Surg

(2001)

M Lesurtel et al.

Laparoscopic versus open left lateral hepatic lobectomy: a case-control study

J Am Coll Surg

(2003)

N O’Rourke et al.

Laparoscopic right hepatectomy: surgical technique

Gastrointest Surg

(2004)

LM Ellison et al.

Telerounding and patient satisfaction after surgery

J Am Coll Surg

(2004)

A Cuschieri et al.

RW Watson et al.

Exposure of the peritoneal cavity to air regulates early inflammatory responses to surgery in a murine model

Br J Surg

(1995)

OD Rotstein

Peritoneal host defenses: modulation by carbon dioxide insufflation

Surg Infect (Larchmt)

(2001)

A Alishahi et al.

Central and peripheral adverse hemodynamic changes during laparoscopic surgery and their reversal with a novel intermittent sequential pneumatic compression device

Ann Surg

(2001)

A Alijani et al.

Abdominal wall lift versus positive-pressure capnoperitoneum for laparoscopic cholecystectomy

Ann Surg

(2004)

S Maartense et al.

Hand-assisted laparoscopic versus open restorative proctocolectomy with ileal pouch anal anastomosis: a randomized trial

Ann Surg

(2004)

JS Wolf

Selection of patients for hand-assisted laparoscopic surgery

J Endourol

(2004)

M Sundbom et al.

Randomized clinical trial of hand-assisted laparoscopic versus open Roux-en-Ygastric bypass for the treatment of morbid obesity

Br J Surg

(2004)

GB Hanna et al.

Ergonomics of handassisted laparoscopic surgery

Sem Laparoscop Surg

(2001)

A Emmam et al.

How safe is high-power ultrasonic dissection?

Ann Surg

(2003)

AR Aurora et al.

A comprehensive review of anti-reflux procedures completed by computer-assisted tele-surgery

Minerva Chir

(2004)

GH Ballantyne

Robotic surgery, telerobotic surgery, telepresence, and telementoring. Review of early clinical results

Surg Endosc

(2002)

A Cuschieri et al.

EAES multicentre prospective randomized trial comparing two-stage vs single-stage management of patients with gallstone disease and ductal calculi

Surg Endosc

(1999)

B Millat et al.

Laparoscopic treatment for choledocholithiasis: a prospective evaluation in 247 consecutive unselected patients

Hepatogastroenterology

(1997)

E Lezoche et al.

Laparoscopic suture technique after common bile duct exploration

Surg Laparosc Endosc

(1993)

MT Hawn et al.

Quality of life after laparoscopic bilateral adrenalectomy for Cushing's disease

Surgery

(2002)

V Kumar et al.

Does laparoscopic cardiomyotomy require an antireflux procedure?

Endoscopy

(1998)

MA Cuesta et al.

Laparoscopic treatment of large hiatal hernias

Semin Laparosc Surg

(1999)

S Diaz et al.

Laparoscopic paraesophageal hernia repair, a challenging operation: medium-term outcome of 116 patients

J Gastrointest Surg

(2003)

H Buchwald et al.

Bariatric surgery worldwide 2003

Obes Surg

(2004)

M Korenkov et al.

Laparoscopic gastric banding as a universal method for the treatment of patients with morbid obesity

Obes Surg

(2004)

JM Chevallier et al.

Complications after laparoscopic adjustable gastric banding for morbid obesity: experience with 1,000 patients over 7 years

Obes Surg

(2004)

PK Papasavas et al.

Laparoscopic Roux-En-Y gastric bypass is a safe and effective operation for the treatment of morbid obesity in patients older than 55 years

Obes Surg

(2004)

Cited by (69)

Patient-reported outcome, perception and satisfaction after laparoscopic cholecystectomy in Kigali, Rwanda
2023, Surgery Open Science
Laparoscopic surgery is the gold standard for many abdominal surgeries. Laparoscopic programs in low- and middle-income countries (LMICs) and in sub-Saharan Africa face many constraints, although its use is safe, feasible, and clinically beneficial. The authors assessed patient-reported outcomes and the experience of patients operated on at the University Teaching Hospital of Kigali (CHUK).
This is a retrospective cross-sectional study combining medical data from medical files and information collected from telephone calls to 288 patients who underwent laparoscopic cholecystectomy at CHUK from January 2015 to December 2020.
Among 446 laparoscopic surgeries performed at CHUK over 6 years, cholecystectomies accounted for 64.6 % of cases (288/446). Postoperative complications and mortality after laparoscopic cholecystectomy were low, respectively 1.7 % and 0.7 %, while the median length of stay was 3 days. About 74 % of surveyed patients had never heard of laparoscopic surgery prior to their procedure. Knowledge of laparoscopic surgery was associated with patient education level (p < 0.001). Half of patients had not been involved in the choice of the surgical technique. Overall satisfaction was over 95 % and >90 % of patients consider laparoscopic surgery as the best surgical approach in Rwanda, and for this reason they declared to be ready to promote this new technology despite its higher cost. However, patients reported some weaknesses and made recommendations for improving public awareness of laparoscopy and its benefits, patient-provider relationships, training of surgical workforce, laparoscopic equipment, and infrastructure.
Laparoscopic cholecystectomy can be performed with a low rate of postoperative complications in a resource-limited setting like Rwanda. Patient satisfaction was high, but efforts should be made to improve public awareness of laparoscopic surgery, improve surgical capacity, laparoscopic equipment, and infrastructure.
Surgeon perception of factors affecting the efficiency of conventional and robotic laparoscopy: A Pan India study
2022, Heliyon
Citation Excerpt :
This method of surgery has generally led to reduced scarring, faster patient recovery and shorter hospital stays. However, the method has its own challenges too [3]. Surgeons lose the touch and feel of the tissues, thus increasing cognitional difficulty in tissue characterization.
Laparoscopic surgery, being minimally invasive, offers many benefits including faster patient recovery, reduced scarring and lower mortality rate. It is, however, technically challenging and requires a long learning curve. These issues can be overcome by Robot-Assisted Surgery (RAS) systems, which incorporate computer-controlled motions enabling enhanced precision and accuracy.
This study involves identifying and verifying various difficulties related to laparoscopy and the role of RAS in their mitigation. It involved 93 surgeons across India, covering a range of demographics, medical specialties and experience. They were interviewed to understand the current status and to compare RAS with conventional laparoscopy. The questionnaire developed for the purpose tests a set of hypotheses related to instruments, comfort, and other factors derived from the available literature as well as inputs from leading laparoscopy surgeons and domain experts.
A grading system was adopted to evaluate the hypotheses based on the surgeons' responses. A statistical method based on T-test was employed to gain useful inferences from the study. The results showed that early-career surgeons preferred haptic enabled systems. As the experience of the surgeon increases, tissue identification becomes easier, thereby reducing the need for haptic feedback-enabled instruments.
The surgeons from across the demographics were strongly in the favour of the need for articulated instruments with surgeon-controlled camera systems. They reported a reduction in physical and mental discomfort during surgical procedures using RAS. They also confirmed the similarity in patient outcomes for both conventional laparoscopy and RAS. These insights are expected to be interesting and useful for further research and development in this field.
Minimally invasive gastrointestinal surgery: From past to the future
2021, Annals of Medicine and Surgery
The improvement of the science and art of surgery began over 150 years ago. Surgical core tasks, “cutting and sewing” with hand and direct contact with the organs, have remained the same. However, in the 21st century, there has been a shifting paradigm in the methodology of surgery. The joint union between innovators, engineers, industry, and patient demands resulted in minimally invasive surgery (MIS). This method has influenced the techniques in every aspect of abdominal surgery, such as surgeons are not required to direct contact or see the structures on which they operate. Advances in the endoscope, imaging, and improved instrumentations convert the essential open surgery into the endoscopic method. Furthermore, computers and robotics show a promising future to facilitate complex procedures, enhance accuracy in microscale operations, and develop a simulation to improve the ability to face sophisticated approaches. MIS has been replacing open surgery due to improved survival, fewer complications, and rapid recoveries in recent years. Minimally invasive surgery's further research in diagnostic and therapeutic modalities is under investigation to achieve genuinely “noninvasive” surgery. Thus, MIS has gained interest in recent days and has been improving with promising outcomes.
A randomized controlled study to establish the effect of articulating instruments on performance in single-incision laparoscopic surgery
2015, Journal of Surgical Education
Citation Excerpt :
Laparoscopic approaches offer improved cosmesis, reduced postoperative pain, and reduced recovery time when compared with open surgery.1
In single-incision laparoscopic surgery (SILS), operating through 1 incision presents ergonomic challenges. No consensus exists on whether articulating instruments (ARTs) may help. This study evaluated their effect on simulated SILS, hypothesizing that they would affect performance and workload.
Surgeons were randomized to 2 straight instruments (STRs), 1 ART and 1 STR, or 2 ARTs. After baseline testing, 25 repetitions of the Fundamentals of Laparoscopic Surgery (FLS) peg-transfer (PEG) task and 5 repetitions of the short-hand for the FLS pattern-cutting task (CIRCLE) were performed. Primary outcomes were maximum FLS PEG scores, CIRCLE times and errors, and Imperial College Surgical Assessment Device hand motion analysis. National Aeronautics and Space Administration (NASA) Raw Task Load Index (RTLX) questionnaires evaluated a secondary outcome—workload.
The trial took place in a simulated operating theater within the Academic Surgical Unit at St Mary’s Hospital, London, UK.
Eligible surgeons had completed at least 5 laparoscopic cases as a primary operator. Surgeons were stratified by laparoscopic experience into intermediate (less than 25 previous procedures as primary operator) or advanced (25 procedures or more). A total of 21 surgeons were recruited and randomized; 7 of them to each instrument combination group. All surgeons completed PEG, and 5 from each group completed CIRCLE.
Groups’ baseline PEG scores were similar (p = 0.625). STR-ART achieved higher maximum PEG scores than STR or ART did (median = 236 vs 198 vs 193, respectively, p = 0.002). Fastest CIRCLE times were similar (median = 190s vs 130s vs 186s, p = 0.129) as were minimum errors (median = 1 vs 2 vs 3, p = 0.101). For PEG, Imperial College Surgical Assessment Device demonstrated similar total path lengths (median = 12.3 m vs 12.3 m vs 16.0 m, p = 0.545) and total numbers of movements (median = 89.6 vs 86.4 vs 171, p = 0.080). Groups’ NASA Raw Task Load Index scores were similar (p = 0.708).
Combining 1 STR and 1 ART improved SILS performance in the PEG task. Therefore, this may be the optimum instrument configuration for use within some clinical SILS applications.
Validation of a training system for laparoscopic longitudinal suturing in lesion
2024, International Journal of Medical Robotics and Computer Assisted Surgery
Assessment of resource capacity and barriers to effective practice of laparoscopic surgery in training hospitals affiliated with the College of Surgeons of East, Central and Southern Africa (COSECSA)
2023, Surgical Endoscopy

View all citing articles on Scopus

View full text

Laparoscopic surgery: Current status, issues and future developments

Am J Surg

Transplant Proc

J Vasc Surg

Am J Surg

Am J Surg

Lancet

Am J Transplant

Surg Oncol

Ann Chir

J Gastrointest Surg

J Am Coll Surg

Ann Thorac Surg

J Am Coll Surg

Gastrointest Surg

J Am Coll Surg

Exposure of the peritoneal cavity to air regulates early inflammatory responses to surgery in a murine model

Br J Surg

Peritoneal host defenses: modulation by carbon dioxide insufflation

Surg Infect (Larchmt)

Central and peripheral adverse hemodynamic changes during laparoscopic surgery and their reversal with a novel intermittent sequential pneumatic compression device

Ann Surg

Abdominal wall lift versus positive-pressure capnoperitoneum for laparoscopic cholecystectomy

Ann Surg

Hand-assisted laparoscopic versus open restorative proctocolectomy with ileal pouch anal anastomosis: a randomized trial

Ann Surg

Selection of patients for hand-assisted laparoscopic surgery

J Endourol

Randomized clinical trial of hand-assisted laparoscopic versus open Roux-en-Ygastric bypass for the treatment of morbid obesity

Br J Surg

Ergonomics of handassisted laparoscopic surgery

Sem Laparoscop Surg

How safe is high-power ultrasonic dissection?

Ann Surg

A comprehensive review of anti-reflux procedures completed by computer-assisted tele-surgery

Minerva Chir

Robotic surgery, telerobotic surgery, telepresence, and telementoring. Review of early clinical results

Surg Endosc

EAES multicentre prospective randomized trial comparing two-stage vs single-stage management of patients with gallstone disease and ductal calculi

Surg Endosc

Laparoscopic treatment for choledocholithiasis: a prospective evaluation in 247 consecutive unselected patients

Hepatogastroenterology

Laparoscopic suture technique after common bile duct exploration

Surg Laparosc Endosc

Quality of life after laparoscopic bilateral adrenalectomy for Cushing's disease

Surgery

Does laparoscopic cardiomyotomy require an antireflux procedure?

Endoscopy

Laparoscopic treatment of large hiatal hernias

Semin Laparosc Surg

Laparoscopic paraesophageal hernia repair, a challenging operation: medium-term outcome of 116 patients

J Gastrointest Surg

Bariatric surgery worldwide 2003

Obes Surg

Laparoscopic gastric banding as a universal method for the treatment of patients with morbid obesity

Obes Surg

Complications after laparoscopic adjustable gastric banding for morbid obesity: experience with 1,000 patients over 7 years

Obes Surg

Laparoscopic Roux-En-Y gastric bypass is a safe and effective operation for the treatment of morbid obesity in patients older than 55 years

Obes Surg