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Evolution of Keyhole Laparoscopic to Pin Hole Laparoscopic Surgery

By Dr. Pradeep Chowbey in Laparoscopic / Minimal Access Surgery

Jan 16 , 2020 | 2 min read

Miniaturization is significant trend that is becoming more pervasive across the globe.Today, we have small, powerful devices such as smart phones, which are even more powerful than the fastest computers available just a few decades back. We have also seen composabilityin the design of armamentarium from the routine STD callerbooths to house telephone operating system to smartphone screens, ruling the world on finger tips. Times have changed and the evolution of technology has taken a giant leap forward towards miniaturization.

The use of laparoscopy has gained widespread popularity in surgical approaches to abdominal wall hernias and intestinal and solid organ resection.   Hernia occurs when contents of body cavity protrude out of the membrane in which they are normally contained through a weak spot in a surrounding muscle or connective tissue. Hernia by themselves may or maynot produce symptoms as they are asymptomatic and can cause slight to severe pain. The symptoms of hernia are feeling of pain while lifting weight, feeling of fullness, Nausea and constipation. The buldge of hernia may be more common while coughing and sneezing. Surgery is the only way to cure hernia and laparoscopic surgery has proven beneficial for fast recovery, less pain and early return to work for patients.

However, no other operation has been as profoundly affected by the advent of laparoscopy as cholecystectomy. Gall stones are common disease, wherein stones are formed within gall bladder whichrequires surgical management. Symptoms of gall stones are severe abdominal pain often called gallstone attack (colic) because they occur suddenly. Symptoms may also be accompanied by pain in the back between shoulder blades, pain under the right shoulder and nausea vomiting. Surgery to remove gallbladder is the only way to cure gall stone. In fact, laparoscopic cholecystectomy has clearly become the procedure of choice for routine gallbladder removal. The advantages of this approach include decreased scarring, decreased incisional pain, shorter hospitalization, and faster functional recovery.

The quest to minimize pain and scarring from surgical access has led to the development of micro-laparoscopy as an alternative to routine laparoscopic procedure.   The aim is to minimize the invasiveness of this procedure by reducing the number and, more commonly, the size of the operating ports (puncture holes)and instruments. “Microsurgical” laparoscopic instruments, traditionally 3 mm or less in size, have been suggested as an alternative since incisions heal with an almost imperceptible scar.   The technology is not only restricted to the modern equipments but to also the experienced anesthetists team which ensures ultra-shortacting anesthesia for early return to work. This cocktail of anesthesia facilitates the drive back policy, where patient post surgery can immediately drive back home

Nevertheless, modern world of miniaturization has generated a revolution worldwide.Micro-laparoscopic cholecystectomy is safe, feasible, and represents an alternative to other minimally invasive techniques. Future developments in surgical technology will allow the use of even smaller instruments, diminishing the surgical "footprint" even further and contributing to better cosmesis and decreased postoperative pain in our patients