Laparoscopic surgery provides several advantages over traditional open surgery such as less pain, shorter hospital stays, faster recovery times, and smaller incisions resulting in less scarring. Key aspects of laparoscopic surgery include creating pneumoperitoneum using CO2 gas insufflation to provide working space, performing surgery using long instruments inserted through small incisions, and relying on camera systems to provide indirect visualization. Common basic laparoscopic procedures include cholecystectomy and appendicectomy, while more advanced procedures involve organs in the abdomen, pelvis, chest and for hernia repairs. Risks include potential complications from the pneumoperitoneum such as gas embolism, organ injury, bleeding, infection and hernia formation.

1. Concept of Laparoscopic Surgery

2. Learning objectives
• Terminologies
• Laparoscopy
– Various methods
– Advantages
– Limitations
– Pre-requisite- workup, setup & tools
– General principles

3. Terminologies
• Minimal Access Surgery(MAS)
– surgical innovation that aims to accomplish
surgical therapeutic goals with minimal somatic
and psychological trauma.
– reduced wound access trauma, as well
– less disfiguring than conventional techniques
• Minimal Invasive Surgery(MIS)

4. Laparoscopy: History
• First laparoscopic cholecystectomy –
– done by Muhe of Germany in 1985 & by Mouret
in Lyon in 1987
– in USA in 1988, by McKeran and Saye
– In India, by Professor TE Udwadia
• First laparoscopic appendicectomy –
– done by Semm as prophylaxis
– by Schreiber in 1987 for acute appendicitis

5. Laparoscopy: Advantages
• Relatively less painful
– Trauma of access is very less
• Shorter hospital stay and early return to work
• Faster postoperative recovery
• Better visualization of the anatomy,
– better approach for dissection and visualization of
other parts of abdomen for any other pathology
• Instrumental access to different locations is
many times better
• Minimal scar

6. Laparoscopy: Limitations
• Relative contraindications:
– Compromised cardiac status
– Peritonitis
– Previous abdominal surgeries.
– Bleeding disorders.
– Morbid obesity.
– Third trimester pregnancy.
– Portal hypertension.

7. Laparoscopy: Limitations..
• Limitations of MIS:
– Reliance on remote vision and operating
– Loss of tactile feedback
– Dependence on hand–eye coordination
– Difficulty with haemostasis
– Reliance on new techniques
– Extraction of large specimens

8. Laparoscopy: Prerequisites
• Overall fitness: cardiac arrhythmia, emphysema,
medications, allergies
• Previous surgery: scars, adhesions
• Body habitus: obesity, skeletal deformity
• Normal coagulation
• Thromboprophylaxis
• Informed consent
• Instruments used

9. Laparoscopy: Prerequisites..
• Instruments used:
– Laparoscope
– Camera
– Cold light source
– Video monitor
– C02 insufflator
– Surgical instruments:
• Long fine dissectors
• Hooks & spatulas
• Clip applicators
• Needle holders
• Endostaplers
• Veress needle
• Suction-irrigation
apparatus
• Trocars
• Reducers

13. Laparoscopy: Prerequisites..
• Preparation:
– General anesthesia
– Prevention of inadvertent injuries
– Pressure bandages/ cuffs
– Position of patient
• Strapping
• According to surgery
• Reverse trendelenberg position

14. Laparoscopy: Technique
• Access:
– Open vs. closed method
• Creation of pneumoperitonium
• Visualisation
• Additional ports
– Triangulation
– Ergonomics
• Sometimes additional incision required

15. Laparoscopy: Physiologic changes
• CO2 causes
– hypercarbia, acidosis and hypoxia.
• Pneumoperitoneum
– decreases the venous return
– increases the arterial pressure
• It compromises the respiratory function
– by compressing over the diaphragm

16. Laparoscopy: Complications
• CO2 narcosis and hypoxia
• Sepsis-subphrenic abscess, pelvic abscess,
septicaemia.
• IVC compression.
• Bleeding.
• Leak from the site, e.g. bile leak.
• Organ injury during insertion of ports.
• Subcutaneous emphysema and
pneumomediastinum.

17. Laparoscopy: Complications..
• Gas emboli, though is rare but fatal.
• Postoperative shoulder pain due to irritation of
diaphragm.
• Cardiac dysfunction due to decreased venous
return.
• Injury to the abdominal wall vessels and nerves.
• Cautery burn to abdominal structures.
• Abdominal wall hernias.
• Wound infection.
• Mortality-0.5%.

18. Laparoscopy: General principles
• Core principles of MAS summarized by acronym I
VITROS
– Insufflate/create space
– Visualise – the tissues, anatomical landmarks and the
– environment for the surgery to take place
– Identify
– Triangulate – surgical tools (such as port placement) to
optimise the efficiency of their action, and ergonomics by
minimising overlap and clashing of instruments
– Retract – and manipulate local tissues to improve access
and gain entry into the correct tissue planes
– Operate – incise, suture, anastomose, fuse
– Seal/haemostasis.

19. Laparoscopy: Procedures
• Basic surgeries:
– Laparoscopic cholecystectomy.
– Laparoscopic appendicectomy.
• Advanced surgeries:
– Hernia repairs, splenectomy, fundoplication,
vagotomy & GJ, Colectomy: APR, LAR,
hysterectomy, urologic procedures,
thoracic/thyroid/paediatric surgeries etc.

21. Thank you