One of the main advantages of the minimally invasive approach is the low incidence of wound infection, specially after the treatment of the most common surgical abdominal emergency, acute appendicitis. With this technique a better protection of the wounds is achieved. The wounds are very small and instruments are not in direct contact with them. Besides, the appendix is placed in a plastic bag that avoids pollution to other sites, even if the appendix is perforated or purulent. Recovery time is highly superior compared to the classic approach (open technique).
This surgical intervention is the main responsible to spread and support the success of laparoscopy. Laparoscopic cholecystectomy has become the “gold standard” in the treatment of gallstones. Really it has no substitute. Its advantages are: less pain, quicker recovery and lower incidence of complications. Most of the patients stay in the hospital from 24 – 36 hours.
Another procedure that has replaced almost completely the conventional approach. Gastroesophageal reflux disease (heartburn) is a common clinical entity whose management several years ago was exclusively medical. Currently, it is approved that in an important percentage of the affected patients, surgical treatment (laparoscopic) offers better results, avoiding long-term and expensive medical treatments. In practical terms, the used technique is called fundoplication, which consists in “wrapping” the esophagus with the upper portion of the stomach. In some cases when there is a hiatal hernia, it has to be repaired simultaneously.
Hernias are a very common medical problem. It is estimated that around 5% of the world population will develop an abdominal wall hernia during their lives, but the prevalence could be higher. Approximately 75% of the hernias occur in the inguinal (groin) area. Men have a 25 times greater risk than women to develop an inguinal hernia. Laparoscopic surgery has become since several years ago a widely accepted alternative to repair inguinal and abdominal wall hernias, with a verified safety and high efficiency. It uses 3 small wounds from 5-10 mm through them the camera and instruments are handled. In this way the hernia is repaired and besides, a mesh is introduced to reinforce the prior defect.
Laparoscopic surgery represents a well recognized technique in the management of benign diseases of the colon, specially diverticuli (sacklike protrusion in the colonic wall that develops as a result of herniation of the mucosa and submucosa trough points of weakness in the muscular wall). Colonic diverticular disease is a very common entity and most of the cases in asymptomatic. Laparoscopic colon resection allows a quicker recovery, an earlier start to resume diet and a sooner reestablishment of the colonic motility.
Splenectomy (spleen removal) is a useful therapeutic resource in the management of hematological diseases, where the spleen acts like an organ of destruction of blood cells (red blood cells and platelets). Since its development in 1991, laparoscopic splenectomy has replaced almost completely the conventional approach. Moreover, its safety and efficiency have been demonstrated throughout the world.
Single Port Surgical procedures a (single port) belong to the group of interventions called “surgery without scars and without traces” because all the instruments used are introduced by a single small wound that virtually leaves no trace or evidence of it. Cholecystectomy and appendectomy are the main techniques performed by the laparoscopic alternative.
The minilaparoscopy as deduced from its name, is to reduce as much as possible the size of the incision required to perform the surgery. That is, the current trend could be called classic. If the evolution of large wounds was to adjust the incision which was merely necessary, we have now traveled the same path in laparoscopy surgery.
The 12 mm incisions we can reduce to 5 mm and the 5 mm incisions are becoming incisions of 2 and 3 mm. All this path increasingly less invasive has been possible thanks to the skill previously acquired by the surgical community in laparoscopic management and technological development of surgical instruaments. Today all laparoscopic procedures can benefit from developments “mini” cholecystectomy cholecystectomy (gallbladder), appendectomy (appendix), colectomy (colon), obesity surgery (gastric band and sleeve), Nissen (anti-reflux ) and many others. The benefits of “mini” surgery are the same as occurred with conventional laparoscopy, such as faster recovery, less trauma to the tissues, less complications of abdominal wall and in this case is to emphasize the aesthetic improvement that we can make interventions wounds almost imperceptible.