Surgical trauma
in open and laparoscopic surgery
Most of the trauma of an open procedure is
inflicted because the surgeon must have a wound large enough to give adequate
exposure for safe dissection at the target site. The wound is often the cause of
morbidity including infection, dehiscence, bleeding, herniation and nerve
entrapment.
The pain of the wound prolongs recovery time, and by reducing mobility
contributes to an increased incidence of pulmonary collapse, chest infection and
deep venous thrombosis.
Mechanical
and human retractors cause additional trauma. Body wall retractors tend to
inflict localised damage which may be as painful as the wound itself. By
contrast, during laparoscopy, the retraction is provided by the low-pressure
pneumoperitoneum giving a diffuse force applied gently and evenly over the whole
body wall, causing minimal trauma.
Exposure
of any body cavity to the atmosphere also causes morbidity through cooling and
fluid loss by evaporation. There is also evidence from the literature to suggest
that the incidence of postsurgical adhesions has been reduced by the use of the
laparoscope because there is less damage to delicate serosal coverings. In
handling intestinal loops the surgeon and assistant disturb the peristaltic
activity of the gut and provoke adynamic ileus.
In
minimal access surgery the trauma of access and exposure is reduced while
visualisation is magnified and improved.