Extent
of minimal access surgery
Minimal access surgery has crossed all
traditional boundaries of specialities and disciplines. Shared, borrowed and
overlapping technologies and information are encouraging a multidisciplinary
approach which serves the whole patient rather than a specific organ system.
Broadly speaking, minimal access techniques can be categorised as follows.
Laparoscopy
A rigid endoscope is introduced through a
metal sleeve into the peritoneal cavity which has been previously inflated with
carbon dioxide to produce a pneumoperitoneum. There is little doubt that
laparoscopic cholecystectomy has revolutionised the surgical management of
cholelithiasis and has become the mainstay of management of uncomplicated gallstone
disease. With improved instruments and more experience, it is likely that
other advanced procedures, currently regarded as controversial, will also become
fully accepted.
Thoracoscopy
A rigid endoscope is introduced through an
incision in the chest to gain access to the thoracic contents. Many feel that
the benefits of thoracoscopy will prove to be even greater than those of
laparoscopy.
Endoluminal
endoscopy
Flexible or rigid endoscopes are introduced
into hollow organs or systems, such as the urinary tract, upper or lower
gastrointestinal tract, and respiratory and vascular systems.
Perivisceral
endoscopy
Body planes can be accessed even in the
absence of a natural cavity. Examples are mediastinoscopy, retroperitoneoscopy
and retroperitoneal approaches to the kidney, aorta and lumbar sympathetic
chain. Other more recent examples include subfascial ligation of incompetent
perforating veins in varicose vein surgery.
Arthroscopy and
intra-articular joint surgery
Orthopaedic surgeons have long used
arthroscopic access to the knee, and have now moved their attention to other
joints including the shoulder, wrist, elbow and hip.
Combined
approach
The diseased organ is visualised and treated
by an assortment of endoluminal and extraluminal endoscopes and other imaging
devices.