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.