Minimally invasive surgery: clinics and centers

Medical technology does not stand still; their development significantly expands the possibilities - both diagnostic and at the treatment stage.

In particular, due to the active development of endoscopic techniques, minimally invasive surgery has become quite widespread. Consider what it is in this article.

Why minimally invasive surgery

All the subtleties of this technique are aimed at minimizing the traumatic effects on the patient's body, which are inevitable during any surgical intervention.

Examples of techniques include endoscopy and laparoscopic surgery.

The combination of laparoscopy with alternative methods of access to internal organs can also be attributed to minimally invasive surgery.

The popularity of the method is easily explained.

This technique meets both the interests of patients (the consequences of these operations are minimal) and socio-economic interests (due to the use of minimally invasive surgery, it becomes possible to significantly reduce the patient’s stay in the hospital).

Laparoscopy is widely used in pediatric abdominal surgery: in children, most operations on the abdominal organs are performed using laparotomy. Laparoscopic surgery is possible in children of almost any age. Moreover, for working with small patients of different ages, sets of instruments for laparoscopy are provided that have different diameters.

In pregnant women, the possibility of laparoscopic surgery is very limited.

Benefits

• Damage to the patient’s body during surgery, performed in accordance with minimally invasive methods of surgery, is significantly lower than with conventional surgical access.
• In a long bed rest after minimally invasive surgery is not necessary. Such manipulations can be carried out in special clinics of minimally invasive surgery (the so-called one-day clinics).
• Low-trauma surgery is well tolerated by patients.
• The level of trauma to body tissues during such manipulations is significantly lower due to a reduction in the time of intervention; and a low level of traumatism can increase the therapeutic and cosmetic effects.

Examples from the story: how it all began

The very first laparocopic operation was performed in France in the 80s of the 20th century. A few years later, this method was already introduced into mass use.

After the beginning of systematic use, this technique was rapidly developed and in a fairly short time became very popular.

Cons of less traumatic interventions

• Surgical interventions performed using endoscopic techniques do not allow tissue palpation.
• The need to install high-tech equipment in a medical institution or to create special centers for minimally invasive surgery; the high cost of such equipment.
• The need for medical personnel to gain skills in working with high-tech equipment.

Laparoscopy

This type of minimally invasive surgery can be used in the following situations:

• Female infertility.
• Endometriosis treatment.
• Ovarian cysts.
• Uterine fibroids.
• Ectopic pregnancy.
• Gallbladder removal.
• Removal of small size neoplasms of internal organs.
• Removal of lymph nodes.
• Treatment of some vascular pathologies.

Surgical intervention begins with the fact that three or four punctures are made in the anterior abdominal wall. Subsequently, carbon dioxide is introduced into the body through them, which is necessary to increase the volume of the cavity and the formation of sufficient space for the operation. Then, through one of the punctures, a camera is introduced, which displays on the monitor the surgical field, internal organs and tools introduced to perform manipulations through the remaining punctures.

Mini-laparotomy (mini-access)

In fact, in this case, a conventional surgical operation is performed, but through a much smaller incision, which is made possible by the use of a special set of tools. In this way, many surgical interventions on the abdominal organs can be performed.

Endoscopy

This technique is used to examine internal organs with a hollow structure, and is carried out using special tools - endoscopes.

Endoscopic minimally invasive surgery, unlike laparoscopy, does not use punctures or incisions; medical instruments are inserted into the hollow organs through natural openings. Accordingly, and recovery after such manipulation is much easier.

Thus, in the clinics of endoscopic and minimally invasive surgery and endoscopic departments of hospital complexes, the following organs are examined:

• esophagus;
• stomach;
• intestines;
• larynx;
• trachea;
• bronchi;
• bladder.

In addition to examination, endoscopy also provides opportunities for medical procedures, for example, stopping gastric bleeding, removing small tumors of the stomach and intestines. Such manipulations are performed both in ordinary medical institutions and in specialized clinics (for example, the clinic of coloproctology and minimally invasive surgery).

Rehabilitation period

Due to the low level of trauma to tissues and organs during operations performed in accordance with the principles of minimally invasive surgery, the rehabilitation period after such interventions has a minimum duration and is well tolerated by patients.

The appointment of a long bed rest using less traumatic methods of surgery is not necessary.

Pain syndrome in small operations is much less pronounced, this fact makes it possible to avoid the use of drugs belonging to the group of analgesics, and therefore their side effects.

When minimally invasive surgery is not suitable

Despite all the advantages, minimally invasive methods of surgery may not be applicable in all cases. It is not possible to transfer some surgical interventions to the category of low-traumatic.

1. The presence of adhesions in the abdominal cavity. This circumstance is an obstacle to some part of such operations. A particularly serious problem is cases where the patient has a history of several surgical interventions leading to the formation of adhesions. However, in some cases, when the patient is denied laparoscopic surgery on the abdominal organs due to the presence of adhesions, surgery can be performed from the so-called mini-access. A unique algorithm does not exist; the decision is made in each case individually.
2. Diseases of the cardiovascular system and lungs in the stage of decompensation. This is due to the fact that laparoscopy requires the introduction of carbon dioxide into the abdominal cavity; and this, in turn, will lead to an increase in intra-abdominal pressure and the creation of additional pressure on the diaphragm and, as a result, on the organs of the chest cavity. In patients with cardiopulmonary insufficiency, this effect leads to a worsening of the condition.
3. Dramatically increased patient weight. Obesity of the third and fourth degree may also be a contraindication for laparoscopic surgery due to the fact that for access to internal organs in these cases the length of the instruments may not be enough. In addition, due to the high mass of the anterior abdominal wall in such patients, in some cases it is not possible to create pneumoperitoneum.
4. Ophthalmic hypertension, in particular with glaucoma. Pneumoperitoneum can provoke an increase in intraocular pressure, worsening of the course of this serious illness and the development of complications (for example, detachment of the retina).
5. A high degree of myopia is above six diopters (for the same reasons - to avoid retinal detachment). However, in some cases, exceptions are possible, for example, with short-term exposure or low-gas laparoscopy, when the intra-abdominal pressure rises slightly.
6. Diseases of the blood system, characterized by a violation of its ability to coagulate. Such conditions are fraught with increased bleeding, which is unacceptable.

In old age, a whole complex of circumstances that are contraindications to laparoscopic surgery is often recorded. In such cases, patients undergo surgery using the mini-access technique, which has practically no general contraindications.