171014_SU_ BMW X4 (3).jpg

Laparoscopic surgery – the future

By Dr. Paulo Vieira de Sousa [email protected]

Dr. Paulo Vieira de Sousa is a general surgeon and clinical director at the Hospital Particular do Algarve in Faro, specialising in local and keyhole surgery. He was a former assistant surgeon at the Hospital Egas Moniz in Lisbon and assistant of the surgery department at the Medical University of Lisbon.

The ability to perform surgery with less pain and faster recovery has been, for a long time, the goal of the vast majority of surgeons throughout the history of medicine.

That goal was accomplished in the last 20 years with the introduction of new philosophies in the surgical management of patients, which started in the 80s with the progressive introduction of video surgery, first as a diagnosis procedure, then as a treatment option.

The latest options of robotic surgery and single port incisions that have been developed over the last decade have drastically reduced the recovery period.

Laparoscopy is the branch of video surgery that allows for operative techniques through small incisions (10mm and 5mm) in the abdominal region.

This option allows the surgeon to perform the procedure with less pain and a faster recovery in the majority of cases, with less risk of damaging organs close by the operating area, due to the magnification of four to eight times of the video camera.

In an abdominal surgery, insufflations of the abdomen with CO2, the gas which is daily inspirited with oxigen, is necessary in order to create a working space. A video camera is then inserted in the patient’s abdomen allowing the surgeon a general inspection of the visible intra-abdominal organs.

After inspection, a three to five millimetre incision is done in order to insert the other instruments that are needed to complete the procedure.

As an example, a gallbladder surgery, which 10 years ago needed a 15-20cm incision, one hour of surgery and five days hospital admission can now be performed with three or four incisions and a one day hospital admission.

The patient can then go back to his normal activities within a week of surgery. Ten years ago, it would take one month to achieve the same result.

Less pain is involved and the patient will feel fitter sooner to work, practice sport or other daily activities. A better cosmetic appearance than a common open abdomen surgery is also achieved.

Laparoscopic surgery can be used, by trained surgeons, to perform almost all intra-abdominal surgeries, but the most common are: gallbladder surgery, appendectomies, hiatus hernia, incisional and inguinal hernias, colon surgery, spleen and suprarenal procedures, obesity procedures, gynaecological surgery for ovarian, tubal and uterus procedures, urological for prostate, kidney and bladder resections.

Thoracic surgery can also be performed through the same small incisions and video camera, for the treatment of emphysema, lung tumours, nodes and several diagnostic treatments both in planned or emergency situations.

Video surgery can be combined with laser techniques, which will mean the reduction of bleeding and pain through a vast option of surgeries and techniques.

For instance, in prostate surgery, the use of the Green Light Laser allows the vaporisation of prostate cells without the need to resection, and to remove kidney stones, they can be fragmented and subsequently removed, with combination of a holmium laser and video surgery.

This technique is performed as a day procedure, with almost no pain for the patient.

The future of surgery will be looking for safety, less aggression and a faster recovery period.  

These  goals can and will be achieved by performing only one incision, making smaller incisions to perform the same procedures by using smaller instruments, and the latest achievement in surgical practice, the use of robotic surgery to help surgeons perform the most delicate types of operations.

The Hospital Particular do Algarve has an experienced team of surgeons in laparoscopic and video surgery, who keep up-to-date with new procedures whose object is achieving the best results for all who seek it.

Click here to follow the Algarve Resident on facebook