Here's to Better Laparoscopic Views
A review of the milestones that have helped advance the quality of the images laparoscopic surgeons work with.
Gerald Fried, MD
Most elective surgery today is carried out using laparoscopic techniques. Nobody can question the benefits of minimally invasive surgery for the patient. There's less pain, nearly invisible scars, improved surgical precision and a markedly accelerated recovery. But what about the surgeon? For all of laparoscopy's benefits, aptly named keyhole surgery poses some very real and often overlooked visualization challenges to the surgeon. Yes, working through puncture-size incisions limits what we can see and feel.
We've done a great job of minimizing the cost of surgical access for the patient, but at some expense. We're left flying somewhat blind, performing surgery without being able to directly see beyond the surface of internal organs and feeling tissues with the tips of long instruments that we've placed through ports in the abdominal wall. We must rely instead on a flat image projected on a monitor generated by the tip of our scope.
Depth perception can be a problem during MIS. We're limited to visualizing internal structures through a 2-dimensional optical system that diminishes depth perception. We must acquire new cues to know where we are in 3-dimensional space. Decreased tactile sensation is another challenge. We're using long instruments interposed between the surgeon's hands and the target to access the organs or tissues being operated on. We also have to contend with limited range of motion that results from passing instruments through trocars and the "Fulcrum Effect." To make the laparoscope tip go in one direction, the surgeon's hands must move the handle of the instrument in the mirror-image direction. Last but not least, nothing can impair the view like a lens coated with blood or mucus.
Technology to the rescue
Thanks to great advances in technology, laparoscopic surgeons can now overcome most of these obstacles. Here are 6 milestones that have helped advance the quality of the image that we work with.
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