MINIMALLY INVASIVE SURGERY: CURRENT PERSPECTIVE AND APPLICATIONS IN ONCOSURGERY

Dr. Hafeez Rahman, Dr. R. Padmakumar, Dr. H. Sanjay Bhat, Sunrise Hospital, Kochi

Minimally Invasive Surgery (MIS) has established itself as the standard of care in abdominal and pelvic surgery. We are in a phase of transition where MIS and robotic surgery will guide the surgeon into the next decade. The initial steep learning curve is the only stumbling block in the realm of the laparoscopic surgeon. Duplication of the principles of open surgery and avoiding too many short cuts will produce the same results as compared to open surgery.

Laparoscopy first established itself in gynaecologic pelvic surgery and has redefined the gold standards in Hysterectomy. Female pelvic surgery for Endometriosis, Infertility and Gynaecologic oncology are the most popular procedures. The modern gadgets like the bipolar electrocautery, Harmonic scalpel and Ligasure has made MIS even more user friendly and easy to master. A systematic way of laparoscopy from the initial point of access to final skin closure has been popularised by the speaker and is well accepted. This way of proceeding has made gynaecologic surgery free from major complications and has better acceptance among patients. The relative pain free perioperative period, easy convalescence and good cosmetic results has reduced the more mutilating open surgical procedures in gynaecology. The speaker stressed the high degree of awareness among doctors and patients which has made MIS a big success in this part of the world. MIS is widely accepted for Cholecystectomy in gastrointestinal surgery and is now considered the best approach to this procedure. Besides this, MIS is useful in upper gastrointestinal surgeries like closure of perforations, gastrectomy and bye pass procedures. The postoperative recovery is remarkable with early ambulation and  

enteral feeding which contributes to better healing. Surgeries like colonic resections and anastomosis for adenocarcinoma is oncologically safe in expert hands. The early recovery from the surgery makes the patient fit for initiation of adjuvant therapies at two weeks after surgery.MIS is now useful in bariatric surgery as the obese patients tolerates it better and acceptance rates are also high. The other major MIS is in thoracic diseases where pleural biopsy, decortications and lymph node biopsies are now routinely performed. Laparoscopy made its entry into urology late and has now led to development of MIS as a subspecialty in Urology. Simple nephrectomies, radical procedures like nephrectomy, prostatectomy, and cystectomy are now performed laparoscopically. Advanced laparoscopic reconstructive procedures like pyeloplasty, ureteral reimplantations, and bladder surgeries are performed routinely at major centers with equally good results. Laparoscopy has been found to be safe and well tolerated in Paediatric urologic procedures. Open adrenalectomy now sounds absurd and laparoscopy is the standard for all adrenalectomies. Varicocele ligations are routinely performed laparoscopically with similar results as in microscopic varicocelectomy. The indications for laparoscopy and MIS widen as surgeons gain expertise in the procedure. At the same time, it is prudent for the surgeon to realise what should not be done by MIS. The acceptability factor has improved particularly in organ donation and bariatric surgery with the onset of MIS. Lack of awareness among clinicians and lay men can be tackled with periodic seminars and awareness campaigns for patients.