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History of minimal access surgery The first experimental laparoscopic procedure was performed by Kelling in 1901. Jacobaeus performed the first thoracoscopy in 1910, again using a cystoscope; however, it took another 70 years before Steptoe in the UK developed l...

History of robotic surgery The first documented clinical robotic procedure was a computed tomography (CT)-guided brain biopsy performed in 1985 utilising the PUMA (Programmable Universal Machine for Assembly) 560 system. This was followed by the ROBODOC, a pre-...

Hybrid minimal access surgery Hybrid surgery may utilise a combination of flexible and straight stick endoscopic approaches or a combination of open and endoscopic surgery . Totally endoscopic hybrid approach The diseased organ is visualised and treated by an...

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LIMITATIONS OF MINIMAL ACCESS SURGERY Minimal access surgery has limitations. A number of these have been addressed with advances in instrumentation and endoscopic systems; however, the basic principles remain. Surgical robots further address a number of the...

Learning objectives To understand: The principles of minimal access surgery • The advantages and disadvantages of minimal access • approaches The safety issues and indications for minimal access • surgery Learning objectives To understand: The principles of mi...

MINIMAL ACCESS APPROACHES Laparoscopy A rigid endoscope is introduced through a port into the perito neal cavity . Full details of laparoscopy including the principles of pneumoperitoneum can be found in Chapter 7 . Georg Kelling , 1866–1945, surgeon, Dresde...

Mobility and convalescence Patients can get out of bed to go to the toilet as soon as they have recovered from the anaesthetic and they should be encouraged to do so. Such movements are remarkably pain free when compared with the mobility achieved after an op...

Operative problems Intraoperative perforation of a viscus or vascular injury Perforation of any viscus, such as bowel, is a potential hazard that may occur inadvertently and go unrecognised or be of a severity that may require emergency conversion. The added...

Oral feeding Provided that the patient has an appetite, a light meal can be taken 4–6 hours after the operation. Some patients remain slightly nauseated at this stage, but almost all eat a normal breakfast on the morning after surgery . Subsequently a balanced...

Oral fluids There is no significant ileus after minimal access surgery , except in abdominal resectional procedures, such as colectomy or small bowel resection. Patients may resume oral fluids as soon as they are conscious; they usually do so 4–6 hours after the ...

Orogastric or nasogastric tube An orogastric or nasogastric tube may be placed for some abdominal surgery if the stomach is distended and obscuring the view . It is not necessary in all cases and is very rarely used in other minimal access surgery . Where pos...

PERIOPERATIVE PLANNING FOR MINIMAL ACCESS SURGERY PERIOPERATIVE PLANNING FOR MINIMAL ACCESS SURGERY PERIOPERATIVE PLANNING FOR MINIMAL ACCESS SURGERY

POSTOPERATIVE CARE The postoperative care of patients after minimal access surgery - is generally straightforward, with a low incidence of pain or other problems when compared with their open counterparts. It is a good general rule that if the patient deve...

Perivisceral endoscopy Body planes can be accessed even in the absence of a natural cavity . Examples are mediastinoscopy , retroperitoneoscopy and retroperitoneal approaches to the kidney , aorta and lumbar sympathetic chain. Some of these approaches have b...

Port site pain and numbness Pain in one or other of the port site wounds is not uncommon and is worse if there is haematoma formation. It usually settles very rapidly . In the case of thoracoscopy , intercostal nerve pain may be more common in those with sm...

Preparation of the patient Although the patient may be in hospital for a shorter period, - careful preoperative management is essential to minimise morbidity . Recognition of patient- or procedure-related factors that may in turn complicate a minimal access a...

Principles of electrosurgery during laparoscopic surgery Inadvertent electrosurgical injuries during minimal access surgery are potentially serious and are often unrecognised at the time. The vast majority occur following the use of monopolar diathermy . For ...