The fact that laparoscopic surgery is learned and preferred by patients with reduced incision size, reduced post-operative pain, shortened hospital stay and rapid recovery, technological progress and the medical industry’s emphasis on this issue have led surgeons to search for new laparoscopic surgery and question classical surgical methods. . The triangle formed by the patient, surgeon and technological developments has formed the basis for the laparoscopic method of many operations performed with the classical method in these past 20 years. Today, while the laparoscopic surgical method is the gold standard for gallbladder and reflux surgery, it is being applied with increasing frequency in appendicitis, adrenal gland, spleen, hernia, large intestine surgery, obesity surgeries.
In order to use laparoscopic instruments, trocar diameters of 10 mm and 5 mm were initially preferred, but today these diameters have decreased to 5 mm and then to 1.7 mm. Despite all these developments, many surgeons still prefer to work with 5 and 10 mm trocars. In this, very high quality images can be taken with 10 mm telescopes. As in every field of medicine, laparoscopic devices are experiencing dizzying changes with each passing day. Today, endoscopic or minimally invasive surgery is increasingly used in General Surgery, Gynecology, Thoracic Surgery, Urology, Pediatric Surgery and other surgical branches. Different trocar entry sites can be used in gallbladder and appendicitis surgeries, which are among the most frequently applied laparoscopic procedures. As a result of the development of laparoscopic surgery, robotic surgery applications are increasingly entering the practice of General Surgery.
Liver, gallbladder and biliary tract diseases
Laparoscopic gallbladder surgery has been the first preferred surgical technique for gallbladder removal. Here, as some patients ask, the entire gallbladder organ is removed, not the stone in the gallbladder. In many large case series analyzes, significant advantages of the laparoscopic surgical method over the open method have been demonstrated. The most important disadvantage of this method is that the injury of the biliary tract is 2-3 times more common than open gallbladder surgeries. Thanks to the increase in experience and technological developments in this field, this complication rate has been reduced to 0.1-0.2% in the last series. It is safely applied today in some clinical conditions such as acute gallbladder inflammation, which was considered an absolute contraindication for laparoscopic gallbladder surgery in the first years. General anesthesia is required for laparoscopic surgery.
Laparoscopic surgery is safely performed in parasitic and nonparasitic cysts of the liver. I think that the fact that the first pioneers of the laparoscopic surgical treatment of liver hydatid cyst in the world are in our country is the best indicator that this new surgical method is rapidly adopted and applied by the surgeons of our country.
Although appendicitis is the most common general surgical operation, laparoscopic appendicitis surgery is not used as widely as laparoscopic gallbladder surgery. Especially in female patients, laparoscopy provides a great advantage in terms of distinguishing some problems related to the reproductive organs.
Laparoscopic surgical approach to inguinal hernia
Laparoscopic inguinal hernia surgery began by plugging a polypropylene patch into the hernia sac described by Schultz et al. in 1990. However, due to the high recurrence rate in this method, they applied a patch on the plug by making modifications. Today, two laparoscopic hernia repair techniques are used in hernia surgery. The first of these is the ‘transabdominal (intra-abdominal) preperitoneal’ (TAPP) approach, and the other is the ‘total extraperitoneal’ (TEP – extra-abdominal) approach developed with the use of balloon trocars. In this last application, it is more preferred because it does not enter the peritoneum and is closer to open surgery principles. We also apply this method at Biga Can Hospital. Both methods require the surgical team to have knowledge of inguinal anatomy and to gain experience. The technique is performed under general anesthesia.