Micro and Mini Laparoscopy
While laparoscopy (key-hole surgery) has been an
enormous advance from open laparotomy (big incisions) recent development in microfibres
and lenses have seen the creation of even tinier laparoscopes measuring two to four
millimeters which are known as micro and mini laparoscopes, respectively. At the same
time, small ball laparoscopic instruments have been produced (KOH Ultramicro instruments)
and others so that the total laparoscopic procedure can be performed with incisions of two
to four millimeters. Conventional laparoscopy uses a 10 mm umbilical incision for the
laparoscope and 5 mm to 10 mm incisions elsewhere. Because of the small diameter of the
micro and mini laparoscopes, under suitable circumstances surgeries may be performed
without general anesthesia.
At the Reproductive Center the micro and mini
laparoscope are used for the following situations.
- Diagnostic laparoscopy both awake and under anesthesia.
- Early 2nd look laparoscopy with lyses of adhesions. This procedure is performed 2 to 4 weeks after advanced laparoscopic surgery in order to push down newly formed adhesions. The procedure typically takes 15 to 30 minutes, and patients may be conscious if desired.
- In laparoscopy of patients who have had multiple abdominal operations.
- Conscious pain mapping. This is done in the awake but slightly sedated patient and areas in the pelvis are touched so that the patient is able to recount where the pain exactly is. This area is then treated using the laser.
As is often the case with new technology, there is a
tendency to overhype the benefits of micro and mini laparoscopy because of its newness.
There is a real possibility of performing incomplete diagnosis or incomplete surgery with
the indiscriminate application of microlaparoscopy in the awake patient. At the
Reproductive Center, we use this technology where it is best suited and as to the more
gimmicky, sensational applications which are better served with the more conventional
laparoscope which allows better visualization.
The Center recently pioneered the world’s first total laparoscopic hysterectomy with mini laparoscopic
instrumentation of 4 and 3 mm. Also, the world’s first laparoscopic microsurgical
anastomosis using 4-mm laparoscope and 3 mm microinstruments was performed in 1996 with
the achievement of a live baby nine months later.