Laparoscopy

Laparoscopy is a surgical technique used to examine or operate within the human abdomen or pelvic cavity through very small incisions—typically between 0.5 and 1.5 centimetres—assisted by a camera-equipped instrument called a laparoscope. As a form of minimally invasive surgery, it has largely replaced many traditional open procedures due to its reduced postoperative pain, shorter recovery times, diminished haemorrhaging and lower risk of infection. Laparoscopic methods are applied across a wide range of medical disciplines, including general surgery, gynaecology, gastrointestinal procedures and urology, and continue to evolve as a key component of modern operative practice.

Development and Principle of the Technique

The first laparoscopic procedure was carried out in 1901 by the German surgeon Georg Kelling, marking the beginning of an operative method that would advance significantly with the advent of fibre optics, digital imaging and specialised instruments. Laparoscopic surgery employs a combination of long, rigid endoscopes, surgical tools and a high-intensity light source introduced through trocars placed in the abdominal wall. The abdominal cavity is most often insufflated with carbon dioxide gas, which creates a working space by elevating the abdominal wall away from the organs. Carbon dioxide is favoured because it is non-flammable, easily absorbed by bodily tissues and rapidly exhaled through respiration.
Minimally invasive techniques rely on enhanced visualisation and carefully coordinated instrument handling. Surgeons operate while viewing a monitor, a process that requires precise hand–eye coordination and an adaptation to limited tactile feedback.

Types of Laparoscopes and Equipment

Two principal forms of laparoscope are used in clinical practice:

• Rod-lens laparoscopes, which utilise a telescopic optical system connected to a video camera. These instruments remain the most common in surgical settings due to their high optical resolution and robust, rigid design.
• Digital laparoscopes, which place a miniature camera directly at the tip of the device. While they improve certain features of flexible endoscopy, they are comparatively rare in routine laparoscopy due to limitations in image quality relative to rod-lens systems.

Illumination is provided by a cold light source, typically halogen or xenon, transmitted via fibre optic cables. A range of surgical tools—such as forceps, scissors, dissectors, hooks and retractors—are inserted alongside the laparoscope through additional trocars.

Patient Position and Physiological Considerations

Patient positioning is fundamental to successful laparoscopic procedures. Two principal orientations are used:

• Trendelenburg position, where the patient is tilted with the head lower than the feet. This increases venous return and can shift abdominal organs upward, improving access to the pelvic cavity but potentially reducing respiratory efficiency due to increased diaphragmatic pressure.
• Reverse Trendelenburg position, where the head is elevated. This improves ventilation by reducing diaphragmatic compression but decreases venous return, potentially causing hypotension and promoting blood pooling in the lower extremities, with an associated risk of deep vein thrombosis.

Common Procedures

Laparoscopy forms part of many operative approaches, including:

• Cholecystectomy: Removal of the gallbladder using four small incisions, with the organ extracted through the navel. Most patients are discharged on the same day.
• Colectomy and nephrectomy: Larger organs such as portions of the colon or kidneys require slightly enlarged incisions for specimen removal. These procedures may be completed entirely laparoscopically or through hand-assisted laparoscopy, whereby the surgeon places one hand into the operative field through a sealed port, allowing tactile assessment.

Laparoscopy is widely utilised for bariatric surgery, endometriosis treatment, adhesiolysis, appendectomy and numerous other interventions. Its applications have expanded into oncology, where studies demonstrate reduced postoperative complications without compromising oncological safety in appropriately selected patients.

Advantages and Outcomes

Compared with traditional open surgery, laparoscopic procedures provide several benefits:

• significantly reduced haemorrhaging and decreased likelihood of requiring transfusion
• smaller incisions, resulting in less postoperative pain and reduced scarring
• shorter hospitalisation, often enabling same-day discharge
• reduced exposure of internal organs to external contaminants, lowering infection risks
• reduced need for systemic analgesics due to lower pain levels
• potential for regional anaesthesia in some cases, such as combined spinal–epidural approaches

Technical Demands and Professional Training

Laparoscopic surgery demands advanced psychomotor skills due to restricted vision, limited depth perception and reduced tactile sensation. Surgeons must develop specialised coordination, adaptability and familiarity with instrument mechanics. As a result, minimally invasive surgery has become a competitive subspecialty, supported by formal fellowship programmes that follow basic surgical training. Obstetrics and gynaecology residency programmes include defined laparoscopy-to-laparotomy training ratios, while other surgical fields have adopted comparable frameworks.

Veterinary Applications

Laparoscopic techniques are increasingly used in veterinary medicine, often in specialist practices due to equipment costs. The benefits mirror those in human surgery, including reduced postoperative pain and faster recovery. Procedures range from spaying in dogs—shown in studies to reduce postoperative discomfort significantly compared with open methods—to endoscopic interventions in exotic animals. Arthroscopy, thoracoscopy and cystoscopy have similarly been adapted for veterinary care.