Minimally invasive surgery – past, present and future
In 1989, I was one of 300 surgeons sitting in a lecture theatre
in Leeds watching Joe Petelin, from Kansas, perform the UK's first
laparoscopic cholecystectomy. It was obvious to most of us that we
were watching 'the future', and on the way home the only topic of
conversation was how we could become involved.
Diagnostic laparoscopy had been ‘in vogue’ for many years, but
apart from female sterilisation, there were few therapeutic
indications. However, surgeons in France and the USA had started to
work with manufacturers to produce instruments that were narrow
enough to be passed down a 5mm port, and long enough to function
within the abdominal cavity. Having overcome the disappointment
that many of these instruments were designed by gynaecologists, we
set about buying a set and developing our technique.
Our first human laparoscopic cholecystectomy took place a few
months later and in 1994, the North West's first laparoscopic bowel
resection was performed for a caecal cancer. Using the same
instruments as for cholecystectomy we were able to mobilise the
right colon and deliver it through an appendicectomy incision. The
tumour was resected and the bowel re-anastamosed before being
replaced in the peritoneal cavity. In the past year we have
performed 32 laparoscopic bowel resections with a completeness of
resection and lymph node harvest were identical to that of open
surgery. Whilst minimally invasive surgery is not without
complications, mean hospital stay was reduced, no patients
developed DVT or wound infection and none required epidural
analgesia or blood transfusions. Who would not choose this
technique for themselves or their relatives?
So, where are we in 2009? Robots, harmonic scalpels that vibrate
at a rate of 8,000 times per second, bipolar coagulators that seal
vessels up to 6mm in size by melting the intima, retractors that
can be straightened to go through a port but bent into various
shapes once within a cavity, suturing devices, 30 degree
laparoscopes, the list is endless. On the other end is the poor old
surgeon, who has been busy playing on the Xbox with the children to
develop and maintain hand-eye co-ordination.
Can we see into the future? Equipment and techniques continue to
evolve. The advent of natural orifice transluminal endoscopic
surgery (such as trans-gastric cholecystectomy) has captured the
imagination of surgeons worldwide. If smaller incisions result in
less pain, faster recovery and better cosmesis, its seems logical
that no incisions would be even better!
None of us are certain how these concepts will evolve. However
most are sure that, once again, traditional concepts will be
challenged and the way patients are treated will change.
Mike Zeiderman
Gastrointestinal Surgeon
Renacres Hospital