Laparoscopic surgery utilizes fiberoptic light and telescopes entered into the body through puncture incisions for surgical procedures. Although these puncture wounds are small incisions, they are multiple. In addition, although the postoperative period may be shortened, surgical time for a number of these procedures may be substantially longer.
Currently, there may be a place in the urologic armamentarium for laparoscopic approaches to perform pelvic lymphadenectomy, localize intra-abdominal testicles, perform varicocele ligation, and drain lymphoceles. Laparoscopic indications and routine use in other procedures, such as nephrectomy, pyeloplasty and bladder neck suspension, are still evolving. Part of the reason for this evolution may also be because of the various health care insurance companies being reluctant to pay for newer procedures. Because the surgery is performed via telescopes and progress is monitored by the surgeon on a TV monitor, hand-eye coordination is an important asset for surgeons and co-surgeons.
Once the patient has been anesthetized, prepped and draped, a blunt obturator insufflation needle (the Veress needle) is pierced through the abdomen into the peritoneum. After intraperitoneal access, CO2 gas is instilled by a high-volume insufflator; and to maintain a constant pneumoperitoneum, the flow rate should be between 6 and 10 liters per minute.
After insufflation, or expanding the abdominal cavity, with the carbon dioxide, the abdominal cavity, or peritoneum, is entered with a sharp-tipped trocar surrounded by a cannula. These cannulas are then used for telescopes and various instruments to perform surgery. The trocars and cannulas then are placed in various strategic points in the abdomen to allow either insertion of a camera connected to a video monitor or one of several different instruments to perform surgery. In order that various scissors and grasping instruments can be passed down these cannulas to perform surgery, the instruments have been considerably modified from conventional equipment. In addition to the scissors and grasping instruments, various electrosurgical, laser, irrigation and aspiration equipment as well as ligature and stapling equipment has been developed so that the surgeon may pass these instruments into the abdomen through these fine cannulas while monitoring the progress of the surgery on the video as recorded by a camera in the abdomen down one of the other cannulas.