The basics of laparoscopic and minimally invasive surgery
DEFINITION AND PRINCIPLES
Minimally invasive surgery (MIS) uses small incisions or natural orifices to access the operative field, aiming to reduce tissue trauma while achieving the same oncological or functional objective as open surgery. Laparoscopy uses a camera and instruments through ports; other approaches include endoscopy, thoracoscopy, robotic surgery and image-guided procedures.
EQUIPMENT AND OPERATING ROOM SET-UP
Core equipment includes a laparoscope (commonly 0° or 30°), camera, light source, monitor, insufflator, CO₂ tubing, ports/trocars, graspers, dissectors, scissors, energy devices, suction-irrigation and specimen retrieval bag. The camera and monitor should be aligned with the surgeon's visual axis. Patient positioning and port placement must provide triangulation, ergonomic instrument angles and safe access while avoiding epigastric vessels and prior scars.
PNEUMOPERITONEUM AND PHYSIOLOGY
CO₂ pneumoperitoneum is usually created with a Veress needle or open (Hasson) technique; optical entry is used by trained surgeons. Typical adult intra-abdominal pressure is commonly maintained around 12–15 mmHg, adjusted to patient physiology and procedure. Increased pressure reduces venous return, increases systemic vascular resistance and can reduce cardiac output; CO₂ absorption may cause hypercarbia and acidosis. Trendelenburg and reverse Trendelenburg positioning affect ventilation and haemodynamics. Monitor end-tidal CO₂, airway pressures and haemodynamics.
INDICATIONS, CONTRAINDICATIONS AND BENEFITS
Common procedures include cholecystectomy, appendicectomy, hernia repair, colorectal resection, bariatric surgery and diagnostic laparoscopy. Benefits may include less postoperative pain, smaller scars, shorter hospital stay and faster recovery. Relative contraindications include inability to tolerate pneumoperitoneum, severe cardiopulmonary disease, uncorrected coagulopathy, extensive adhesions and haemodynamic instability; many are case-dependent rather than absolute.
COMPLICATIONS AND SAFETY
Entry complications include vascular injury, bowel/bladder injury and gas embolism. Intraoperative risks include bleeding, visceral injury, thermal injury, port-site hernia and conversion to open surgery. Physiological complications include hypercarbia, subcutaneous emphysema, pneumothorax and haemodynamic compromise. Prevent complications with safe entry, appropriate port placement, direct visualisation, careful energy-device use, instrument counts and clear conversion thresholds. Conversion is a safety decision, not a failure.
POSTOPERATIVE CARE AND LEARNING CURVE
Assess pain, nausea, wounds, urine output, respiratory status and signs of bleeding or visceral injury. Early mobilisation, oral intake and multimodal analgesia support recovery. Surgeons require structured training, simulation, supervised operating, knowledge of ergonomics and a low threshold to seek help. Informed consent should include specific risks, possibility of conversion and alternatives.