Minimally invasive is a general term that refers to the nature in which a procedure is performed. The basic principle involves performing the same standard of care procedure with smaller incisions. One of the main ways of doing minimally invasive surgery is through laparoscopy. Laparoscopy refers to performing surgery with the aid of a laparoscope as pictured here. To do this, small tubes called trocars are inserted through the abdominal wall. The majority of these are 5 millimeter or about a 1/4 inch. Most proceudres involve the use of one larger port about 10-12 millimeter, or a 1/2 inch, for larger devices like staplers or to extract surgical specimens. The largest incision in most laparoscopic procedures is limited by the size of the specimen being extracted.
Not all laparoscopic procedures are the same. Some procedures may be laparoscopic assisted, meaning a portion of the procedure is performed laparoscopically before the planned conversion to an open procedure. As a surgeon fellowship trained in minimally invasive surgery, Dr Mark Glover is able to at least potentially perform the vast majority of intraabdominal procedures completely laparoscopically.
Laparoscopic surgery means smaller incisions and less scarring, but it is also much more than that. Abdominal incisions carry a significant risk both short term and long term. Every incision carries risk of wound infection, hernia formation, and bowel obstructions. The risk of wound infection is proportionate to the size of the incision. Therefore, the larger the incision the more likely you are to have a wound infection or other complication. Most surgical infections need more than just antibiotics and often require leaving the skin of the incision open and draining. Wound infections also increase your risk of the wound not healing properly and creating a hernia. A hernia is basically a hole in the abdominal wall and if it happens at an incision, it is referred to as an incisional hernia. The risk of the abdominal wall forming an incisional hernia is proportionate to the length of the incision. These risk are not always immediate and bowel obstructions and hernias occur several years after surgery.
With most laparoscopic surgeries, patients are able to return to activities and work much quicker and shorten the recovery time. This means less days in the hospital and less overall cost.
Needlescopic surgery is essentially laparoscopic surgery performed through even smaller incisions. Some basic procedures like cholecystectomy (removal of the gall bladder) can be done with 3 millimeter (1/8th inch) incisions. The trocars used are about the width of a large needle, hence the term needlescopic surgery. When these incisions heal, they have a very pleasing appearance comparable to a large freckle.