“It’s always been a revolutionary procedure,” says Dr. David Olive, president of the American Association of Gynecological Laparoscopy (AAGL).He is talking, unsurprisingly, about laparoscopy (lap-a-RAH-sco-py), the surgical technique that his organization is dedicated to promoting. Laparoscopy enables physicians to perform complicated surgical procedures, even removing whole organs, without making more than a 1/2 inch cut in the abdomen. “Almost any gynecological procedure can be accomplished through laparoscopy,” Dr. Olive says. “There’s virtually no limit depending on the ability of the surgeon.” And the procedure is not limited to gynecology—kidneys, gall bladders, spleens and almost any abdominal organ can be operated on or removed with a laparoscope. The procedure usually takes less time than open surgery, and the patient recovers faster, often going home the same day.
The laparoscope is a small camera that is inserted into the abdomen. The camera projects images onto a screen, so the physician can easily view the organs. The doctor can use the laparoscope to diagnose problems—or, surgical instruments can also be inserted into the abdomen. The doctor can remove tumors and lymph nodes, treat adhesions and cysts, aid with an hysterectomy, remove the gall bladder or any number of other procedures.
How, one might wonder, can an organ be removed through a 1/2 inch incision?
“We chew it up, basically,” Dr. Olive explains.
Laparoscopy has only become common in the last 15 years. It has been used in simple gynecological procedures since the late 1960s; equipment was crude, however, and the procedure was not nearly as safe as it is now. In the late eighties, non-gynecological surgeons discovered the procedure’s benefits. Once that happened, Dr. Olive says, technology companies began making better equipment. Previously, doctors had to look directly through the laparoscope to view the organs; images were not yet projected onto a monitor. This projection, Dr. Olive says, was a crucial development that made laparoscopy easier and more readily available.
Dr. Alex Gandsas, Assistant Professor of Surgery at the University of Kentucky and founder of Laparoscopy.com, says that learning the technique in the 1990s was “like learning to walk again.” He originally attended medical school in Argentina, before the procedure was frequently used. Now he specializes in gastric bypass for obese patients, a procedure he performs with a laparoscope. The lessons of open surgery don’t apply to laparoscopy, he says. Looking at a two-dimensional screen is much different from looking directly at an organ. Doctors also lose the ability to touch the instruments and the body directly. And if you want to move an instrument to the right, you move your hand to the left. “They’re not intuitive movements,” Dr. Gandsas says.
That may be one of the reasons why laparoscopy still is not more widespread. Though most surgeons can perform simple procedures, “There are still too few who know how to make use of the modern capabilities of laparascopy,” Dr. Olive says. Dr. Gandsas agrees. “For those that feel comfortable with it, the operating time can be significantly reduced,” he says. But many doctors do not.
The AAGL tries to promote knowledge about the procedure. And so does Dr. Gandsas, through his Web site and his research. “We’re trying to improve doctor training,” he says. He has worked to develop virtual reality training sessions, where medical students wear goggles that simulate an operation. Using a grant from Compaq, he has also developed technology to broadcast surgeries to personal and hand-held computers. While viewing a surgery cannot replace hands-on practice, any exposure to the procedure helps medical students learn more about it.
“If the student cannot go to the operating room,” Dr. Gandsas says, “we try to bring the operating room to the student.”
