ABSTRACT
Access through the abdominal wall for open surgery must be made through an incision of sufficient length to allow the surgeon a good view of the operating field and to permit the entry of hands and instruments. An exception is an operation on a mobile structure that can be delivered through a small wound and the surgery performed outside the abdomen (e.g. appendicectomy). In laparoscopic surgery, the surgeon’s hands remain outside the abdomen, while a gas-filled space is created into which the camera and instruments are inserted via trocars passed through the abdominal wall. Good views and operating conditions can be obtained for deep-set structures that would require large incisions for safe conventional surgery. Laparoscopic dissection must often be combined with a small incision at the end of the operation to deliver an intact specimen. For example, whereas an appendix or a gallbladder can be delivered through the camera port site, a right hemicolectomy specimen with a malignant caecal tumour cannot. (There is the added advantage in this scenario that the bowel ends are exteriorised for the anastomosis.) A compromise between laparoscopic and open techniques may also be beneficial. For example, a laparoscopic mobilisation of the splenic flexure allows the surgeon to perform an open left hemicolectomy through a much smaller incision. Laparoscopic surgery has advanced greatly in the last 20 years, and with refinement of both skills and equipment there is a choice of open or laparoscopic surgery for almost all intra-abdominal procedures.
