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Minilaparoscopy

Minilaparoscopy

                               
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Minilaparoscopy is an emerging aspect of laparoscopic surgery relating to the utilization of miniaturized scopes and instruments to help reduce perioperative morbidity and enhance cosmesis. Recent improvements in optical technology and instrument design and style have enabled relatively broad applications of minilaparoscopy to incorporate diagnostic and therapeutic procedures in both inpatient and outpatient settings.

Early results claim that minilaparoscopic procedures at the disposal of experienced laparoscopic surgeons appear to be similarly effective and safe with minimally perceptive scarring. Although promising, clear advantages in reducing perioperative pain and morbidity have yet to be determined. Nowadays aesthetics play a substantial role within the selection of the surgical technique.

With the upcoming of NOTES and Associated Procedures the mini-laparoscopic method has regained importance for the last few years. Besides the convincing cosmetic aspect the advancement of the minimal invasive surgical techniques towards the low-risk Mini-Laparoscopy bears an essential advantage: trauma and strain from the patient are reduced to some minimum.

                               
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Because of the mixture of established 5 mm coagulation instruments with 3 mm forceps and scissors, smallest access could be coupled with finest preparation and effective homeostasis. Along with an umbilical 6 mm trocar, a second 6 mm suprapubic trocar can be used, that allows the use of a bipolar RoBi® forceps or the GORDTS and CAMPO bipolar suction and irrigation electrode with 5 mm of outer diameter.

Furthermore it enables a change of the 5 mm telescope in the umbilical to the suprapubic access in case of distinct adhesions. The two lateral 3.5 mm trocars enable while using small 3 mm instruments, leaving only hardly visible scars to the patient. There has been several advances in telescope design and video imaging which have allowed the introduction of smaller laparoscopes, while limiting the amount of light attenuation inside the system. As a result, the quality and durability of small diameter optics has improved substantially.

                               
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Additional breakthroughs in instrument design also have enabled a decrease in diameter, while keeping durability and function. These technologic innovations have given rise towards the field of minilaparoscopy (ML), which we define as laparoscopes and instrumentation = 3 mm in diameter. Even though there has been no randomized prospective trials assessing the restorative and diagnostic efficacy of ML, the literature and our very own institutional experience indicate that comparable, or satisfactory, images is possible to safely perform certain determined procedures.

At World Laparoscopy Hospital the diagnostic procedure is performed with one 2-mm micrograsper and one 2-mm microprobe to evaluate the pelvis. In particular we grasp utero-ovarian ligaments to get proper exposure; we touch, grasp, and distended fallopian tubes with Mitheline blue dye; we move the uterus with a manipulator inserted at the cervix; and in Minilaparoscopy we touch and grasp bowel and omentum using 2 mm atraumatic grasper..

Level of pain was recorded in minilaparoscopy on a visual analog scale. In minilaparoscopy very less pain was elicited when we touch and graspe ovary, omentum, and bowel. Even bedside minilaparoscopy can be a safe and accurate method to evaluate critically ill patients in whom the possibility of mesenteric ischemia or other intra-abdominal process is entertained.

Nontherapeutic laparotomy can be avoided in many critically ill patients if minilaparoscopy is timely performed. Bedside diagnostic laparoscopy can be a useful replacement for diagnostic laparotomy in the operating room. It should be included in the diagnostic algorithm in the evaluation of the unstable patient in the ICU with a suspected acute intra-abdominal process.