AT PRESENT Advances target to the surgery without scars backing on the technology and its development. The multiple tecnological advances of the last 25 years of the last century fortunatelly included those of the medicine field, being surgery one of the most benefited branch for such advances, which were complemented with greater training and development of new abilities from the surgeons, bringing patients a number of benefits ranging from pain reduction to esthetic benefits, with minimal scars in their bodies. Before the 80’s, when removing a gallbladder it was necessary to perform an incision in the upper abdomen of 20 or even 25 centimeteres, which caused great pain due to the magnitud of the injury of the tissues (skin, subcutaneous cellular tissue and muscle), increasing in this way the hospitalization time, recovery, infection risk, and hernia formation in the place of the injury; additionally, it left a scar that affected the patient’s esthetic and self-esteem. From the end of the decade of the 80’s up to date, laparoscopic surgery has developed more and more, because it is the surgery that is performed with the support of technology, when performing the same procedures that are used with the conventional surgery, but through orifices of 5 and 10 milimeters, supported with a lens that transmits the image to a monitor, and with specialized instruments for the manipulation and the resection of tissues of the abdominal cavity.
Guatemala has been at the forefront of these advances, and in the year of 1993 the first procedure by means of laparoscopic video was performed in the General Hospital San Juan de Dios; from that moment this type of surgery has developed more and more, currently reaching to the performance of procedures such as colecystectomy (resection of the gallbladder), appendicectomy (appendix), hernia repair, gastroesophageal reflux correction, obesity surgery, ovarian and matrix surgery among others, all by laparoscopic means.
From the end of the decade of the 80’s up to date, laparoscopic surgery has developed more and more, because it is the surgery that is performed with the support of technology, when performing the same procedures that are used with the conventional surgery, but through orifices of 5 and 10 milimeters, supported with a lens that transmits the image to a monitor, and with specialized instruments for the manipulation and the resection of tissues of the abdominal cavity.
This is a new concept of Laparoscopic Surgery that is essentially based on the change of the instruments that are used to perform this kind of surgery. With the conventional laparoscopic surgery instruments of 5, 10 and even 15 mm of diameter are used. But now, with the Mini Laparoscopic Surgery, these instruments have decreased from 2, 2.8 and 3 mm of diameter (as shown in images 1 and 2), which makes a great difference in many aspects of the surgery’s results.
Work port of 3 mm, through which a disector instrument is introduced.
Ports of 2.8 mm through which a disector and a grasper are introduced in a cholecystectomy
ADVANTAGES OF MINI LAPAROSCOPIC SURGERY
This kind of surgical technique offers many significant advantages over the conventional laparoscopic surgery, within the most important are: • It diminishes the post surgical pain in a 50% from the conventional laparoscopic surgery, which was already relatively very little. • Sutures are not used for the injuries of the skin, which makes them heal more easily and, besides, they are less annoying and painful. • The use of medical analgesics and anti-inflammatories diminishes in relation to the conventional laparoscopic surgery since the pain is almost null.
Comparison of instruments’ diameter of 12.5, 10, 5 and 2.8 mm of diameter.
• Diminishes the physiological and immunological consequences of the surgery since it has been proved that the less size of the surgical injuries the less physiological and immunological are the changes the patient suffers.
Image of scars from Mini Laparoscopic Surgery
• Better esthetic of the surgical result because, even though this is not the more important aspect of this kind of technique, it has demonstrated that the final result, after finished the process of cicatrization in the patients, has been fantastic in the sense that in a large majority of patients the scars that are produced are not visible.
EVEN OUR BRAZILIAN COLLEAGUE, ITS CREATOR, COMPARES IT WITH THE TECHNIQUE OF SURGERY WITHOUT SCARS. AS SHOWN IN THE FOLLOWING IMAGES, THE ESTHETIC RESULTS ARE REALLY UNBEATABLE, AND MAYBE THIS IS THE BEST WAY TO REACH SURGERY WITHOUT SCARS IN THE FUTURE.
PROCEDURES IN WHICH PROCEDURES THE MINI LAPAROSCOPIC SURGERY CAN BE USED?
Basically, it can be used in any procedure that is actually performed by conventional laparoscopic surgery; there are some techniques of Hernioplasties that can use it; it also has been used a lot in diagnostic explorations. It could have an important use in some ginaecological procedures, and it only will be not indicated in obesity procedures because of the instruments’ fragility.
Scar of 2 mm after the mini surgery
In effect, a special equipment is needed in order to carry out this kind of procedures, as well as the appropriate training when managing it. It is an equipment that is not easy to get since very few enterprises distribute them worldwide.
EQUIPMENT IS EQUIPMENT AND SPECIAL TRAINING NECESSARY?
Medical surgeons members of the Group of Mini Surgery of Guatemala (From left to right:) Dr. Héctor L. Sagastume, Dr. René Gándara Grijalva (R.I.P), Dr. Roberto Gallardo Díaz, Dr. César Paz O., Dr. Rodrigo Zepeda H.
In Guatemala this type of surgery is already available to the patients since January 31st, 2009, when it was performed, in Guatemala, the first procedure by Mini Laparoscopic Surgery in Sanatorio Nuestra Señora del Pilar, and currently more than 900 procedures have been successfully performed.
These procedures have been in charge of the Group of Minimally Invasive Surgery of Guatemala, which is composed by the prestigious Surgeons members of the Latin American Association of Endoscopic Surgery: Dr. Roberto Gallardo Díaz, Dr. César Paz Ortiz, Dr. Héctor Sagastume and Dr. Rodrigo Zepeda who also lead this type of surgery at national and international level.
REACHING TO THE SURGERY WITHOUT SCARS