UW CVES: Exploring Surgical Innerspace


		EXPLORING SURGICAL INNERSPACE: The New Frontier of Videoendoscopic Surgery Videoendoscopic surgery is a new method of performing surgical procedures and is at the forefront of what is termed minimally invasive surgery or MIS. In essence, during videoendoscopic surgery, a space is created within the body (i.e. by inflating the abdomen with carbon dioxide gas, by collapsing one lung in the chest, or by infusing fluid into a joint space) and specialized instruments and scopes are inserted into the space through small incisions, allowing a wide range of surgical procedures. Although laparoscopic procedures (videoendoscopic procedures in the abdomen) have been performed for over 50 years, the technology was primitive and the types of procedures that could be performed safely were limited because the surgeon had to operate while holding the scope in one hand and a single instrument in the other. A few gynecologic procedures had been performed using these techniques, and specialized joint (arthroscopic) and bladder (cystoscopic) procedures had also developed along similar lines. In the latter part of the 1980's, several technological advances were made that vastly improved the scope of endoscopic surgery. First, small, sterilizable high-resolution video cameras were developed that allowed all members of the team to view the surgical field by looking at a video scene of the surgical field rather than the surgeon peering down the scope alone. This capability also gave the surgeon back one hand because now, other members of the surgical team could "run" the camera freeing up both of the surgeon's hands. Another development was a new generation of surgical telescopes with so-called, rod lenses that transmitted a much wider angle, brighter image than prior scopes. The third important innovation that made modern videoendoscopic surgery possible was the development of halogen high intensity light sources with fiberoptic connections. Putting these innovations together, surgeons were able to obtain bright, magnified images that could be viewed by all members of the surgical team on a video monitor, allowing cooperative teamwork that opened the possibility for surgical procedures of increasing complexity, including the possibility of suturing and surgical reconstruction done only with videoendoscopic vision. In the latter part of the 1980's, surgeons in France and the US took this enabling technology and built upon it by developed new, specialized instruments for tissue handling, cutting, and hemostasis. These included specialized ports with valves to preserve the carbon dioxide pressure, scissors, cautery devices for coagulation of blood vessels, and means of applying metal clips to blood vessels. Using prototype instruments, technical maneuvers for the procedure of laparoscopic cholecystectomy were pioneered in the laboratory and rapidly transferred to patient care. Due to the obvious immediate benefits of small scars, less pain, and a more rapid recovery, this procedure was rapidly adopted and in the past 6 years has become a standard method for cholecystectomy worldwide. Demand from patients has had much to do with the rapid evolution of the technology. Building on the success with this procedure, other applications of videoendoscopic surgery have been, and continue to be, developed. Minimally invasive approaches to the esophagus (reflux, heartburn), stomach (ulcers, cancer), bowel (Crohn's disease, ulcerative colitis, diverticulitis, cancer in selected patients), spleen, and adrenal gland have been developed. These techniques have also been extended to other surgical specialties such as urology (laparoscopic nephrectomy, lymph node biopsy, bladder suspension), gynecology (laparoscopically-assisted hysterectomy), thoracic surgery (lung resection, staging of cancers), otolaryngology (endoscopic sinus surgery), and orthopedics (videoarthroscopic surgery, lumbar disk surgery). Clearly, the full potential of videoendoscopic surgery has yet to be realized. New instruments are being developed continually with a product cycle that approximates that of computer processors. In the near future, we can expect to see work in this area to further increase safety and efficacy for these innovative techniques, as we work out the true cost-benefit to patients for MIS videoendoscopic surgery.

University of Washington School of Medicine

This page last updated 09/03/97
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