Minimally invasive surgery is any surgical procedure that is less invasive than open surgery used for the same purpose. Minimally invasive procedures typically involve the use of laparoscopes and remote control manipulation of instruments with indirect observation of the surgical field through an endoscope. Anticipated benefits include less operative trauma for the individual, and consideration of the tissue and functional presentation, while accomplishing the same goals as equivalent invasive procedures.59
Major surgical procedures are being used less often in favour of minimally invasive procedures in conjunction with imaging processes.2 This change has been possible due to:
- advances in surgical techniques
- an improved understanding of the patterns of spread of specific diseases
- the development of adjuvant therapies which can control microscopic disease.
In recent years, the role of laparoscopy has expanded to include diagnosing, staging, treating, monitoring and palliating a long list of malignancies. Some of the benefits of laparoscopic surgery are the reduction in post-operative pain, decreased healing time and decreased adhesion formation.60 These may be attributed to the use of smaller incisions and avoidance of the need for retractors to hold incisions open for hours.
The major concerns regarding laparoscopic surgery for the treatment of cancer included:60
- maintenance of the integrity of the oncologic resection (margins of resection, removal of lymph nodes, evaluation of other intra-abdominal organs)
- demonstration of feasibility in improving outcome parameters for the resection without undue risk (decreased hospital stay, decreased pain, decreased cost, more rapid return to work)
- absence of any negative impact on survival (induction of metastases by laparoscopy, port-site recurrences).
Randomised trials in colon cancer and gastric cancer, have demonstrated the concerns are unfounded.9
Identify a laparoscopic procedure and the associated open procedure that is carried out in your health facility, and:
- Compare the advantages and disadvantages of each procedure for the person affected by cancer
- Compare the nursing care considerations associated with each procedure.