Could laparoscopic surgery be safely practised in a single-handed surgical setting?

Summary

In spite of the deep concern amongst medical professionals and general public regarding its safety and complications, laparoscopic surgery is rapidly expanding world-wide. This study appraises the safety of practising this surgery in small rural surgical units like those existing in different parts of the UK. In the 14 months until April 1995, 100 laparoscopic procedures were performed: 48 cholecystectomies (10 operative cholangiographies), 24 inguinal hemiorrhaphies (2 bilateral, 2 recurrent), 15 diagnostic laparoscopies, nine appendectomies, two division of adhesions, one assisted anterior resection for diverticular disease and one assisted AP resection for low rectal carcinoma. All procedures were carried out by the single consultant surgeon in the unit except for a few performed, under his supervision, by his regular associate. Both the consultant and the associate specialist surgeon have attended advanced courses in laparoscopic surgery. Open laparoscopy was performed routinely. In cholecystectomies, all cystic ducts were tied and laparoscopic operative cholangiography was performed selectively. In all appendectomies, appendicular stumps and mesentery were tied. In inguinal hemiorrhaphies, polypropylene meshes were used employing the transperitoneal approach. All patients were followed up for at least 6 weeks post-operatively. No fatality, major complications or hernia recurrence took place. Only two cholecystectomies were converted to open procedure due to dense adhesions. Provided training and experience are acquired and maintained by all members of the surgical team, audited and properly selected patients may safely undergo laparoscopic surgery in small surgical settings.

Key Words:

• laparoscopy
• single handed