AIM: To review current applications of the laparoscopic surgery while highlighting the standard procedures across different fields.

METHODS: A comprehensive search was undertaken using the PubMed Advanced Search Builder. A total of 321 articles were found in this search. The following criteria had to be met for the publication to be selected: Review article, randomized controlled trials, or meta-analyses discussing the subject of laparoscopic surgery. In addition, publications were hand-searched in the Cochrane database and the high-impact journals. A total of 82 of the findings were included according to matching the inclusion criteria. Overall, 403 full-text articles were reviewed. Of these, 218 were excluded due to not matching the inclusion criteria.

RESULTS: A total of 185 relevant articles were identified matching the search criteria for an overview of the current literature on the laparoscopic surgery. Articles covered the period from the first laparoscopic application through its tremendous advancement over the last several years. Overall, the biggest advantage of the procedure has been minimizing trauma to the abdominal wall compared with open surgery. In the case of cholecystectomy, fundoplication, and adrenalectomy, the procedure has become the gold standard without being proven as a superior technique over the open surgery in randomized controlled trials. Faster recovery, reduced hospital stay, and a quicker return to normal activities are the most evident advantages of the laparoscopic surgery. Positive outcomes, efficiency, a lower rate of wound infections, and reduction in the perioperative morbidity of minimally invasive procedures have been shown in most indications.

CONCLUSION: Improvements in surgical training and developments in instruments, imaging, and surgical techniques have greatly increased safety and feasibility of the laparoscopic surgical procedures.

Laparoscopic surgery: A qualified systematic review.

Robotic cholecystectomy versus conventional laparoscopic cholecystectomy: A meta-analysis.

Although laparoscopy has the potential to reduce peritoneal trauma and post-operative peritoneal adhesion formation, only one randomized controlled trial and a few comparative retrospective clinical studies have addressed this issue Laparoscopy reduces de novo adhesion formation but has no efficacy in reducing adhesion reformation after adhesiolysis Moreover, several studies have suggested that the reduction of de novo post-operative adhesions does not seem to have a significant clinical impact Experimental data in animal models have suggested that CO2 pneumoperitoneum can cause acute peritoneal inflammation during laparoscopy depending on the insufflation pressure and the surgery duration Broad peritoneal cavity protection by the insufflation of a low-temperature humidified gas mixture of CO2, N2O and O2 seems to represent the best approach for reducing peritoneal inflammation due to pneumoperitoneum However, these experimental data have not had a significant impact on the modification of laparoscopic instrumentation In contrast, surgeons should train themselves to perform laparoscopy quickly, and they should complete their learning curves before testing chemical anti-adhesive agents and anti-adhesion barriers Chemical anti-adhesive agents have the potential to exert broad peritoneal cavity protection against adhesion formation, but when these agents are used alone, the concentrations needed to prevent adhesions are too high and could cause major post-operative side effects Anti-adhesion barriers have been used mainly in open surgery, but some clinical data from laparoscopic surgeries are already available Sprays, gels, and fluid barriers are easier to apply in laparoscopic surgery than solid barriers Results have been encouraging with solid barriers, spray barriers, and gel barriers, but they have been ambiguous with fluid barriers Moreover, when barriers have been used alone, the maximum protection against adhesion formation has been no greater than 60% A recent small, randomized clinical trial suggested that the combination of broad peritoneal cavity protection with local application of a barrier could be almost 100% effective in preventing post-operative adhesion formation Future studies should confirm the efficacy of this global strategy in preventing adhesion formation after laparoscopy by focusing on clinical end points, such as reduced incidences of bowel obstruction and abdominal pain and increased fertility

Peritoneal adhesions after laparoscopic gastrointestinal surgery.

Robotic surgery, an emerging technology, has some potential advantages in many complicated endoscopic procedures compared with laparoscopic surgery. But robot-assisted cholecystectomy (RAC) is still a controversial issue on its comparative merit compared with conventional laparoscopic cholecystectomy (LC). The aim of this study was to evaluate the safety and efficacy of RAC compared with LC for benign gallbladder disease. A systematic literature search was conducted using the PubMed, EMBASE, and Cochrane Library databases (from their inception to December 2017) to obtain comparative studies assessing the safety and efficacy between RAC and LC. The quality of the literature was assessed, and the data analyzed using R software, random effects models were applied. Twenty-six studies, including 5 RCTs and 21 NRCSs (3 prospective plus 18 retrospective), were included. A total of 4004 patients were included, of which 1833 patients (46%) underwent RAC and 2171 patients (54%) underwent LC. No significant differences were found in intraoperative complications, postoperative complications, readmission rate, hospital stay, estimated blood loss, and conversion rate between RAC and LC groups. However, RAC was related to longer operative time compared with LC (MD = 12.04 min, 95% CI 7.26–16.82) in RCT group, which was consistent with NRCS group; RAC also had a higher rate of incisional hernia in NRCS group (RR = 3.06, 95% CI 1.42–6.57), and one RCT reported that RAC was similar to LC (RR = 7.00, 95% CI 0.38–129.84). The RAC was not found to be more effective or safer than LC for benign gallbladder diseases, which indicated that RAC is a developing procedure instead of replacing LC at once. Given the higher costs, the current evidence is in favor of LC in cholecystectomy.

Robotic-assisted versus laparoscopic cholecystectomy for benign gallbladder diseases: a systematic review and meta-analysis

Objective—To describe the operative technique for single-port laparoscopic cryptorchidectomy (SPLC) in dogs and cats and evaluate clinical outcome for patients that underwent the procedure. Design—Retrospective case series. Animals—25 client-owned dogs (n = 22) and cats (3). Procedures—Dogs and cats that underwent SPLC with 3 commercially available single-port devices between 2009 and 2014 were retrospectively identified through a multi-institutional medical records review. Surgery was performed via a single-port device placed through a 1.5- to 3.0-cm abdominal incision either at the region of the umbilicus or caudal to the right 13th rib. The cryptorchidectomy was performed with graspers, a bipolar vessel sealing device, and a 30° telescope. Results—SPLC was performed with a single-incision laparoscopic surgery port (n = 15), a multitrocar wound-retractor access system (8), or a metal resterilizable single-port access device (2). Median age was 365 days (range, 166 to 3,285 days). Median body weight was ...

Single-port laparoscopic cryptorchidectomy in dogs and cats: 25 cases (2009–2014)

Background: Although current guidelines recommend performing cholecystectomy via laparoscopy, consensus on the application of single-incision laparoscopic surgery for cholecystectomy is still lacking. The aim of the current study was to perform a meta-analysis of randomized controlled trials (RCTs) and nonrandomized comparative studies (NRCSs), comparing single-port laparoscopic cholecystectomy (SPLC) and conventional multiport laparoscopic cholecystectomy (CMLC) for benign gallbladder diseases. Subjects and Methods: A systematic review of the literature was performed to identify studies published between January 1997 and December 2012 comparing SPLC and CMLC. Operative outcomes, postoperative parameters, complications, cosmetic results, and quality of life were evaluated. Results: Forty studies were included in the analyses (16 RCTs, 24 NRCSs) that included 3711 patients (1865 SPLCs, 1846 CMLCs). SPLC had higher conversion rates (odds ratio [OR], 4.21; 95% confidence interval [CI], 2.71–6.56; P<...

Single-port versus conventional multiport laparoscopic cholecystectomy: a meta-analysis of randomized controlled trials and nonrandomized studies.

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Single-port versus conventional multiport laparoscopic cholecystectomy: a meta-analysis of randomized controlled trials and nonrandomized studies.