Just 30 years ago, medical students were taught that “big surgeries were done with big scars.” But this is now ancient history since the development of minimally invasive surgery thanks in particular to French doctors (see box). “Minimally invasive surgery is based on carrying out small incisionsas opposed to large incisions (laparotomy, thoracotomy),” explains Professor Hubert Johanet, secretary general of the National Academy of Surgery.
In practice, Minimally invasive surgery operations are simpler than traditional interventions. “We put the patient to sleep or perform locoregional anesthesia on the limbs. Then we inflate the stomach or the thorax to create a space, we pass 5 or 10 millimeter trocars (hollow, pointed and cutting cylindrical rods) to introduce the camera and the instruments (forceps, scissors, coagulation instrument, etc.) and maintain the seal. Then, we follow the operation on the monitor, we remove the organ when there is a need for ablation, we deflate and close the small incisions,” explains Professor Johanet.
Varied indications
The indications for minimally invasive surgery, accessible in sector 1, are very broad. “As we carry out the same operations as before but with small incisions, they have spread considerably,” confirms Professor Johanet. Minimally invasive surgery can thus be used in gynecology, urology, oncology, otorhinolaryngology but also to carry out digestive or orthopedic surgical interventions. “Certain interventions are still carried out by opening, either because the surgeon has not adapted, or because the technical platform does not allow it, or also because the pathology does not authorize it (organ transplants, trauma , large tumors). But for example, in France in 2022, more than 60% of digestive surgery interventions interesting the inside of the belly were carried out laparoscopically! », notes Professor Johanet.
More precise surgery
This technique has many advantages. “It causes less tissue damage and allows for more precise surgery because the surgeon and the entire team can see better by bringing the camera closer and magnifying the image transmitted on a monitor,” the surgeon emphasizes. He also mentions a reduction in pain, hospital stays and work stoppages, and an earlier return to autonomy.
Minimally invasive surgery is also responsible for a reduction in adhesions in the abdomen, which cause occlusion. “White laparotomies (you open up and find nothing) have disappeared and interns and surgeons alike are better trained because they can review the recorded interventions,” adds Professor Johanet, who points out that technological advances have further improved it. Robotics allows for even finer surgery and reduces the length of stay. Increasingly precise imaging also allows for better preparation of the intervention to make increasingly elective ablations. For example, for lung cancer, we no longer remove a lobe of the lung but increasingly segments of lobes with the same oncological results.
