Is every operation suitable for minimally invasive surgery?

Minimally invasive surgery has little trauma and patients recover quickly after operation, but is it suitable for every operation? Should we choose traditional surgery or minimally invasive surgery for surgery?

Minimally invasive surgery, as its name implies, is a surgical method that has less trauma to human body and achieves the same goal compared with the big trauma of traditional surgery. With the rapid development of medicine and instruments, minimally invasive surgery can be performed from head to toe, which has become quite common.

Minimally invasive surgery has little trauma and quick recovery.

Huang Junjie, an attending surgeon in the Department of Hepatobiliary Gastroenterology, Hsinchu Branch of National Taiwan University Hospital, said that the term "minimally invasive surgery" was first used in the1970s. The main way is to make several small incisions on the body surface, body cavity or through the natural openings of the human body, such as urethra, * * *, * *, and oral cavity, and then insert an endoscope or similar monitoring structure and surgical instruments into the body.

Compared with traditional surgery, the main advantages of minimally invasive surgery are less trauma, less wound pain and scar, faster time to return to normal activities, shorter hospitalization days and lower postoperative adhesion probability. For doctors, it is also better to see the whole process of surgery and achieve satisfactory surgical results.

However, minimally invasive surgery also has some disadvantages, including high cost, high technical content, relatively long operation time and relatively long learning curve of doctors. However, with the progress of science and technology, the continuous innovation of instruments and the accumulation of experience of surgeons, these shortcomings have been gradually overcome. Therefore, minimally invasive surgery has been widely used in many surgical operations.

Not every operation is suitable for minimally invasive surgery.

Huang Junjie said that theoretically, all operations have a relatively minimally invasive way, and many patients want to have minimally invasive surgery. However, is this really better? In fact, it's not entirely true, because if the wound is reduced, the number of wounds is reduced, and minimally invasive surgery is adopted, sometimes it will increase the pain, damage more tissues in the body, greatly increase the operation time, or even do more harm to the patient if the cancer cells cannot be cleaned up.

The real spirit of minimally invasive surgery is to use surgical technology and existing technology and equipment to help patients get less trauma and achieve the same surgical purpose. It is not only the pursuit of smaller and more beautiful wounds, but also for the benefit of doctors and hospitals. Therefore, not every operation is suitable for every patient.

Minimally invasive surgery in a broad sense includes physical minimally invasive, psychological minimally invasive, economic minimally invasive, and even minimally invasive for doctors. It not only refers to the wound or the operation itself, but also needs to be considered as a whole, which is called personalized medicine. Therefore, Huang Junjie suggested that every patient should discuss with doctors to understand the indications, advantages and disadvantages, sequelae, costs and possible risks of various surgical methods, so as to tailor the most suitable minimally invasive surgery.

Common types of minimally invasive surgery

Huang Junjie said that minimally invasive surgery in vivo needs enough operating space, and the peritoneal cavity (including abdominal cavity and pelvic cavity) is the largest natural cavity in human body, so laparoscopic surgery is the earliest and most commonly used minimally invasive surgery.

◎ Laparoscopic surgery: From the earliest salpingectomy, ligation and appendectomy, with the improvement of instruments, it is widely used in cholecystectomy, gastrointestinal functional surgery and hernia surgery. After the emergence of various endoscopic automatic instruments such as ultrasonic scalpel, tissue agglutination device and gastrointestinal automatic stapler, laparoscopic surgery is more widely used in various organs in abdominal cavity, including gastrointestinal tract, spleen, pancreas, liver, bile duct, colorectal cancer, adrenal gland, kidney, fallopian tube, bladder, ovary and uterus. With the accumulation of time, many documents have confirmed that laparoscopic surgery has the same effect on the prognosis of some cancers compared with traditional surgery, so laparoscopic surgery has developed more vigorously, and has developed to single-hole laparoscopic surgery with a wound of about 2 cm and the latest robot-assisted surgery.

◎ Thoracoscopic surgery: In addition to abdominal cavity, thoracic cavity is another large natural cavity of human body. At present, the development of thoracoscopic surgery is also mature, which greatly reduces the discomfort of patients who need thoracotomy.

◎ Surgery in other parts: In addition to the above two kinds, minimally invasive surgery in many parts of the human body is constantly developing, which can be tried from head to toe, including some intracranial lesions, sinusitis, thyroid gland, * * *, joints of limbs, heart (coronary artery bypass grafting), spine (disc herniation) and varicose veins of feet, which can make patients suffer less and less damage and can also maintain wounds.

Should we choose traditional surgery or minimally invasive surgery?

It depends on the disease.

Huang Junjie said that at present, some laparoscopic operations are very mature, such as cholecystectomy and appendectomy, almost all of which are done by laparoscopy. However, some abdominal operations still depend on the situation and are not completely suitable for minimally invasive surgery.

As far as gastric cancer is concerned, it is technically possible to achieve minimally invasive, and it can indeed achieve the purpose of minimal trauma and rapid recovery. However, there is still no literature to prove that the long-term prognosis of patients with advanced or lymph node metastasis is the same as that of open surgery. The purpose of cancer surgery is to clean up lymph nodes and cancer cells. It takes more time to clean up some lymph nodes in the stomach, and laparoscopic surgery may not be able to clean up cancer cells. Therefore, the effectiveness of laparoscopic surgery for advanced gastric cancer still needs literature and time to prove.

However, it is also abdominal cancer, and colorectal cancer does not have this problem. The paper proves that the traditional surgery and minimally invasive surgery have the same effect, and if it is rectal cancer, because it is located in the deep pelvic cavity, the traditional surgery is more difficult to see clearly, but the focus can be seen through laparoscopic or robotic surgery, so it has been adopted by most doctors. In addition, it is also a malignant tumor. Gastrointestinal stromal tumor is more suitable for laparoscopic surgery because it does not require lymph node dissection.

Many hospitals have introduced robotic arm surgery, because the stability of the robotic arm is relatively high, the operation process will not shake, and the joints of the robotic arm can rotate 360 degrees, which is more flexible. It is more suitable for some places with narrow space, such as thyroid surgery and prostate surgery in urology. When fine movements are needed, it can play a greater role.

It depends on the patient's physical condition

For example, the main surgical method for pancreatic head cancer is pancreatoduodenectomy, and the scope of operation includes pancreatic head, duodenum, upper jejunum, gastric antrum, gallbladder, common bile duct and so on. It takes 4 ~ 10 hour for a knife. If it is done by laparoscopy, it may take a long time and may cause harm to the patient.

In addition, due to the long duration of anesthesia, the elderly or people with unstable blood pressure may have serious sequelae such as stroke or myocardial infarction after such a long operation. Therefore, to evaluate the patient's physical condition, it is not necessarily suitable for the elderly or people with weak immunity to do minimally invasive surgery.

In addition, if you have had abdominal surgery recently, especially the upper and lower abdomen, because the abdominal tissue is sticky, it is not suitable for laparoscopy. But if there is a knife in the upper abdomen and a hole in the lower abdomen, it can still be considered; It was operated 10 years ago, and it may not be so sticky. Laparoscopic surgery can also be considered. Huang Junjie said that any examination before operation can't show the degree of tissue adhesion, so patients should first tell their doctors for details, and then evaluate which operation method is appropriate.

Consider economic problems

Some minimally invasive surgery is not covered by medical insurance, or even if medical insurance covers the cost of surgery, some materials are not covered. Therefore, patients can ask clearly before choosing the operation method to avoid small wounds, but the economic gap is getting bigger and bigger.

Is there medical insurance for minimally invasive surgery?

Huang Junjie said that there are many kinds of minimally invasive surgery. Usually, health insurance will pay for the operation, but some materials will not, such as harmonic knife, tissue coagulator and automatic gastrointestinal suture gun. Medical insurance pays for some gastrointestinal sutures, but high-grade sutures that are not easy to leak bleeding will be at their own expense, and a nail is about 15000 yuan.

Therefore, in the case of laparoscopic gastric surgery, if all advanced staples and a suture gun are needed, it will cost hundreds of thousands of yuan, which is not affordable for every patient. Some patients would rather have a bigger wound than just use medical insurance nails, which can save tens of thousands of yuan.