PERSONAL VIEWPOINT Year : 2021  |  Volume : 17  |  Issue : 2  |  Page : 271-273  

Twenty years of mini-laparoscopy in Brazil: What we have learned so far

Diego Laurentino Lima1, Gustavo Lopes Carvalho2, Raquel Nogueira Cordeiro3
1 Health and Biologic Sciences Center, Catholic University of Pernambuco, Recife, Pernambuco, Brazil
2 Department of General Surgery, University of Pernambuco, University Hospital Oswaldo Cruz, Recife, Pernambuco, Brazil
3 Medical Student, School of Medicine, Pernambuco Health College, Recife, Pernambuco, Brazil

Date of Submission23-Jul-2019Date of Decision26-Aug-2019Date of Web Publication28-Jan-2020

Correspondence Address:
Dr. Diego Laurentino Lima
Desembargador Joao Paes Street, Number 421, Apartment 1101, Recife, Pernambuco
Brazil

Source of Support: None, Conflict of Interest: None

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DOI: 10.4103/jmas.JMAS_179_19

The mini-laparoscopic cholecystectomy (MLC) was first performed in 1996, as the logical advancement of the conventional laparoscopic cholecystectomy. In Brazil, mini-laparoscopy was first performed in 1998, by Professors Peter Goh and Go Wakabaiashi, who performed a cholecystectomy using 3-mm instruments. The first study, with a considerable number of patients, was performed in Recife by Dr. Carvalho, and he reported that 719 patients were submitted to a MLC with a small rate of conversion for conventional laparoscopy. We discuss the development of mini-laparoscopy in Brazil for the past 20 years.

Keywords: Cholecystectomy, hernia, laparoscopy, minimally invasive surgical procedures

How to cite this article:
Lima DL, Carvalho GL, Cordeiro RN. Twenty years of mini-laparoscopy in Brazil: What we have learned so far. J Min Access Surg 2021;17:271-3

Laparoscopic cholecystectomy has become the standard procedure for the treatment of gallbladder diseases, since this technique allows the possibility of smaller incisions, reduced hospital stay, less post-operative pain, and better cosmetic results.[1],[2],[3],[4],[5],[6],[7],[8] Using a minimally invasive technological advancement, the mini-laparoscopic cholecystectomy (MLC) was first performed in 1996, as the logical advancement of the conventional laparoscopic cholecystectomy (CLC).[1],[2],[4],[9],[10] Different terms were used to describe this technique: mini-laparoscopy, needlescopic surgery and microlaparoscopy. In Brazil, mini-laparoscopy was first performed in 1998, by Professors Peter Goh and Go Wakabaiashi, who performed a cholecystectomy using 3-mm instruments. The first study, with a considerable number of patients, was performed in Recife by Dr. Carvalho et al., and he reported that 719 patients were submitted to a MLC with a small rate of conversion for conventional laparoscopy (3.2%).[11] In <24 h after the procedure, 96% of the patients were discharged from the hospital. In 2008, Cabral et al. performed a prospective study with 60 patients, comparing MLC to the conventional 5-mm laparoscopic procedure. He concluded that both techniques were safe, with similar operative durations. However, the patients submitted to MLC presented a better aesthetic outcome and less pain until the postoperatory day 4.[12]

For many years, surgeons discussed the advantages of mini-laparoscopic procedures, such as aesthetic improvements and less pain? Several studies tried to find answers to these questions. Bisgaard et al.[13] showed that the cosmetic results were expressively superior in the 3.5-mm trocar group. Cheah et al.[14] showed that the MLC scars were 32% smaller than those of CLC. Kimura et al.[15] demonstrated that the scars become significantly smaller than the trocar diameters right after the surgery and after a 6-month follow-up. Besides, the pigmentation attenuates while the scar reduces.

In 2009, another publication by our team showed the results after 1000 cases in Brazil. One important finding was that the use of knots instead of clips significantly reduced the cost of the procedures.[3]

However, mini-laparoscopy has proven to provide more than just better aesthetic results. Other advantages of its use have been confirmed; they include better visualisation of the surgical field and allows the surgeon to perform more precise movements.[16] We conducted a study comparing the abilities of surgeons, residents and students performing different tasks with conventional 5-mm instruments and 3-mm minilaparoscopic instruments. When comparing CLC to MLC, medical students and residents took less time to perform more precise tasks (such as tying a knot, passing a suture through metal rings, and creating a necklace) when using mini-laparoscopic instruments.[16]

The most traditional use of mini-laparoscopic instruments is while performing cholecystectomies. However, these instruments can also be used in hernia procedures and more complex surgeries.[17],[18],[19],[20] It has become very popular in inguinal hernia repairs. When working in a limited space, such as in totally extraperitoneal (TEP) repair, smaller instruments have helped surgeons perform more precise movements and have a better visualisation of the surgical field.[20],[21]

Carvalho et al. showed a combined totally transabdominal pre-peritoneal and a TEP technique) for inguinal hernia repair. With a successful description of 22 cases, this technique proved to be safe and simple and with reduced costs. There was no use of balloon dissection or mesh fixation.[21]

Malcher et al. showed that mini-laparoscopic TEP (TEP inguinal hernia procedure) can benefit patients and surgeons due to the reduction in early post-operative pain and reduced operative time when compared to the conventional laparoscopic TEP procedure. He also described the reduced costs due to not using a dissection balloon or mesh fixation.[20]

The mini-laparoscopic technique, over the years, has proved to be a very reliable and important option for Brazilian surgeons. It cannot be declared as being better or worse than other consecrated techniques. However, surgeons ought to be aware of this technique while preparing this strategy for the next surgery. It is been 20 years of mini-laparoscopy in Brazil, and even with the rising popularity of the robotic surgery, mini-laparoscopy is far from becoming obsolete.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.

 

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