Advances in Abdominal Surgery

In the traditional method of open surgery, a large incision is made in the skin to enable the surgeon to “open up” the area and gain access to the tissues and organs. In the abdominal area, the incision may be made horizontally (called a transverse incision) or vertically (down the center, a midline incision). The large incision associated with open surgery can lead to a significant amount of postoperative pain, prolonged recovery and an increased risk for infection.

The next advance in abdominal surgery techniques came about 20 years ago, with the introduction of laparoscopic surgery. Instead of one large incision, surgeons make three to five small cuts in the skin (each up to about ½ inch long). Through one incision doctors place a tube with a lighted video camera. The camera captures and magnifies the images and sends them to a video monitor. A tube placed through another incision introduces carbon dioxide or another harmless gas into the body. The gas creates extra space in the abdominal cavity for the surgeon to “see” and maneuver tiny surgical instruments inserted through the remaining incisions.

Laparoscopic surgery is now being used for many different types of abdominal surgery. In fact it has become the standard of care for some types of procedures. For example, the Society of Laparoendoscopic Surgeons estimates over 90 percent of gallbladder surgeries can be done laparoscopically. With smaller incisions, patients have less pain and a faster recovery. In many cases, they can go home from the hospital on the day of the surgery. As the area heals, patients are left with several tiny marks rather than a large scar.

The newest advance in abdominal surgery is single incision access. The principle is similar to laparoscopic surgery except that only one incision is made. The incision is hidden within the belly button, so there are no marks or tiny scars on the skin from extra cuts.

Single Incision Access for Children

Most recently, surgeons at St. Christopher's Hospital for Children in Philadelphia have been able to access the abdominal cavity of a child through single incision access surgery via the belly button. Pediatric Surgeon, Matthew Moront, M.D., says, in children, the surgery is technically more difficult than in adults. Children have much smaller bodies, which may limit the size of the incision. In addition, the smaller bodies mean less room for instruments and maneuvering while working inside the abdomen.

One single incision surgery was done to remove an ovarian tumor. A tube for the carbon dioxide gas is inserted through the belly button. When the abdomen is inflated, the belly button pops out, making it a little easier to stretch the incision and pass through the camera and other instruments. The ovary is grasped and placed in a bag. Then the fluid is drained from the tumor, shrinking the tumor down to a size small enough for removal through the belly button.

In addition to ovarian tumors, surgeons at St. Christopher's have used the single incision access technique in children to remove an appendix and spleen. They have also used a similar single incision approach in a child’s chest wall to perform a lung biopsy and lung surgery.

Moront emphasizes that patient safety is of utmost concern. The single incision surgery leads to a little less pain than laparoscopic surgery, but at this point, is mostly done for its cosmetic benefit (the hidden incision). If during the procedure doctors believe the procedure is no longer safe, or if unexpected complications occur, the surgeons will revert to standard laparoscopic techniques.

For general information on laparoscopic surgery: Society of Laparoendoscopic Surgeons