Preface

Minimally invasive surgery has led to a paradigm shift in surgical techniques over the past thirty years. Open surgical procedures are gradually being replaced with minimally invasive methods. In recent times, we have witnessed the development of different technological advances in surgery, new surgical approaches, and the introduction of surgical robotics in daily clinical practice. This technology along with highly skilled work by surgeons have allowed the laparoscopic approach to be applied in a wide range of surgical procedures across all medical specialties.

Technology is an essential part of our everyday lives, and medicine and surgery have also adopted some current technological advances to benefit patients. Everything seems to indicate that the future of surgery will remain closely linked to robotics, image-assisted surgery, wearable technologies, and others, such as artificial intelligence, that are still evolving. However, it will be a while before we know their true impact on clinical medicine.

Aimed at surgeons of all levels, this book outlines some of the most recent advances in the field of laparoscopic surgery. We have collected valuable contributions from relevant surgeons who present their diagnostic and therapeutic experience using minimally invasive approaches. Topics range from surgical robotics to the use of the transanal approach and single-incision laparoscopic surgery, among others.

We hope you enjoy reading this book as much as we enjoyed preparing it.

**Francisco M. Sánchez Margallo and Juan A. Sánchez-Margallo** Jesús Usón Minimally Invasive Surgery Centre, Cáceres, Spain

**1**

Section 1

Introduction and Basic

Aspects of Minimally

Invasive Surgery

Section 1

Introduction and Basic Aspects of Minimally Invasive Surgery

**3**

surgery [3, 4].

**Chapter 1**

Surgery

*and Jesús Usón*

**1. Introduction**

and faster recovery.

Introductory Chapter: Addressing

the Challenges of Laparoscopic

*Francisco M. Sánchez-Margallo, Juan A. Sánchez-Margallo* 

The field of surgery has experienced a revolution in the present era with a dramatic shift from the traditional open surgery to minimally invasive surgery (MIS). This has been associated to numerous advantages over open surgery, mainly for patients, such as a reduction of tissue trauma and smaller postoperative scars, which in turn involves shorter hospital stays, reduction of the postoperative pain,

Apart from all these meaningful benefits, this evolution in surgery also results

Laparoscopic surgeons are required long training time, experience, and practices in order to deal with the technical limitations introduced by laparoscopic surgery and become proficient. Due to the steep learning curve that laparoscopic surgery demands in certain surgical procedures, advanced and structured training programs and methods are constantly being introduced [1, 2]. Recently, there is a paradigm shift from traditional subjective assessment methods of trainees to more objective assessment tools that can accredit surgeons as competent in laparoscopic

Despite the many advantages laparoscopic surgery offers to patients, laparoscopy also entails a number of technical limitations for surgeons. The performance of this surgical technique implies important restrictions on freedom of movement, mainly due to the use of rigid and long surgical instruments with poor ergonomic design, the location of the screens, the use of pedals to control the diathermy system, and by the fixed surgical ports for the instruments. These limitations result in an increased incidence of static postures in surgeons and the adoption and

in many technical challenges for surgeons. Relative to open surgery, surgeons lose direct vision, and only two-dimensional indirect vision through a display is available. This indirect vision sometimes takes the sense of orientation and depth perception away from surgeons. The precise manipulation of the laparoscopic instrument tip is restricted mainly because these instruments are generally slim and long and with limited dexterity. Most of the instruments are straight and do not have flexible tips. This surgical tools also lead to a reduction of sensory feedback during surgery due to surgeons cannot directly touch the organs in the body. Some of these limitations make the development of common surgical procedures in open surgery not as straightforward and simple through minimally invasive surgery. This book is just a step forward for the readers to learn further the recent surgical techniques and technologies that have emerged in order to deal with the

aforementioned challenges in minimally invasive surgery.
