First, the characteristics of laparoscopic surgery 1, small local trauma laparoscopic surgery of local trauma is mainly manifested in: (1) lighting deep into the surgical field, small abdominal wall opening. Open surgery requires a large opening, mainly because the lighting source outside the body and the operator’s hand to enter the abdomen for operation and field exposure. The illumination used in laparoscopic surgery reaches deep into the operative field and is well illuminated, so that the operator’s hand does not enter the body and the operation can be performed outside the body, using position changes and pneumoperitoneal pressure and appropriate traction to achieve the required operative field exposure. Multiple small incisions in the abdominal wall and protected by trocars should cause less damage than the sum of it. (2) The hand does not enter the abdominal cavity can reduce the damage to the organ peritoneum and interference with organ function, and the postoperative gastrointestinal function recovers quickly with less abdominal adhesions. (3) Laparoscopic surgery requires a bloodless surgical environment, and the principle is bloodless surgery, with coagulation and hemostasis before separation or separation while hemostasis. Most laparoscopic gallbladder surgery rarely bleeds, generally bleeding 25ml on average, and the bleeding with laparoscopy for low rectal cancer surgery is only 5-80ml. 45ml on average, and the bleeding in the laparoscopic splenectomy group is also less than that in the open group, and the small wound is also a reason for less bleeding. (4) The operation time was shortened. In the early stage of laparoscopic surgery, the operation time was longer than that of open surgery due to unskilled technique; with the improvement of technique and accumulation of experience, as well as the development of new and applicable instruments, the operation time of experienced doctors and mature surgery was gradually shortened. A typical cholecystectomy takes about 20-30 minutes; a colectomy takes about 2 hours, and a splenectomy takes about 30-100 minutes. Shortening the operation time can reduce trauma. 2.Light systemic reaction With the wide development of laparoscopic surgery, the research on systemic reaction caused by laparoscopic surgery is increasing. The systemic reactions caused by surgical trauma are mainly manifested in: (1) neurohumoral system; (2) immune system; (3) recovery of organ function. The neurohumoral system: Adrenocorticotropic hormone (corticosterone) is mostly used as the measurement index, and KuntzC et al. did an experimental study on colon resection surgery in rats, and the animals were divided into three groups: anesthesia only, traditional surgery and laparoscopic surgery. BerguerR did an experimental study with rats, and the animals were divided into three groups: (1) anesthesia-only unoperated group, (2) open fundoplication group, and (3) laparoscopic fundoplication group. The results were that plasma corticosterone levels were significantly lower in the laparoscopic fundoplication group than in the open fundoplication group. The results of these experiments showed that laparoscopic surgery induced a significantly lower organismal stress response than open surgery. Immune system: interleukin has a strong response to trauma and infection and is a commonly used indicator to determine the degree of tissue damage. Interleukins are elevated after laparoscopic cholecystectomy and open cholecystectomy, and the elevated levels are more pronounced in the open than in the laparoscopic, as has been reported in several articles. kuntzC used IL-1 and neopterin as observational indicators in experiments with murine colectomy. neopterin belongs to the pteridine group, which is a biochemical indicator of the cellular immune response to surgical trauma. Its biosynthesis increases in the presence of inflammatory diseases, trauma and surgical stress. experimental results showed that neopterin was significantly elevated in the open surgical group after surgery and returned to its original level on the first postoperative day; while the changes in the laparoscopic and simple anesthesia groups were small, and the difference between the two was obvious. changes in IL-1, which began to increase in the open group after surgery, peaked on the first postoperative day and lasted until the seventh day It still did not return to its original level. There was a mild change in the laparoscopic group and no significant change in the anesthesia group. The difference between the results of the postoperative open group compared with those of the laparoscopic group was significant. Therefore, he concluded that the changes in the immune system caused by laparoscopic colectomy were less than those caused by open surgery. 3. Fast recovery of organ function The comprehensive results above show that laparoscopic surgery is less traumatic to the surgical local area, less systemic stress and less impact on the immune system. Patients can resume normal activities in a short period of time, thus some pulmonary complications, wound complications can be avoided. Early feeding and nutrition from normal sources are possible. Laparoscopic cholecystectomy allows the patient to move and eat on the same day or the next day after surgery, and he is usually discharged on the third postoperative day and resumes normal activities 7-10 days after surgery. Bowel function is restored 2 days after laparoscopic splenectomy and fluid is allowed, with an average stay in the hospital of 5 days after surgery. The recovery of bowel function and the time to eat after laparoscopic colectomy as well as the postoperative stay in the hospital were also significantly shorter than those after open surgery. In summary, laparoscopic surgery has outstanding advantages compared with traditional surgery: (1) good illumination of the surgical field, magnification of images, excellent surgical instruments, and microsurgical features; (2) avoidance or minimal severance of nerves or muscles in the body wall, and reduced incisional complications; (3) light visceral interference and rapid recovery of organ function; (4) small poke holes, flexibility, and ease of combined diagnosis and treatment of multiple surgical diseases; ( (5) Since the participating surgical personnel can share the same picture, it is conducive to cooperation and teaching; (6) The threat of disease to the surgical personnel is reduced, and it is also possible to sit down and operate, reducing labor intensity. However, laparoscopic surgery also has its limitations: (1) the precision and fragility of laparoscopic equipment and instruments, the many links, greatly increasing the dependence of the surgeon on the instruments, (2) the loss of stereoscopic vision, increased operational difficulty, stereoscopy is far from ideal, (3) the loss of the surgeon’s ability to use the direct sensing of the fingers, probing, traction exposure and emergency treatment, (4) the higher cost of surgery. Therefore, the principles of laparoscopic surgery should be based on its superiority and limitations to master the surgical indications and strictly follow all the basic principles of surgery to achieve the same safe and effective surgical purpose as open surgery. In China, the design of complex types of laparoscopic surgery should be based on national conditions, with the premise of minimally invasive surgery, as far as possible to make the operation economical and safe, simple and easy, practical and fast, and easy to promote. Second, the application of laparoscopic surgery in the diagnosis and treatment of general surgical diseases 1, the application of laparoscopic technology in the diagnosis and treatment of biliary tract diseases The application of laparoscopic technology in biliary tract diseases is an example of the successful application of laparoscopic technology, and is also an important backing for the promotion of laparoscopic technology. Laparoscopic cholecystectomy soon emerged from the shadow of high initial complications and became accepted by almost all surgeons, gradually becoming the “gold standard” in the treatment of gallbladder diseases. The laparoscopic choledochotomy for extraction of stones on this basis is also becoming mature, and laparoscopic bile-intestinal drainage, laparoscopic choledochal cystectomy and biliary malignancy surgery are being attempted. Laparoscopic cholecystectomy is one of the most widely used and technically most mature procedures in general surgery. With the continuous improvement of technology and accumulation of experience, its indications have been expanded, and the previous contraindications can now be changed into indications. The indications are: (1) various types of symptomatic gallbladder stones, including acute and chronic calculous cholecystitis, gallbladder stone impaction, atrophic cholecystitis with stones, etc. Laparoscopic cholecystectomy during acute inflammatory attack is difficult, and the decision to avoid the attack period should be based on technical conditions, as is the case for atrophic cholecystitis with stones. Forced surgery when the technical conditions are not mature will increase the incidence of complications, and if intraoperative difficulties are found timely consideration should be given to intermediate open abdomen. (2) Recurrent non-stone cholecystitis is generally more cautious, but laparoscopic cholecystectomy should be considered if the symptoms are more severe and other diseases have been excluded as possible causes. (3) Polyp-like lesions of the gallbladder, such as large and fast-growing polyps, single polyps, neck polyps, etc. with suspected malignant changes, or combined with stones. (4) Asymptomatic gallbladder stones, such as large stones (greater than 2CM), porcelain-like gallbladder, long history (greater than 10 years), full of stones and other susceptible to malignant change, or gallbladder has irregular thickening. The main contraindications are: (1) severe heart, lung, liver and kidney disease, and inability to tolerate general anesthesia. (2) Severe bleeding tendency, which may cause intraoperative bleeding that is difficult to handle and control. (3) Severe infection in the abdominal cavity, and laparoscopic surgery may cause the spread of infection. (4) Severe cholangitis. (5) Severe cirrhosis and portal hypertension, where surgery may cause hemorrhage. (6) Those with suspected malignant change of gallbladder. Complications of laparoscopic cholecystectomy (LC) and their management: (1) Biliary tract injury is the most common complication of LC. In 1998, there were 114,005 cases of LC in the United States, and the biliary tract injury rate was 0.5%, and domestic statistics on biliary tract injury are generally lower than those abroad. LC biliary tract injury is generally more difficult to deal with because the common bile duct is generally not dilated in LC patients, and the bile duct may have been freed during surgery, and injury is more common with pad cautery, and in severe cases the common bile duct has been removed. At this time, the blood supply of the bile duct should be fully considered, and the end-to-end anastomosis should not be forced, which will lead to scar growth and biliary stricture. At this time, bile-intestinal internal drainage is often the best choice, and bile ductoplasty should be performed if necessary, and the suture must be fine, and complications such as postoperative bile leakage should be avoided as much as possible, otherwise it will also cause biliary stricture. (2) Biliary leakage is one of the common complications of LC. Domestic and foreign statistical results show that the complication rate of bile leak is between 0.14-0.29%. It mostly occurs due to bile duct stump leakage and bile duct paracolic duct injury. The occurrence of bile leak causes biliary peritonitis and in severe cases can cause toxic shock. If intraoperative drains have been placed and can be completely drained, the injury will generally heal on its own as long as it is not a bold duct. If the drainage can not be completely or intraoperative tube is not placed, often should be a second surgery to solve the problem. (3) intraoperative and postoperative bleeding LC intraoperative operation should be gentle, avoid violence, acute inflammation is easy to bleed, when the vessel is very brittle and easy to break, dissection should be kept in place, the tension should not be too great when the smaller vessels are severed, otherwise it will also cause bleeding. Some of the vessels have been closed at the time of dissection, but there is a possibility of recanalization after surgery, and titanium clips should still be left in place at this time. (4) Residual common bile duct stones About 15-20% of gallbladder stones are combined with common bile duct stones, preoperative examination should be based on the presence or absence of bile duct stones, if the diagnosis of bile duct stones is clear, ERCP can be performed first, if bile duct stones are suspected, intraoperative imaging is feasible, and laparoscopic choledochotomy choledochoscopy is feasible after clear diagnosis, or ERCP can be performed two days after LC. 2, laparoscopic techniques in the diagnosis and treatment of gastrointestinal diseases (1) Progress of laparoscopic gastric surgery The earliest laparoscopic partial gastrectomy was performed by Peter Goh, a Singaporean doctor, in February 1992, and the first laparoscopic subtotal gastrectomy in China was successfully performed by Qiu Ming and others in 1993. After more than 10 years of efforts, the laparoscopic gastrectomy technique has been greatly improved and the scope of clinical treatment has been broadened. The clinical application of laparoscopic gastric surgery in China has involved ① treatment of peptic ulcer and its complications; ② local excision of benign tumor of gastric wall; ③ subtotal resection of gastric ulcer with atypical hyperplasia; ④ radical surgery of early gastric cancer; ⑤ palliative surgery of advanced gastric cancer; ⑥ fundoplication for gastric reflux Esophageal reflux ⑦ Gastric decompression for morbid obesity. (2) Progress of laparoscopic colorectal surgery Fowler and Jacobs were the first to report laparoscopic colectomy in the early 1990s, and laparoscopic-assisted colorectal resection began to be carried out in Hong Kong in 1993, and the following year Shanghai Ruijin Hospital began research in this area, but the development was much slower than other laparoscopic surgeries, mainly because of the difficulty of surgery, expensive surgical instruments, and doubts about the treatment effect. The introduction and clinical use of ultrasonic knife in the 1990s led to the rapid development of laparoscopic colorectal surgery. Laparoscopic colorectal surgery has obvious advantages over traditional surgery in terms of recent recovery, and the follow-up data of several groups showed no statistical difference in survival rates at 3 and 5 years. This work has been performed in dozens of hospitals in China, and the surgical procedures involved are right hemicolectomy, transverse colectomy, left hemicolectomy, sigmoid colectomy, anterior rectal resection, combined abdominoperineal resection, sigmoid fixation, and colostomy. There are total laparoscopic surgery, laparoscopic-assisted colorectal surgery and hand-assisted laparoscopic surgery for benign and malignant colorectal tumors, congenital megacolon and redundant sigmoid colon, etc. 3.The application of laparoscopic technology in liver surgery The liver is the largest substantial organ in the human body, and with the development of liver surgery, the abnormally vascular liver is no longer a restricted area for surgery. With the invention of laparoscopic ultrasonic knife and endo-gia etc. making laparoscopic hepatic resection also possible, despite the relatively prominent difficulties encountered, it has still been developed to some extent, from the initial partial hepatectomy to left outer lobe resection of liver, right anterior and posterior lobectomy of liver and regular left and right hemicolectomy, and the diseases involved also range from benign liver cysts. hepatic hemangioma, intrahepatic bile duct stones to hepatocellular carcinoma. However, the development of laparoscopic hepatectomy has been relatively slow because there is not yet a good way to control the liver gate and laparoscopic hepatectomy is often encountered with hemorrhage. At present, dozens of cases of liver resection can be seen in China, and we have reason to believe that with further improvement of laparoscopic instruments, all livers that can be resected openly can be done laparoscopically. 4, laparoscopic techniques in pancreatic surgery clinical application The pancreas is an important digestive gland, pancreatic surgery is complex and difficult, its tissue is brittle surgery prone to bleeding and pancreatic leakage, laparoscopic surgery has the advantage of good illumination and magnified field of view, such as skilled technology, has certain advantages in stopping bleeding and preventing pancreatic leakage. Due to technical reasons and risk factors, laparoscopic pancreatic surgery is rarely performed, but a variety of procedures have been involved, such as laparoscopic pancreatitis drainage and laparoscopic internal drainage of pancreatic cysts. laparoscopic islet cell tumor resection, laparoscopic pancreatic body and tail resection, laparoscopic pancreaticoduodenectomy, and palliative surgery for advanced pancreatic cancer. Diagnostic staging of pancreatic cancer. Resection of pancreatic body caudal tumor is currently considered the most appropriate laparoscopic pancreatic surgery and has the largest number of surgical cases; resection of insulinoma requires a certain distance from the pancreatic duct; the biggest controversy of pancreaticoduodenectomy is the incomplete resection of the pancreatic hook. China has also carried out all of the above procedures, pancreatic body tail resection has also been reported in dozens of cases, more than ten cases of insulinoma reported, laparoscopic pancreaticoduodenectomy has been carried out in 8 cases in China, although not many cases carried out, but it can be seen that the role of laparoscopic technology in pancreatic surgery will become increasingly important. 5, laparoscopic technology in the clinical application of neck surgery As early as the early 1990s laparoscopic technology was used in thyroid surgery, the benefits of the operation to the patient is obvious, and therefore quickly accepted by the patient, in foreign countries has become the first choice of benign thyroid disease, even early thyroid cancer has also been completed under the lumpectomy. In China, the procedure was carried out almost simultaneously to treat thyroid diseases, but since most of the doctors who carried out the procedure in the early days were not thyroid surgeons, there were some complications and the thoroughness of the procedure was also problematic. With further development, the procedure has now been recognized and participated by thyroid surgeons, and the incidence of complications has decreased significantly, even lower than that of open surgery, and the benefits brought by the procedure have The benefits of the procedure have been not only in its cosmetic effect, but the good illumination and vision of laparoscopic surgery can further reduce intraoperative bleeding and the possibility of intraoperative nerve and parathyroid gland injury, and the good vision is still the basis for complete but not excessive resection, thus laparoscopic thyroid surgery will definitely be the mainstream surgical approach for thyroid disease in the future. Parathyroid adenoma resection is also a very suitable lumpectomy procedure because the number of cases is low and the number of surgical cases is still small. Hyperparathyroidism caused by parathyroid hyperplasia is one of the complications of chronic renal failure and long-term hemodialysis, and is more common in clinical practice. Traditional surgery can make patients have more bleeding and greater trauma. Laparoscopic surgery can avoid all the drawbacks brought by traditional surgery and bring cosmetic effects at the same time. 6, laparoscopic techniques in emergency surgery clinical application Acute abdomen is a common clinical disease, and most acute abdominal diseases can be diagnosed by clinical manifestations. The basic examination and laboratory tests clearly diagnose, such as acute appendicitis, acute cholecystitis, acute pancreatitis, gastroduodenal perforation, etc. Some acute abdominal conditions are difficult to diagnose definitively, but once signs of peritonitis are present a dissection should be performed, and the exploration incision is often separated from the lesion or far more complicated than expected. The application of laparoscopic techniques can avoid the difficulties and surgical trauma associated with dissection, and the diagnosis can generally be clarified. At the same time, as long as the good illumination and field of view of the laparoscope can be fully utilized, and the basic laparoscopic operating techniques can be skillfully applied, the surgery can be completed laparoscopically except for acute abdominal conditions with difficult exposure and tight adhesions. Acute rupture of substantial organs should depend on the condition. If it is a life-threatening hemorrhage, immediate open surgery should be performed, and laparoscopic surgery can be considered if the vital signs are stable. However, laparoscopic emergency surgery must require laparoscopic surgeons with considerable experience in open surgery and superb laparoscopic surgical techniques, otherwise it is difficult to ensure the safety of surgery. The conditions for the development of minimally invasive surgery are already in place, and the key is to change the concept. First of all, as an advanced medical practitioner should recognize and keep up with the form of scientific development, establish the patient-oriented medical principles, choose and master the treatment methods that make the patient get reasonable treatment and suffer the least damage. Minimally invasive surgery and traditional surgery are complementary relationships, minimally invasive surgery must be based on traditional surgery, traditional surgery standards to measure the effectiveness of minimally invasive surgery, but also traditional surgery as the backbone, minimally invasive surgery and traditional surgery are to follow the principle of minimally invasive. Minimally invasive surgery is the direction of development, and there is a process of concentration, proliferation, promotion and popularization, which requires the efforts of all surgeons.