We are all familiar with various “mirrors” in medicine, such as gastroscope, colonoscope, cystoscope and so on. The name “mirror”, as the name implies, is used to look at, what mirror is to look at where. So, laparoscopy was initially used to investigate the inside of the abdominal cavity. Only, unlike gastroscopy, enteroscopy, etc., where the organ is accessed through the body’s natural cavity, laparoscopy requires a hole to be made in the abdominal wall to look inside. The earliest clinical use of laparoscopy occurred in 1901. Later, it was realized that laparoscopy could not only be seen, but also operated. So, in 1986, some doctors began experimenting with laparoscopic cholecystectomy on animals, and in 1988 the world’s first laparoscopic cholecystectomy was performed in France, and in 1989 a video of the operation was shown at a medical congress in the United States, causing a huge shock in the surgical community worldwide. At that time, many people were questioning that this type of surgery, which cannot be visualized inside the abdominal cavity, is irresponsible to the patient. Time has given us the answer, and now laparoscopic cholecystectomy has become the simplest and most common minimally invasive procedure that can be done very skillfully in almost any hospital, with no more than three days from admission to discharge. The hospital where I studied calls it a “one-day procedure” and has no problem doing seven or eight units a day. In the United States, laparoscopic cholecystectomy does not even require hospitalization at all. In addition to gallbladder removal, many hospitals prefer laparoscopic surgery for gastric and colorectal cancers. How is laparoscopic surgery done? Take laparoscopic cholecystectomy as an example, let’s talk about the process of a laparoscopic surgery: After the patient is diagnosed with gallbladder stones and has clear indications for surgery, all preoperative examinations are completed in the outpatient clinic and contraindications to surgery are ruled out before admission to the hospital. After general anesthesia, two surgeons come on stage and make a small 1 cm incision in the skin next to the navel, then lift the abdominal wall near the navel with a scarf clamp and insert a pneumoperitoneum needle into the abdominal cavity through the incision, which is connected to carbon dioxide gas at the end to inflate the abdominal cavity, the purpose of this step is to enlarge the abdominal cavity and leave sufficient space for the operation. After inflation, the pneumoperitoneum needle is withdrawn and a 1 cm diameter trocar (called a poke card in technical terms) is inserted in the same incision, withdrawing the core and leaving the sheath, which enters the rigid mirror through this sheath and acts as a laparoscopic video system, displaying the situation inside the abdominal cavity in real time through a bedside monitor, acting as the surgeon’s eye, so that the surgeon is not looking at the patient but only at the “TV” during surgery. By looking inside the abdominal cavity, the surgeon selects 2-3 appropriate operating points on the abdominal wall and makes small 0.5-1.5 cm incisions through which poke cards are inserted to allow insertion of operating instruments (e.g., separating forceps, electric hooks, etc.). The above text can be simplified to the following diagram. At this point, even if the position is set up, the following is the open cut. The excision is performed without using either a knife or hands, but by pulling and electrocautery with one long and thin instrument, making the tissue separate and disconnect layer by layer. For an incision of about 0.5 cm, no stitches are needed and a band-aid is applied. for an incision of about 1 cm, a stitch under the skin and a band-aid on the epidermis is sufficient. The entire procedure takes about 1 hour. Laparoscopy vs open surgery Advantages: The advantage of laparoscopy over open surgery is that it is “minimally invasive”, i.e., the incision is small, which has the following benefits: less psychological pressure on the patient before surgery; less bleeding during surgery; quicker recovery after surgery, no analgesics needed, happy, can go to the floor on the same day; smaller scars after recovery. Disadvantages: The limitations of laparoscopic surgery also lie in “minimally invasive”: the intraoperative field of vision is not as good as that of the open abdomen, and some complex situations cannot be seen; the space for extracorporeal operation is limited, and complex surgical procedures cannot be completed. Therefore, laparoscopy can currently only be used for simple surgeries with little bleeding. If abnormal conditions such as heavy bleeding occur during laparoscopic surgery, or if intra-abdominal adhesions are very serious. If they cannot be resolved under laparoscopic operation, they will be converted to open surgery. All doctors will explain this problem to the family before laparoscopic surgery, so the family should be prepared for the possibility of open surgery midway through the operation. Laparoscopy is still evolving These limitations of laparoscopy are what medical practitioners are trying to break through. In less than 30 years of laparoscopic surgery, the pace of innovation in surgical instrumentation has been phenomenal, and the availability of a variety of instruments has greatly facilitated laparoscopic incision, suturing, clamping, dissection, and kissing. Today, 3D laparoscopic technology is available, allowing doctors to wear 3D glasses similar to those used in movie theaters and operate on a screen to get a more immersive view of what is happening inside the abdominal cavity. The photo shows a 3D laparoscopic surgery. What should patients choose? The question I get asked most often by friends and relatives about laparoscopy is: “Should I have this surgery done laparoscopically? My answer is always four words: “Listen to the doctor. Although psychologically, a relative or friend who knows about medicine can be trusted more, the fact is that the basis for my decision must not be as rich as your attending doctor. Since you have decided to let him operate on you, you should trust him completely, which is also beneficial to improve the success rate of the operation.