Surgical Techniques

Laparoscopic surgery, also known as keyhole surgery, is safe, established and minimally invasive and has replaced many open procedures. It reduces trauma and wound healing problems, benefiting patients. This advanced technique can be used for all kinds of laparoscopic procedures, from standard interventions such as cholecystectomy, appendectomy or inguinal hernia repair to advanced procedures such as laparoscopic rectal resection or laparoscopic gastric bypass and sleeve gastrectomy in bariatric surgery.

With the trend toward patient-friendly surgery, demand for small-diameter instruments is growing. Minilaparoscopic surgery continues the scarless advantages of natural orifice transluminal endoscopic surgery (NOTES) and single-port techniques while avoiding the drawbacks and risks of complex handling and a long learning curve. As an interdisciplinary technique, it is used in laparoscopic surgery, gynecology and urology.

With access ports of only 3.5 mm outer diameter and the right instruments, the scars are so small they are barely visible. The technique also minimizes surgical trauma, so hospital stays can be greatly shortened and patients can expect less pain. Surgeons can use familiar methods – just with smaller-diameter instruments.

Based on the successful ERAGONmodular concept, a new generation of three-part modular 3.5 mm instruments has been developed that meets high hygiene and application standards. The instruments can be used in surgery on adults and children.

As a refined, modern surgical method, minilaparoscopic surgery is now a standard procedure for cholecystectomy and appendectomy.

Gynecological laparoscopy is a specialty attracting more and more attention. Its main advantages are high patient acceptance, minimal trauma in hysterectomy, good surgical results and a markedly shorter recovery. In many cases, procedures such as hysterectomy can therefore be performed laparoscopically.

The following procedures can be performed by gynecological laparoscopy:

• Hysterectomy

Total laparoscopic hysterectomy (TLH)

Laparoscopic supracervical hysterectomy (LASH)

Laparoscopically assisted vaginal hysterectomy (LAVH)

• Myomectomy

• Oophorectomy

• Salpingectomy

• Urogynecological surgery

• Fertility surgery

• Surgery for ectopic pregnancy

• Endometriosis surgery

• Oncological surgery

Transanal endoscopic microsurgery (TEM) is used to treat diseases of the rectum. These treatments are collectively known as colorectal surgery and include procedures for benign and malignant tumors. They can be performed with conventional or laparoscopic techniques.

Most benign conditions requiring intervention are diverticular diseases. Diverticulitis is a disease of the colon – an inflammation caused by herniation of the mucosa. It often affects the sigmoid colon (sigmoid diverticulitis, sometimes called "left-sided appendicitis"). Most colon and rectal tumor operations can be performed laparoscopically, depending on the size and location of the tumor and the surgeon's experience.

Pediatric surgery is a separate surgical discipline covering patients from newborns to adolescents. Pediatric surgeons must therefore understand each patient's characteristics and stage of development in relation to their age. Today, minimally invasive techniques are naturally a common treatment in this field.

It covers every area from abdominal, thoracic and oncological surgery to pediatric urology and orthopedics. One focus of pediatric surgery is malformations. These conditions are often not limited to a single organ system, so pediatric surgeons rarely specialize in one organ as in adult surgery. Pediatric surgical techniques build on adult surgery, but because children are a special group, they often require special surgical approaches.

This means that surgical techniques and the technical development of the related instruments must follow specific rules that take the needs of child patients into account. Pediatric surgeons therefore often use their own particular approaches.

Richard Wolf has taken on this challenge too, working with experienced pediatric surgeons to develop special endoscopy systems and instruments for this specialty.