Visualization Options

Abstract

Minimal access surgery has come of age over the last 30 years. Urologists have been practicing minimal access surgery that has been genuinely scarless for more than 80 years. However, those scarless surgeries (and genuinely natural orifice endoscopic surgeries) were performed using the portal of the urethra to access the genitourinary organs. Since the first laparoscopic cholecystectomy by Muhe in 1985, laparoscopic surgery has been used to operate on every organ within the abdominal cavity using multiple small incisions ranging from 3 to 15 mm. These were all performed using rigid rod-lens endoscopes for visualizing the abdominal cavity. In open surgery the vision was binocular and the visual axis and the operating hands were in line, causing an acute and equal azimuth angle (defined in laparoscopic surgery as the angle between the visual axis and the operating or working axis) and allowing movements to be automatic, ingrained, and intuitive. In laparoscopy, the magnification and reproduction of the image on a monitor via a closed-circuit system significantly alter the image, influencing visual perception and causing a peripheral convexity or barrel distortion, called the fish-eye effect. Coupled with a widening and at times obtuse azimuth angle, this made laparoscopic surgery difficult and necessitated a great deal of mental processing, including learning hand-eye coordination, interpretation of the dimensions, and tissue recognition and depth perception based on the visual clues provided by this enhanced apparent image. However, this “Nintendo Surgical Revolution,” which began in 1987, was something that the “Nintendo” generation or the twenty first-century surgeon could relate to, and by the turn of the century, laparoscopy was the accepted gold standard for most routine abdominal surgery.