Editing Laparoscopy (section)

===Colon and kidney===
In certain advanced laparoscopic procedures, where the specimen removed is too large to pull through a trocar site (as is done with gallbladders), an incision larger than 10&nbsp;mm must be made. The most common of these procedures are removal of all or part of the colon ([[colectomy]]), or removal of the kidney ([[nephrectomy]]). Some surgeons perform these procedures completely laparoscopically, making the larger incision toward the end of the procedure for specimen removal, or, in the case of a colectomy, to also prepare the remaining healthy bowel to be reconnected (create an [[Surgical anastomosis|anastomosis]]). Many other surgeons feel that since they will have to make a larger incision for specimen removal anyway, they might as well use this incision to have their hand in the operative field during the procedure to aid as a retractor, dissector, and to be able to feel differing tissue densities (palpate), as they would in open surgery. This technique is called hand-assist laparoscopy. Since they will still be working with scopes and other laparoscopic instruments, CO<sub>2</sub> will have to be maintained in the patient's abdomen, so a device known as a hand access port (a sleeve with a seal that allows passage of the hand) must be used. Surgeons who choose this hand-assist technique feel it reduces operative time significantly versus the straight laparoscopic approach. It also gives them more options in dealing with unexpected adverse events (e.g., uncontrolled bleeding) that may otherwise require creating a much larger incision and converting to a fully open surgical procedure.<ref>{{cite journal | vauthors = Kaban GK, Czerniach DR, Litwin DE, Litwin DE | title = Hand-assisted laparoscopic surgery | journal = Surgical Technology International | volume = 11 | pages = 63–70 | date = 2003 | pmid = 12931285}}</ref>

Conceptually, the laparoscopic approach is intended to minimise post-operative [[pain]] and speed up recovery times, while maintaining an enhanced visual field for surgeons. Due to improved patient outcomes in the early 21st century, laparoscopic surgery has been adopted by various surgical sub-specialties, including gastrointestinal surgery (including bariatric procedures for [[Obesity|morbid obesity]]), gynecologic surgery, and urology. Based on numerous prospective [[randomized controlled trial]]s, the approach has proven to be beneficial in reducing post-operative morbidities such as wound infections and incisional [[hernia]]s (especially in morbidly obese patients), and is now deemed safe when applied to surgery for cancers such as cancer of colon.<ref name=":0">{{cite journal | vauthors = Shabanzadeh DM, Sørensen LT | title = Laparoscopic surgery compared with open surgery decreases surgical site infection in obese patients: a systematic review and meta-analysis | journal = Annals of Surgery | volume = 256 | issue = 6 | pages = 934–45 | date = December 2012 | pmid = 23108128 | doi = 10.1097/SLA.0b013e318269a46b | s2cid = 5286895 }}</ref><ref>{{cite journal | vauthors = Ma Y, Yang Z, Qin H, Wang Y | title = A meta-analysis of laparoscopy compared with open colorectal resection for colorectal cancer | journal = Medical Oncology | volume = 28 | issue = 4 | pages = 925–33 | date = December 2011 | pmid = 20458560 | doi = 10.1007/s12032-010-9549-5 | s2cid = 24029741}}</ref>

[[File:Laparoscopic Hand Instruments 001 JPN.jpg|thumb|Laparoscopic instruments]]

The restricted vision, the difficulty in handling of the instruments (new hand-eye coordination skills are needed), the lack of tactile perception, and the limited working area are factors adding to the technical complexity of this surgical approach. For these reasons, minimally invasive surgery has emerged as a highly competitive new sub-specialty within various fields of surgery. Surgical residents who wish to focus on this area of surgery gain additional laparoscopic surgery training during one or two years of fellowship after completing their basic surgical residency. In OB-GYN residency programs, the average laparoscopy-to-laparotomy quotient (LPQ) is 0.55.<ref>{{Cite journal |last1=Sami Walid |first1=M. |last2=Heaton |first2=Richard L. |date=2011-05-01 |title=Laparoscopy-to-laparotomy quotient in obstetrics and gynecology residency programs |url=https://doi.org/10.1007/s00404-010-1477-2 |journal=Archives of Gynecology and Obstetrics |language=en |volume=283 |issue=5 |pages=1027–1031 |doi=10.1007/s00404-010-1477-2 |pmid=20414665 |issn=1432-0711}}</ref>