approacheslaparoscopic

Approaches in laparoscopic surgery refer to the methods used to access the abdominal or pelvic cavity for minimally invasive procedures. The principal access categories are transperitoneal, retroperitoneal, and extraperitoneal approaches, each with specific indications, advantages, and limitations.

Transperitoneal laparoscopy enters the peritoneal cavity and generally provides a wide working space and familiar anatomy, making it the most common route for many operations such as cholecystectomy and colectomy. Retroperitoneal or extraperitoneal approaches access the target organ without opening the entire peritoneal cavity; these can reduce intraperitoneal adhesions and contamination risk. They are commonly used for kidney and adrenal procedures and for certain hernia repairs.

In groin hernia surgery, the transabdominal preperitoneal (TAPP) and totally extraperitoneal (TEP) approaches illustrate different routes to create a preperitoneal space for mesh placement. Single-incision laparoscopy (SILS) and laparoendoscopic single-site (LESS) techniques use one port or a few closely spaced ports for a more limited incision. Conventional multiport laparoscopy uses several ports to optimize triangulation and instrument range. Robotic-assisted laparoscopy adds articulating instruments and advanced visualization but generally employs similar access principles.

Safety and outcomes depend on careful patient selection, surgeon experience, and readiness to convert to open surgery if visualization or safety is compromised. Indications span gallbladder, appendix, hernia repairs, nephrectomy, colectomy, and many gynecologic and urologic procedures, with ongoing assessment of operative time, blood loss, recovery, and complication rates.