Bleeding is one of the main complications during surgery, and may lead to transfusion and/or an increase in morbidity or mortality.[1,2] To understand the utilization of the different tools available today, here we explain the general concept of hemostasis.

Hemostasis is the process of blood clot formation at the site of vessel injury. As soon as the continuity of the endothelial layer is disrupted, a coordinated series of events are set in motion to seal the defect.[3] There are two pathways to hemostasis that may occur: intrinsic and extrinsic.

Abdominal laparoscopy was first introduced by Kelling and Jacobaeus in the early 1910s and later by Palmer in the 1950s and 1960s.[1,2] Palmer noted that this new operative technique was superior to culdoscopy as there was a decreased chance of infection, better views of the pelvis, improved access to the pelvic organs and cul-de-sac, and easier application of surgical techniques.

One of the most significant advancements in modern medicine has been the shift away from large incision “open” surgeries to video-assisted endoscopy, a groundbreaking innovation invented and pioneered by Camran Nezhat, MD, in the late 1970s.[1–4] Initially referred to as “keyhole,” “Band-Aid,” video surgery, or video laparoscopy, video-assisted endoscopy and video-assisted thoracoscopy (VAT) are now universally referred to as “minimally invasive surgery” (MIS), with or without robotic assistance. Dismissed as a barbaric and dangerous gimmick just 30 years ago, today MIS is recognized for profoundly improving the health outcomes of hundreds of millions of patients around the world. Indeed, with countless lives saved and millions of hospitalizations and surgery-related permanent disabilities prevented, the transformative impact that MIS has had on patients has been so remarkable that it has been described as a change to surgery as revolutionary for our era as anesthesia was for the nineteenth century.

This chapter presents a systematic approach to learning laparoscopic suturing and discusses technologies that aid in laparoscopic suturing. The foundation of the systematic approach to laparoscopic suturing depends upon an understanding of the geometric relationships between the anatomy, the instruments, the needle, the suture, and the camera. The system breaks the complex tasks of laparoscopic suturing and knot-tying into manageable parts but avoids oversimplification. The goal is to learn the proper mechanics of suturing and use those mechanics to reproduce efficient and accurate suturing.

Vascular surgery has been one of the last fields in surgery to incorporate laparoscopy. This may largely be due to the fact that laparoscopic control of bleeding remains challenging and because vascular procedures inherently involve bleeding. However, recent improvements in laparoscopic approach, exposure, and instrumentation have resulted in an increase in the number of surgeons performing laparoscopic vascular surgery especially at the aortic level. Here, we present an overview of the current advantages, disadvantages, and special considerations of laparoscopic aortic surgery (LAS) and provide a description of the laparoscopic technique for aortobifemoral bypass.

Hysterectomy continues to be the most common gynecologic surgery in the US, as an estimated 600000 women undergo hysterectomy for benign indications each year. For women who require hysterectomy, the appropriate route of surgery is determined by anatomic considerations, the type of pathologic condition expected, patient preference, and physician experience and training. Since the first laparoscopic hysterectomy was performed by Reich in 1988, laparoscopic hysterectomy has emerged as an alternative to the traditional abdominal or vaginal hysterectomy.[1] In 1990, Nezhat et al. described the first laparoscopic hysterectomy performed with the GIA multifire stapler.[2] Minimally invasive approaches to hysterectomy have gained favor over the traditional abdominal approach because of their various benefits, which include decreased blood loss, less adhesion formation, fewer complications, shorter hospital stay, faster recovery, and improved cosmesis. Even some of the earliest studies regarding laparoscopic-assisted vaginal hysterectomy have shown favorable outcomes when compared to an abdominal approach.

The development of nonobstetric endoscopic surgery in pregnancy is relatively recent. Studies investigating the use of anesthesia and the performance of nonobstetric surgery in pregnancy were not performed until the second half of the twentieth century. Around the same time, video-assisted laparoscopy was invented and pioneered by Camran Nezhat and as it became embraced by the surgical community, it was also applied to the pregnant patient. Early concerns about the use of laparoscopy in pregnancy revolved around unknown effects of anesthesia and pneumoperitoneum on the fetus, difficult surgical entry due to the enlarged uterus with a potential for uterine injury, and the physiologic changes inherent to pregnancy. Numerous studies have demonstrated the safety of anesthesia in pregnancy, and pneumoperitoneum has likewise been shown to be safe for the mother and fetus. Once the feasibility of laparoscopic entry was demonstrated, a variety of procedures were found to be safe in pregnancy. Now, surgical procedures may be performed as indicated in any trimester of pregnancy.

The rapid co-evolution of instrumentation and surgical technique has allowed an ever-growing number of pediatric procedures to be performed using minimal access surgery (MAS). At present, any size or age patient (i.e., from fetus to adolescent) can benefit from MAS. Thoracoscopy and laparoscopy have many proven advantages when compared to open surgery including less postoperative pain, earlier return to normal activities, less risk of cosmetic and mechanical musculoskeletal deformities, possible less postoperative adhesive disease, and in many cases better exposure and magnification of the operative field. Given these potential benefits, MAS has been increasingly adopted by pediatric surgeons as the preferred approach for management of many surgical diseases in children and infants.

This chapter offers a relatively broad perspective on factors continuing to shape the development, manufacture, and clinical use of medical equipment. In addition to the changes that new technologies spark in the medical device field, discussion includes the ongoing development of medical devices to the present time, a process that has been essentially an incremental yet persistent continuum of evolutionary refinement of both tools and applications – from rudimentary tools and practices initially uncertain at best, to remarkable high-tech implements and systems that enable procedures unimaginable a decade ago.

Knowledge of anatomy is the keystone for moving through every kind of surgery, even if some technical peculiarity of each technique might change our point of view of the landmarks (i.e., laparotomic traction versus laparoscopic magnification).

Surgical anatomy sometimes seems different from textbook anatomy, but following simple embryologic rules, puzzling distortions caused by infiltrative diseases may be unraveled.

Nezhat invented video laparoscopy and pioneered its use in surgical disciplines. This revolutionized modern-day surgery.[1–7] The inherent advantages of minimally invasive surgery over open abdominal surgery include reduced surgical trauma, reduced postoperative pain, shorter recovery times, and fewer pulmonary complications.[8] These benefits of laparoscopy were realized only after the introduction of video laparoscopy in 1986 – prior to that time, laparoscopy was diminished by limited visibility given the need to look through the scope with one eye, and the inability of the rest of the surgical team to see the operative field and anticipate the needs of the primary surgeon.[9] Current disadvantages of laparoscopy with and without robotic assistance include longer operating times and higher equipment costs.

Adhesions are a known postoperative complication of gynecologic surgery occurring in 75–90% of patients following surgery. Adhesions can cause bowel obstruction, pain, infertility, and difficulty with the next surgery. Adhesions are formed as a physiologic healing response to tissue injury. Currently, despite research and the availability of multiple adhesion barriers, adhesions remain a persistent problem. The American Society for Reproductive Medicine (ASRM), along with many other international medical societies, recommends that efforts to minimize adhesion formation should be utilized including minimally invasive techniques and surgical barriers when performing pelvic surgery.

The adnexa are in an anatomic region in the pelvis that includes the ovaries, the fallopian tubes, and the structures within the broad ligament. The differential diagnosis of an adnexal mass is complex because of the wide spectrum of disorders that involve the adnexa. Most frequently, adnexal masses involve the ovary itself because of its inherent growth properties through ovulation.[1] The evaluation of an adnexal mass may be complicated, as imaging does not always clearly delineate the adnexa from other nearby organs. Between 5% and 10% of US women will undergo a surgical procedure in their lifetime because of a suspected ovarian neoplasm and between 13% and 21% of these women will be diagnosed with ovarian cancer.

To date, vascular surgery has largely been dominated by open surgical and endovascular techniques and has only more recently begun to adopt laparoscopic techniques in management. Laparoscopic-assisted techniques for aortoiliac disease were first developed and later modified into a totally laparoscopic approach. Equipment has steadily improved from early devices first adopted from general surgery to allow large vessel manipulation and anastomosis. Currently, evidence has shown the feasibility of laparoscopy in aortoiliac occlusive disease (AIOD) and abdominal aortic aneurysm (AAA) surgery. In this chapter, we discuss the current state of the laparoscopic and robotic approaches in vascular surgery, highlighting the benefits and limits of the procedure.

The field of modern surgery has evolved to be as minimally invasive as possible. The endorsement of laparoscopic surgical techniques in the past three decades has fundamentally transformed multiple procedures in several surgical spheres, with the Nezhat brothers being at the cutting edge of this revolution.[1]

Conventional laparoscopic surgery has set itself as the gold standard surgical approach compared to traditional open surgery. It allows surgeons to use smaller incisions to perform the same procedures done through traditional open surgery. The advantages of laparoscopy over laparotomy have been discussed extensively in the literature. These advantages include lower morbidity and mortality evidenced by decreased blood loss, reduced postoperative pain, shorter hospital length of stay, as well as faster recuperation and return to normal activity.

Monopolar electrocautery was first used for female sterilization. However, tragic problems like thermal injury to the bowel quickly raised concern surrounding the use of monopolar energy. Bipolar electrosurgical techniques without transection or resection of the fallopian tube have the longest history in the US among all methods of female sterilization.