Benefits of Low Impact Laparoscopic Surgery for Patients

This report delves into the benefits of low impact laparoscopic surgery, specifically within the field of gynaecology. It begins with an abstract summarizing the research and an introduction highlighting the evolution of laparoscopy and the advantages of low impact techniques like reduced insufflation pressure and microcoelioscopy. The report clearly states its aim to assess low impact laparoscopy, identify its challenges and advantages, and its objectives include analyzing the concept, comparing it to conventional methods, and recommending advancements. The background section explains the shift from open surgery to laparoscopy and the evolution towards mini-laparoscopy, emphasizing its potential to reduce postoperative pain and improve patient outcomes. A comprehensive literature review follows, exploring existing research on low impact laparoscopy, comparing it with conventional methods, and identifying challenges and benefits. The research methodology outlines the need for the study, the research philosophy, and the proposed data collection and analysis methods, including a questionnaire-based approach with 30 gynaecological surgeons. Finally, the report includes proposed dissertation chapters, ethical considerations, a conclusion, and a timeline, all of which contribute to a comprehensive assessment of low impact laparoscopic surgery's benefits and implications.

LOW IMPACT
LAPROSCOPIC SURGERY
IS BENEFICIAL FOR
PATIENTS

Table of Contents
ABSTRACT.....................................................................................................................................3
INTRODUCTION...........................................................................................................................3
AIM AND OBJECTIVES................................................................................................................4
Aim..............................................................................................................................................4
Objectives....................................................................................................................................4
BACKGROUND.............................................................................................................................4
LITERATURE REVIEW................................................................................................................5
RESEARCH METHODOLOGY.....................................................................................................7
Why research is required?............................................................................................................7
Research Philosophy....................................................................................................................7
Hierarchy of Evidence.................................................................................................................8
METHODOLOGY........................................................................................................................10
Study design...............................................................................................................................10
Research question......................................................................................................................11
Data Collection..........................................................................................................................11
Proposed search strategy............................................................................................................12
Data Analysis, Interpretation and Synthesis..............................................................................12
PROPOSED DISSERTATION CHAPTERS................................................................................13
ETHICAL CONSIDERATION.....................................................................................................13
CONCLUSION..............................................................................................................................13
INTENDED TIMETABLE............................................................................................................14
REFERENCES..............................................................................................................................15

ABSTRACT
The use of Laparoscopy as a gynaecological surgical method is constantly evolving and
under this research, the researcher will identify the benefits of Low Impact Laparoscopy over the
conventional method of Laparoscopy. The researcher will conduct a qualitative research and the
data analysis will be done in the form of thematic analysis technique. The research that has been
proposed will utilize a questionnaire method where the 30 gynaecological surgeons i.e. doctors
will be selected as respondents and data will be analysed accordingly. Finally, the conclusion
will be drawn and the recommendations on the basis of the research finding will be made in the
proposed research.
INTRODUCTION
The use of Laparoscopy has continuously evolved where it is no longer limited to the
treatment of tubal ligations or a for the diagnostic purpose and it is increasingly being used in the
gynaecological as well as non gynaecological surgeries. The use of laparoscopy basically
involves use of a surgical tool laparoscope that has a small camera and a led pointer at its tip and
is used to conduct operations majorly in the abdomen or lower pelvis in individuals. Earlier this
tool was used mainly in the lower abdomen related surgeries and the shorter cuts that could heal
in a better way as opposed to the long cuts of open surgery are some key benefits that have made
the use of laparoscopy so popular (Gear, Eppel & Koziol-Mclain, 2018). The cuts were made
only of half inches as opposed to the 6-12 inches cut that were made earlier in the open surgery
and these also healed much quickly than that single cut.
However, the postoperative pain that occurred in the laparoscopy was immnse and the
patients sometimes developed serious consequences due to the scarring that occurred internally.
The Low Impact Laparoscopy is an invasive technique which assists in minimizing the
postoperative pain and the recovery time of the patients significantly. Under this, the insufflation
pressure is reduced from the standard pressure of 12 to 15 mmHg to the lower pressure range of
7 to 10 mmHg. The microcoelioscopy is another technique which involves the use of trocars in
the surgery and from the standard of 5 to 12 mm trocars the size is effectively reduced to only 3
mm trocars. Collectively, these both help in reducing the postoperative pain because the size of
incisions gets reduced. The current research is conducted to examine the advantages of such low
impact laparoscopy in the gynaecological surgeries and its benefits over the conventional
laparoscopy surgical methods.

AIM AND OBJECTIVES
Aim
To assess the implementation of low impact laparoscopy in gynaecological surgery and identify
the challenges and advantages associated with its use in the surgeries performed.
Objectives
 To analyse the concept of Low impact Laparoscopy or mini laparoscopy in the field of
gynaecological surgeries.
 To identify and compare the results of low impact laparoscopy as opposed to
conventional laparoscopy.
 To ascertain the challenges and benefits that arise from the Laparoscopy in
gynaecological surgery.
 To recommend correct strategies and discuss further advancements in the field of mini
laparoscopy in the gynaecological sector.
BACKGROUND
Laparoscopy in gynaecological treatments is a much preferred treatment method and is
the best alternative to the open surgery that was used until much recently. Laparoscope allows
the doctor in reviewing the inside of the body with a telescope that is very small and there are
variety of surgeries that can be performed such as ovarian cyst removal, tubal ligation,
hysterectomy etc. being major surgeries under gynaecology (Lawrie& et.al., 2019). Although
laparoscopy is a good intervention for the treatment of the problems related to abdomen, pelvis
etc., the fact that there have been further development of mini laparoscopy and use of robots
leaves the conventional or traditional laparoscopy as an almost redundant method.
It is necessary to evaluate how effective the mini laparoscopy or the Low Impact
laparoscopy is in the gynaecological surgeries that take place and whether the lower incision
levels and the insufflation are effective in reducing the postoperative pain in the patients which is
considered to be significantly higher under the traditional laparoscopy. The technique further
assists in improving the outpatient management by the ability of the scars to heal very quickly
and the scarring being significantly lower which allows the patient to quickly recover (Brown,
Chien & Tang, 2019). The study that has been proposed will basically compare the effectiveness
of Mini Laparoscopy with that of the traditional Laparoscopy and the identification of the
various challenges or benefits that are associated with it.

LITERATURE REVIEW
Literature review is considered to be one of the most appropriate approach which tends to
include substantive findings on the particular research topic. It is based on the secondary source
of data and it also helps in critical evaluation of the research problem.
To analyse the concept of Low impact Laparoscopy or mini laparoscopy in the field of
gynaecological surgeries.
de’Angelis & et.al. (2018) determined the fact that, Low impact Laparoscopy is
considered to be one of the most advanced surgical protocol which in turn tends to combine use
of min laparoscopic tool under stable and low pressure pneumoperitoneum. This in turn helps in
minimizing the risk associated with the carbon dioxide insufflation and surgical invasiveness on
the environment. Petrucciani & et.al. (2019) examined that, Low impact Laparoscopy is
considered to be as an invasive technique which aids in minimizing the postoperative pain and
also helps in reducing the recovery time of the patients significantly. Gynaecological
laparoscopic surgery in turn is considered to be as an alternative to an open surgery.
Laparoscopic surgery helps to look inside the pelvic area of the person seeking care. A
laparoscope is referred to as a slender which helps health care practitioner to see inside the body
of an individual. Zinsou & et.al. (2019) argued that, Laparoscope surgery tends to have shorter
recovery time as compared to an open surgery. The key benefits of low impact laparoscopy
surgery in the field of gynaecological surgery is that, it helps in avoiding incisions and it also
results in lower blood loss, discomfort and pain. Mini laparoscopy is turn is referred to be as a
surgery which has been carried out with the instrument which is 2 to 5 mm in the diameter. It
helps in performing variety of gynaecological surgery such as removal of the ovarian cyst, tubal
ligation and hysterectomy.
To identify and compare the results of low impact laparoscopy as opposed to conventional
laparoscopy.
Souche & et.al. (2018) determined the fact that, technical limitation and physical strain is
faced by the conventional laparoscopic surgery. Micro laparoscopic surgery is considered to be
one of the safe and prominent alternative when compared with the results of conventional
laparoscopic. Patients who tends to undergo Micro laparoscopic surgery in turn has significantly
low body mass index. They also tend to stay less in the hospital prior to the surgery. Low impact
laparoscopic surgery tends to have decreasing impact on the patients as compared to

conventional laparoscopic surgery. Mini laparoscopy surgery vs Conventional laparoscopic
surgery has been used to for the patient suffering from endometriosis. When the results have
been compared, Mini laparoscopy surgery is considered to be more safe for the patients with
endometriosis. On the other hand, Boujlel & et.al. (2019) sought to investigate that, Mini
laparoscopy surgery vs Conventional laparoscopic surgery has been used to for the patient
suffering from Benign Adnexal masses. When the results have been compared, Mini laparoscopy
surgery is considered to be more safe for the patients with Benign Adnexal masses.
Challenges and benefits associated with the Laparoscopy in Gynaecological Surgeries.
The authors, .Maitra, Das & Das (2020), in their research paper have detailed the
complications that arise while conducting the Laparoscopic surgery where they state that the
intricacy of the surgery and the technical difficulty that is poses is one of the major complication.
The degree of precision and adeptness that this surgery requires is too high and therefore the use
of robots as the operators is a very beneficial potion that has been developed. The authors have
further illustrated that there is a major risk of the surgery going wrong which might affect the
patient negatively and the consequences that have been developed might also be very severe.
They have however stated the benefits of Low Impact Laparoscopy over the original
Laparoscopy stating that it can be more beneficial for the patients as it is effective in reducing
the pain that the patient might experience after the surgery has been done and it also minimizes
the chances of the potential side effects of these surgeries where the healing time for the patients
is much lower, and they are able to perform outpatient surgeries which earlier was impossible
when the open surgeries were performed.
However, the Dick & Hannay (2017), have criticized the above point stating that the use
of robots as a substitute for the laparoscopic surgeries is not an effective solution. They have
argued that using robots is a very advanced and developed technology that everyone cannot
afford. The authors also state that in certain backwards areas, even laparoscopy is not possible
due to lack of adequate funds for the healthcare sector and concluding that use of robots will
minimize the challenges that laparoscopy poses will be a wrongful assumption. Further,
elaborating on the inefficiency of the laparoscopy, the authors identified that obesity in the
patient, cardiac arrest and the use of technical instruments in the surgery pose to be the reasons
for major complications where the risk increases ten folds in the gynaecological surgeries that
are performed through this technique of treatment.

The literature review done above helps in concluding that although some very significant
points in the field of laparoscopy have been raised in the past research, the benefits of mini
laparoscopy have not been fully analysed and presented and only one or two major factors have
been discussed. The proposed research will help in filling up the research gap by collecting the
view of different gynaecologists whose view will be collected in the proposed research.
RESEARCH METHODOLOGY
The research methodology will help in understanding that what are the various research
tools that are available to the researcher and how these can be used to conduct the intended
research in the field of laparoscopy. This section will help in identifying what are the best
options for the research related to laparoscopy surgery and which the researcher shall select.
Why research is required?
This section highlights what is the purpose behind carrying the proposed research i.e.
how will it contribute to the existing research that has been done in the field of laparoscopy
(Brown, Chien & Tang, 2019). The research is usually done in order to identify what are the new
fields that need to be observed and what are the new questions that will be addressed by the
completion of the research.
The research on the advantages of Low Impact Gynaecological Surgery will help in
ascertaining that what are the key developments in the field of research and it will help in
widening the knowledge about how this technique is more useful than the traditional laparoscopy
research surgery. The various benefits and challenges that arise while exercising the research will
be discussed and evaluated regarding the implementation of Low Impact Gynaecological
Surgery. In order to conduct the research successfully, the researcher needs to develop a proper
research philosophy that will help in addressing the research objectives accordingly.
Research Philosophy
The research philosophy illustrates the belief of the researcher regarding the method of
data collection, evaluation or analysis and ultimately interpretation. Such research philosophies
help in determining what is the series of steps that need to be adopted in order to conduct the
research successfully. There are two major classification of research philosophy i.e. positivism
philosophy and Interpretivism philosophy. The positivism philosophy is also called scientific
philosophy where the hypothesis method is used in order to analyse the data that has been
collected and develop proper deductions (Lee & et.al., 2018). This philosophy is generally used

in the quantitative research types where the collection of data is majorly in the numerical terms
and the researcher issues statistical analysis tools. On the other hand, Interpretivism approach is
used only when the data type is more theoretical in nature and the researcher plans to undertake a
qualitative research technique. Under this, the researcher analysed the qualitative facts and then
appropriate deductions are made.
For the proposed research, the researcher will undertake a qualitative research and
therefore will use the Interpretivism research philosophy that will help the researcher in
analysing the qualitative data that has been collected and therefore the research on Low Impact
Laparoscopy will be conducted effectively where the researcher will draw relevant conclusions.
Hierarchy of Evidence
The hierarchy of evidence is basically a ranking method that is used to rank the reliability
of the strength of the results that have been adopted in the research that has been conducted by
adopting different methods of data collection and analysis (Minas, 2017). The hierarchy of
evidence technique is mainly used in the medical researches that are undertaken and it illustrates
that whether the design of the study based on the data or evidence that has ben collected is at
higher scale on the hierarchy of evidence. The evaluation of the quality of study that has been
undertaken helps in understanding the precision and accuracy level of the results or conclusions
that have been drawn in the research.

As it can be inferred from the image above, the meta analysis or the systematic review technique
is considered as the strongest form of evidence that can be used in order to conduct the research
successfully and the expert opinion or the case study analysis or cohort studies are considered as
the weakest form of evidence for the medical researches.
Meta Analysis and Systematic Review Technique: The meta analysis is a technique where the
data is collected from a multiple studies and these are then compared with each other using
different statistical tools and techniques (Verheijen, 2018). The use of statistical tools increase
the accuracy level or precision level of the results thus increasing the evidence strength.
Systematic Review on the other hand is that technique where each research question is addressed
by the comprehensive collection of all the data that is available on that particular research
question. This technique is more thorough in collecting all the data that is available in a
systematic manner and then analysing it accordingly. Meta analysis technique, however, is often
found to be integrated with the systematic require technique because both involve collection of
the data specific to the research technique.
However, the accuracy is not 100% and there might be some chances of biasness even if
these are at the highest level on the hierarchy. Often the systematic review technique is a time
I
llustration 1: Hierarchy of Evidence
Source: Bedregal & et.al., 2017

taking procedure and some factors might be found to have changed by the time research gets
published i.e. there might have been some recent developments that can reduce the reliability of
the research.
Randomized Controlled Trials: This method is considered as the best method when the data
needs to be collected for a clinical trial. This technique provides the flexibility of comparing one
treatment method over another easily and is usually used to evaluate the impact of certain new
treatment methods in comparison to the older methods that were available for the selected
control group (Chodankar, Chamberlain & Rose, 2019). The RCT Technique helps in
eliminating any biasness that might be incorporated at the time of selection and the selection of
factors from a different range of field helps in the application of the probability method so that
data is analysed effectively.
Literature Review: Literature review technique helps in the evaluation of the past research that
has already been done in relation to the topic of the proposed research. This helps in collecting
and then critically analysing the various pros and cons of the research topic or area. This is a key
area in developing or generating the synthesis of the research work that has already been done in
the current field (Mansuri & et.al., 2017). Based on the research questions of the proposed
research, the researcher selects the past literature that has already been published and therefore
the disadvantages of the previous research can be used to develop better research methods for the
current research.
Other Research Methods: There are a variety of other research methods apart from the ones
discussed above, that can be used by the researcher such as cohort studies, or the case studies or
the reports that have been published in the past. Observational studies, trend analysis, expert
opinion etc. are all those methods that can be used in order to conduct the research in a proper
manner but these are low on the hierarchy of evidence.
METHODOLOGY
Study design
The research design that has been proposed is a qualitative research design where the
researcher will use questionnaire method in order to collect the data. The sample selected for the
research will be of 30 doctors who are working in the gynaecological department and have
performed the laparoscopy surgery (Chao, Mandigo, Opoku-Anane & Maine, 2016). The sample
will be selected on the basis of purposive sampling where out of the population of doctors who

have performed laparoscopy, 30 doctors will be selected on a random basis. They will be given a
questionnaire to be filled thus collecting their views on the low impact laparoscopy and then
draw relevant conclusions regarding whether it is beneficial as opposed to the conventional
laparoscopy.
Research question
PICO model technique can be used to develop a correct question that will address the
problem relevantly satisfying the objectives with which the research has been proposed (Kumar,
2019).
P Population The doctors of all age group who are working or have worked in the
gynaecological department but have done the laparoscopic surgery have
been selected in the population group.
I Intervention The use of Low Impact Laparoscopy technique as opposed to the
conventional laparoscopic technique will be done and the benefits of mini
laparoscopy will be ascertained.
C Comparison Comparison of different techniques will be done related to the laparoscopic
technique and the benefits of mini laparoscopy over the conventional
laparoscopy will be identified.
O Outcome The outcomes based on the different views of the doctors will be presented
where their answers will be collected and interpreted in a relevant manner.
The PICO Model helps in deciphering the question that is relevant for the proposed research i.e.
“How is the Low Impact Laparoscopy more beneficial in the gynaecological surgeries as
opposed to the conventional laparoscopic surgeries? ”
Data Collection
Data will be collected through both primary and secondary technique i.e. the primary data
collection technique will be used by using questionnaire method top collect the opinion of 30
doctors selected in the sample and secondary research technique will be used in the form
literature review section. Under this the past research that has been conducted in the relevant
filed will be collected and critically evaluated thus assisting in completing the qualitative
research.

Proposed search strategy
A comprehensive search technique will be used to collect the past literature that has been
published related to the topic. Elsevier database, Medline etc. will be used to collect the research
papers and the keywords that will be used are Low Impact Laparoscopy, Gynaecology,
Conventional Laparoscopy etc. will be used (Ziogas & Tsoulfas, 2017). In order to make the
search more precise, Boolean operators such as “And”, “Not”, “Or” etc. will be used and studies
only for past 5 years will be included.
The biasness in the research will be tried to be minimized by not making respondents
favour a particular notion or opinion and the data will be collected from valid and reliable
sources. However, there are certain limitations that are inherent in the proposed research:
 The design of the research is not meta-analysis or systematic review but primary and
secondary research will be done to analyse better.
 The study will only take into account the doctors' opinion in order to develop better
insight and the patients' aspect will be avoided.
Data Analysis, Interpretation and Synthesis
Data Analysis is the evaluation and interpretation of the data that has been collected
through different sources. In the current research, the researcher will use the thematic analysis
technique in order to analyse and present the data that has been collected in the form of
questionnaire technique from different respondents. Under thematic analysis, the researcher will
use different charts, bar graphs, pie charts etc. to analyse the data that has been collected and
then interpretation of such charts will be drawn on the basis of such charts.
While conducting the secondary research by the means of collection of past literature, the
researcher will use the CASP framework which helps in deciding whether the study that has ben
selected in a valid and accurate research contributing in the different evidence level that have
been used and their relevance and reliability.
In order to conduct a better synthesis of the primary and secondary research techniques
that the researcher will adopt, a data extraction table will be prepared by the researcher where the
literature review that is being used will be kept track of the and the thematic analysis will be
done by developing proper sub- themes so that analysis can be done in a better manner.

PROPOSED DISSERTATION CHAPTERS
 Introduction will be the beginning where the problem statement, aim of the research and
the relevant research questions will be evaluated in the proposed research.
 The next section will be the literature review where the epidemiology of Laparoscopy
will be studied and the evolution of the treatment strategies that have been adopted such
as open surgery, laparoscopy and then mini laparoscopy will be discussed through the
past research papers that have been published by different authors.
 The research methodology will be the third chapter followed by data analysis as the
fourth chapter under which thematic analysis tool will be used in order to conclude the
research findings that were collected through the primary research.
 The discussion will be the fifth chapter where the limitations of the study will be
discussed, an appropriate conclusion will be presented and the recommendation will be
made on the basis of the study undertaken.
 This will be followed by the reference and appendix section containing the relevant
documents.
ETHICAL CONSIDERATION
The researcher will ensure that the entire research that has been proposed will be their
own work and a declaration regarding the same will be attached (Lawrie & et.al., 2019). The
researcher will give appropriate reference wherever they have used the views of some authors
that have already published their research paper. The researcher will also make the respondents
sign a consent form stating that they have willingly given their opinion and have not been
coerced by the researcher to incorporate biasness of any kind, and they have not tried to modify
the research with biasness in any manner.
CONCLUSION
The rising complication in the laparoscopy were evaluated in the research above and the
increased risks have further made the mini laparoscopy as a more feasible and better option. The
proposal above highlighted the outline in which the research is intended to be carried out and the
different techniques and tools that will be used by the researcher pertaining to the data collection
tools and techniques were discussed and evaluated by the researcher. It was concluded that the
qualitative research technique was the most appropriate technique and the researcher also
ascertained that both primary and secondary data collection tools will be used in order to conduct

the research successfully. The study also concluded that the field of Low Impact Laparoscopy in
the Gynaecological sector was under researched and people did not have adequate knowledge
related to the different benefits or challenges that were associated with such mini or Low Impact
Laparoscopy and therefore the research topic will be crucial in researching this sector or
treatment strategy.
INTENDED TIMETABLE
Task Name Duration
Selection of specific topic 1 day
Formulation aim and objectives for research study 2 days
Developing a brief plan 2 days
Research methods selection 2 days
Preparing questionnaire 2 days
Sending questionnaire for collection of data 2 days
Recording specific data set in a structured format 5 days
Interpreting the data collected 4 days
Concluding findings and recommending solutions 2 days
Formatting 3 days
Taking feedback 2 days
Doing changes as per the feedback provided 3 days
Final submission 2 days

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