02/26/2024
Laparoscopic surgery employs a laparoscope, a narrow rod with a camera attached, to view the abdominal and pelvic cavities through tiny keyhole incisions. This minimally invasive surgical method is linked to quicker recovery and improved patient outcomes.
Laparoscopic Surgery
Laparoscopic surgery is a minimally invasive procedure performed in the abdominal and pelvic regions. It uses a laparoscope, which is a thin, telescopic rod with a camera at the end, to see inside your body without completely opening it up. Instead of the 6- to 12-inch cut required for open abdominal surgery, laparoscopic surgery makes two to four small incisions that are half an inch or less. One is for the camera, while the others are for surgical instruments. Minimally invasive surgery is often known as "keyhole surgery" due to the small incisions used.
Laparoscopy
A laparoscopy is a type of exploratory surgery utilizing a laparoscope. The surgeon makes one or two keyhole incisions to investigate the abdominal and pelvic chambers. This is a less intrusive alternative to laparotomy. It is frequently done for diagnostic purposes, to seek out issues that imaging tests haven't detected. The surgeon may collect tissue samples for biopsy during the examination. They may also be able to treat minor issues during the laparoscopy, such as removing growths or blockages discovered during the procedure.
Indications For Laparoscopic Surgery
Today, numerous common operations can be performed laparoscopically. Your candidacy for laparoscopic surgery will be determined by the complexity of your medical condition. Certain serious illnesses may necessitate open surgery to treat them. However, due to its cost-saving benefits and better patient outcomes, laparoscopic surgery is becoming the default approach for an increasing number of common operations. The list contains:
- Cyst, fibroid, stone, and polyp removals.
- Small tumor removals.
- Biopsies
- Tubal ligation and reversal
- Ectopic pregnancy removal
- Endometriosis surgery
- Urethral and vaginal reconstruction surgery
- Orchiopexy (testicle correction surgery)
- Rectopexy (rectal prolapse repair)
- Hernia repair surgery
- Esophageal anti-reflux surgery (fundoplication)
- Gastric bypass surgery
- Cholecystectomy (gallbladder removal) for gallstones
- Appendectomy (appendix removal) for appendicitis
- Colectomy (bowel resection surgery)
- Abdominoperineal resection (rectum removal)
- Cystectomy (bladder removal)
- Prostatectomy (prostate removal)
- Adrenalectomy (adrenal gland removal)
- Nephrectomy (kidney removal)
- Splenectomy (spleen removal)
- Radical nephroureterectomy (for transitional cell cancer)
- Whipple procedure (pancreaticoduodenectomy) for pancreatic cancer
- Gastrectomy (stomach removal)
- Liver resection
Can Laparoscopic Surgery Be Used Outside The Abdomen And Pelvis?
Many different parts of the body are treated with minimally invasive surgical methods. Outside of the abdominal and pelvic areas, the approach may be identical, but it is referred to differently. A surgeon may use a thoracoscope to examine your lungs through a keyhole incision in the chest. In the knee, a surgeon may utilize an arthroscope. The scopes have names that vary differently based on the parts of the body they examine, but they are all modified variations of the same thing.
How Safe Is Laparoscopic Surgery?
It is at least as safe as open surgery, and some risks are reduced. Smaller incisions lower the chances of infection, blood loss, and postoperative problems such as wound separation and incisional hernia. Laparoscopic surgery avoids direct contact between the surgeon and the patient, lowering the danger of germ transfer between the two. It also reduces the post-operative recovery period, minimizing the risks of prolonged bed rest, such as blood clots.
Procedure Details
How Should I Prepare For My Laparoscopic Surgery?
Most laparoscopic operations are performed under general anesthesia, so you'll need to prepare in a few ways. You will need to fast for roughly eight hours before the operation. This is to prevent anesthesia-induced nausea. You should also plan for someone to drive you home following the surgery. You'll most likely be able to go home the same day, but the anesthesia may cause you to feel disoriented. Your doctor may give you further, thorough guidance about your medications.
What Happens Before The Procedure?
When you arrive at the hospital, you will change into a hospital gown, and a nurse will take your vital signs to ensure you are fit for surgery. In some situations, they may perform additional tests before the procedure, such as a blood test or surgical site imaging.
Once the testing is completed, you will proceed to the operation room. You'll have an IV (intravenous) line inserted into a vein in your arm or hand to give fluids and anesthesia. The anesthesia will paralyze your muscles, relieve discomfort, and put you to sleep. You will also have a breathing tube inserted into your throat to keep your airway open.
What Happens During The Procedure?
The procedure begins with a tiny incision at the abdominal button or pelvic bone. The first incision is used to inject carbon dioxide gas into the abdominal or pelvic cavity. Laparoscopic surgery makes use of thin surgical tubes known as trocars to serve as ports for surgical tools. The surgeon will insert the first trocar and then insert the gas tube through it to fill your abdominal or pelvic cavity with gas. This helps to separate your abdominal wall from your organs, making them easier to see on the monitor. After inflating the cavity, the surgeon will withdraw the gas line and insert the laparoscope via the trocar. The laparoscope will display real-time video images of the surgical site on a video monitor. This will guide the placement of the remaining surgical instruments. Depending on the surgery, they may create one or more keyhole incisions and insert trocars. Laparoscopic surgery employs long, narrow instruments that are intended to fit through trocars. In some cases, a surgical drain may be implanted into the cavity to remove excess fluids caused by inflammation. Fluids will drain through a tiny tube.
For some conditions, the tube may need to stay in your body for a while after the surgery to continue draining fluids. Everything else will be stitched together after the operation. The gas will be expelled from your body before the incisions are closed. Before withdrawing your breathing tube and IV, your surgical team will check your vital signs to verify they are stable.
What Happens After The Procedure?
You will be taken to a postoperative recovery room, where your vital signs will be monitored until you wake up. At this stage, you may require a different type of pain medicine. Gas discomfort is a typical adverse effect of laparoscopic surgery that results from residual carbon dioxide in the body. It may feel like it's on your shoulders. That's because it stimulates a neuron that sends pain to the shoulder region. This is normal and will resolve itself within a day or so.
Depending on your procedure and how your body responds, you may be able to leave the same day or stay overnight.
Your healthcare team will teach you how to care for yourself when you return home. This includes wound care, drain care (if applicable), and nutrition guidelines, particularly if you have undergone abdominal surgery. You will also schedule a follow-up visit before leaving to monitor your healing and, if necessary, remove your fluid drain.
Advantages Of Laparoscopic Surgery
- Less trauma to the abdominal wall
- Less blood loss
- Reduced risk of hemorrhage
- Smaller scars
- Reduced risk of wound infection
- Shorter hospital stay
- Less time in the hospital means less expense
- Faster recovery time and return to activities
- Less wound pain during healing
- Less pain medication is necessary
Complications Of Laparoscopic Surgery
Trocar Injuries
Since the original trocar may be inserted blindly before the laparoscope is inserted, there is some risk of injury from the original trocar insertion. Complications are rare, but serious. They include:
- Blood vessel injury
- Bowel injury
- Nerve injury
- Port-site hernia
- Insufflation complications
Some people may have an adverse reaction to the carbon dioxide gas that is used to inflate the abdominal cavity for the procedure. You will be screened for any cardiopulmonary conditions that would put you at risk of these complications before surgery. Complications include:
- Hypercapnia (carbon dioxide retention)
- Pneumothorax (collapsed lung)
- Subcutaneous or mediastinal emphysema (air trapped under the skin or in the chest cavity)
- Hypothermia (if cold gas isn’t prewarmed)
General Surgical Risks
- Allergic reaction to anesthesia
- Internal adhesions from scar tissue
- Excessive bleeding
- Wound infection
Contraindications For Laparoscopic Surgery
- Prior surgery in the area: This increases the likelihood of scars and adhesions that may interfere with the access and visibility of the laparoscopic tools.
- Excessive body mass in the area: This can make it too hard to see via laparoscope.
- Extensive infection or bleeding. This emergency requires immediate open access to management.
- Cardiopulmonary conditions: These increase the risk of adverse reactions to carbon dioxide.
Recovery
In most circumstances, you will be able to return home that same day. The full recovery time is approximately two to three weeks. During this period, you should expect some normal wound pain. This should be treatable with short-term pain medication and should improve within a few days. If it doesn't, notify your doctor.