Gone are the days when surgeons would always need to make long incisions on the abdomen or pelvic area to perform surgeries. Today, doctors perform laparoscopic surgery widely. This blog provides a complete understanding of laparoscopic surgery, its purpose, procedure, and its benefits.
What is laparoscopic surgery?
Laparoscopic surgery (keyhole surgery) is a minimally invasive surgical technique that uses a laparoscope device. In an abdominal laparoscopy, a doctor uses a laparoscope, a thin long tube with a high-intensity light and a high-resolution camera at the front, to look at your abdominal organs. The instrument is inserted through an incision in the abdominal wall. As it moves along, the camera sends images to a video monitor.
An open surgery needs a 6- to 12-inch incision on the body, whereas laparoscopic surgery has 2 to 4 small incisions of half an inch or less. One incision will be for the camera, and the others are for inserting the surgical instruments.
Why is laparoscopy conducted?
A laparoscopy can be done to find the cause of symptoms like pelvic pain or abdominal pain, pelvic region or swelling of the abdomen. It may also be performed if a previous test (such as an X-ray or scan) has identified a problem. A laparoscopy enables a doctor to see clearly inside your abdomen. Some common conditions which can be seen by laparoscopy include:
What surgeries are performed laparoscopically?
Many common surgeries can also be performed laparoscopically today. But some complicated conditions may require open surgery. Some procedures that can be done using laparoscopy are:
- Tubal ligation and reversal.
- Remove ectopic pregnancy (pregnancy in the fallopian tube)
- Laparoscopy can treat endometriosis– growths of the endometrium (uterus lining) outside the uterus.
- Urethral and vaginal reconstruction surgery
- Gallbladder removal to treat gallstones
- Appendix removal to treat appendicitis
- Hysterectomy– Removal of the uterus
- Colectomy (bowel resection surgery)
- Abdominoperineal resection
- Cystectomy (bladder removal)
- Prostatectomy (prostate removal)
- Adrenalectomy (adrenal gland removal)
How to prepare for laparoscopic surgery?
Laparoscopic surgeries are normally performed under general anaesthesia. The patient may have to fast a few hours before the surgery to prevent nausea due to anaesthesia. If no other complications arise, the patient can leave the hospital premises on the same day. Therefore, it is advisable to have a relative or a friend get the patient home since they can still be disoriented from the anaesthesia. The patient may have to stop taking certain medications as per the doctor’s instruction.
The patient’s vital signs are checked to make sure that they are in good condition for surgery. Sometimes blood tests or imaging tests may also be done.
After the tests, the patient will be moved to the operating room, and an IV (intravenous) line will be placed through the arm to administer anaesthesia and other fluids. A breathing tube may also be placed.
What happens during the procedure?
The doctor makes a small cut/incision near the belly button or pelvic bone, and the surgeon may insert the first trocar carrying a gas tube to inflate the pelvic cavity with gas. Inflation of the body cavity helps to see the internal organs vividly.
The laparoscope projects real-time video images of the surgical site on the monitor that guides the surgeon to undertake the entire surgery. Depending on the requirement, the surgeon can make one or more incisions.
A surgical drain can also be placed postoperatively to draw out excess fluids from the body. The drain may remain for a few days. The gas is released, and the incisions are covered after the operation. The patient’s vital signs are checked before removing the breathing tube.
What happens after the procedure?
Post surgery, the patient is shifted to the post-operative recovery room to continuously monitor the vital signs. You may experience some pain in the shoulder tip which is caused by the gas pumped inside. It can irritate the diaphragm that has the same nerve supply as the shoulder tip to make it feel as though the shoulder hurts. This wears off soon.
The doctor may recommend the patient to stay for a longer duration if the body is taking time to recover. Instructions are provided to care for the incision. Dietary and medicinal guidelines are given along with the schedule for the follow-up visits.
One should immediately contact the healthcare provider if experiencing any of the following:
- High fever/chills
- Persistent nausea and vomiting
- Uncontrollable pain
- Swelling at the incision sites
- Excessive bleeding
What are the advantages of this procedure?
The advantages of this procedure are as follows:
- Minimal blood loss and trauma to the abdominal wall due to less-invasive nature causing less postoperative pain and hospital stay
- The scar may disappear within a few months after the procedure
- Reduces the risk of wound infection
- Faster recovery
What are the risks or complications of laparoscopic surgery?
Even though the surgery is almost risk-less, it does involve some complications like:
- Injuries due to surgical devices: The trocar or other surgical instruments used may cause blood vessel injury, bowel injury, nerve injury, or port-site hernia in the patient.
- Insufflation complications: The carbon dioxide gas used to inflate the abdominal cavity tends to cause allergic reactions in certain people, even though tests are taken prior to the surgery to check for allergies. Some of the complications can be:
- Hypercapnia or carbon dioxide retention.
- Pneumothorax or collapsed lung.
- Subcutaneous or mediastinal emphysema where the air is trapped under the skin or in the chest cavity.
- Hypothermia if gas is administered without warming it enough.
The surgery can also cause some general complications like an allergic reaction to anaesthesia, internal adhesions from scar tissue or excessive bleeding.
Most of the operations that were once considered too difficult, are now performed laparoscopically.
Frequently Asked Questions (FAQs)
Can laparoscopic surgery be used in other parts of the body outside the abdomen and pelvis?
Outside the abdominal and pelvic areas, the same method can be used, but the name of the device and procedure differs. For example, a surgeon may use a thoracoscope to view your lungs through a keyhole incision and an arthroscope in the knee.
When is laparoscopic surgery not recommended?
Laparoscopic surgery may not be recommended if a prior surgery in the area has been performed because the scars and adhesions may restrict the view. Extensive infection or bleeding is an emergency that requires an immediate switch to open surgery.