by Rosalyn Carson-DeWitt, MD
Anatomy and Physiology
Laparoscopic surgery is performed to diagnose and treat conditions affecting the organs and tissues of the abdomen and pelvis.
Traditional open surgery requires a relatively large incision. Laparoscopic surgery involves the creation of one or more tiny "keyhole" incisions, through which pencil-thin instruments are inserted to view the inside of the abdomen or pelvis, and to perform various procedures. This technique considerably reduces recovery time.
Reasons for Procedure
Laparoscopy is done to examine, diagnose, and treat problems inside the abdomen and/or pelvis. The procedure can: diagnose, and sometimes treat, causes of pain, retrieve a tissue sample, evaluate the presence of abnormal fluid, evaluate infertility, help determine if a cancer has spread, monitor previously treated cancer.
Many surgeries that were traditionally performed through an open incision can now be performed laparoscopically. These include: appendectomy, ectopic pregnancy removal, egg retrieval for assisted reproductive technology, hernia repair, hysterectomy, certain surgeries of the gallbladder, stomach, colon, liver, spleen, adrenal gland, or kidney, biopsies, which entail retrieving a tissue sample, tubal ligation, and/or tumor removal In some of these cases, an open surgical procedure may still be required.
In the days leading up to your procedure: Arrange for a ride to and from the hospital, and for help at home as you recover. The night before, eat a light meal and do not eat or drink anything after midnight. If you regularly take medications, ask your doctor if you need to temporarily discontinue them. Do not start taking any new medications before consulting your doctor. Depending on the type of operation, laparoscopic surgery may be done under general, spinal, or local anesthesia. In general anesthesia, you will be asleep during the entire procedure. In spinal anesthesia, you will be rendered numb from the chest down. In local anesthesia, you will be numb at the site of the incision only.
To begin the procedure, your surgeon will insert a sharp instrument called a trocar through a small half-inch opening, usually just above or below your navel. The exact location of this opening will depend on the type of operation being performed.
In most cases, your surgeon will then pump carbon dioxide gas though this port in order to puff up your abdomen so its contents can be viewed more easily.
Next, your surgeon will insert the laparoscope. Images from its camera are magnified and projected onto a video monitor in the operating room. The surgeon will carefully examine your abdominal or pelvic organs and tissues, looking for signs of disease that might explain your symptoms.
Your surgeon may place other trocars through which surgical instruments can be inserted. These instruments may be used to:
- Move organs out of the way for better viewing
- Remove diseased or scarred organs or tissue
- Take tissue biopsies Sample and drain abnormal fluid
- Perform other surgical techniques
- When the laparoscope is removed, all of the gas will be allowed to escape.
Each keyhole incision will be closed with just a few sutures or staples, and then covered with bandages.
Risks and Benefits
Possible complications of laparoscopy include: damage to blood vessels or organs in the surgical area, excessive bleeding Infection, anesthesia-related problems, during the laparoscopic procedure, your surgeon may need to switch to a traditional open procedure. This may occur if the area is damaged or it appears that the laparoscopic approach is not going to be successful.
Compared to traditional open surgeries, the benefits of laparoscopy include: smaller scars, shorter hospital stay or same-day discharge, fewer complications, less pain after the operation, and/or shorter recovery time.
However, these benefits are a tradeoff with the limited access available through the laparoscopic approach.
In a laparoscopy, or any procedure, you and your doctor must carefully weigh the risks and benefits to determine whether it's the most appropriate treatment choice for you.
After the Procedure
In most cases, patients are discharged within one to two days of their procedure. Depending on the reason for your laparoscopy, you may be able to leave the hospital the same day it was performed.
Proper care after your laparoscopy largely depends on the particular operation performed. In most cases, however, you will be advised to: remove the bandages the morning after surgery, return to your usual activities within a few days, avoid heavy lifting for several weeks.
Be sure to call your doctor immediately if you experience: severe nausea or vomiting. faintness or dizziness, coughing, shortness of breath, or chest pain, fever or chills, redness, swelling, increasing pain, excessive bleeding, or discharge from any of the incisions, difficulty urinating.
- How to do diagnostic laparoscopy. Laparoscopy hospital. Available at: http://www.laparoscopyhospital.com/diagnostic.htm. Accessed February 6, 2004.
- Laparoscopic Surgery. Sabiston Textbook of Surgery, 16th edition. Philadelphia: W.B. Saunders, 2001. pp. 294-305.Laparoscopy. American College of Obstetricians and Gynecologists. Available at: http://www.medem.com/search/article_display.cfm?path=TANQUERAYM_ContentItem&mstr=/M_ContentItem/ZZZODAA697C.html&soc=ACOG&srch_typ=NAV_SERCH. Accessed February 6, 2004.
- Laparoscopy. JAMA and ArchivesJournals of the American Medical Association. Available at: http://www.medem.com/search/article_display.cfm?path=TANQUERAYM_ContentItem&mstr=/M_ContentItem/ZZZIJLGD8WC.html&soc=JAMA/Archives&srch_typ=NAV_SERCH. Accessed February 6, 2004.
- Performing a Safe Laparoscopy. Online Laparoscopic Technical Manual, Year 2003. Available at: http://www.laparoscopy.net/safe/safe3.htm. Accessed February 6, 2004.
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