Index
It is a type of surgery that uses smaller cuts than you might expect.
The process takes its name from the laparoscope , a thin tool that has a small video camera and a light on the end.
When a surgeon inserts it into your body through a small cut, you can look through a video monitor and see what is happening. Without those tools, they would have to make a much larger opening.
Doctors first used it for gallbladder surgeries and gynecology operations. Then it came into play for the intestines, liver and other organs.
Process
Before this system emerged, a surgeon operating on his patient’s belly had to make a 6 to 12-inch long cut.
That gave them enough room to see what they were doing and to get to what they had to work on. In laparoscopic surgery, the surgeon makes several small cuts.
Each is usually no more than a half inch long (which is why it is sometimes called keyhole surgery).
They insert a tube through each opening, and the camera and surgical instruments pass through them. Then the surgeon does the operation.
Profits
Working in this way has several advantages compared to traditional surgery:
- Smaller scars remain.
- You will get out of the hospital faster.
- You will feel less pain as the scars heal and heal faster.
- You will be back to your activities earlier than normal.
- You may have fewer internal scars.
Here’s an example, with traditional methods, you can spend a week or more in the hospital for bowel surgery, and your full recovery can take 4-8 weeks.
If you have laparoscopic surgery, you may only stay in the hospital for 2 nights and recover in 2 to 3 weeks. And a shorter hospital stay generally costs less.
History
Laparoscopy was first performed on animals in the early 1900s, and the term laparoscopy (laparothorakoskopie) was coined by the Swedish surgeon Jacobaeus in 1901.
However, better techniques were not developed until the 1960s, when laparoscopy was accepted as a safe and valuable procedure.
In the beginning, the laparoscopic technique, sometimes known as keyhole surgery, was used only to diagnose conditions.
Then doctors began to perform such surgeries, such as tubal ligation in women .
The technique has evolved so much that operations that once required doctors to make a very large incision, such as removing the gallbladder, can now be done with this less invasive surgery.
For patients, laparoscopy can often mean faster recovery from surgery, less time in the hospital or outpatient surgery center, and less trauma to the body.
Doctors do not have to cut large abdominal muscles to reach vital organs.
Features
Laparoscopic instruments and techniques are used for a variety of procedures, including knee and shoulder surgery .
Operations that are often performed laparoscopically include the following, among many others:
- Removal of diseased organs: such as the gallbladder or the appendix.
- Removal or repair of diseased parts of the colon or stomach (digestive system).
- Removal or repair of the bladder, ureters, or kidneys (urinary system).
- The removal or repair of a woman’s reproductive organs: such as the uterus or fallopian tubes.
- Tubal ligation.
- Removing a kidney from a living donor.
- Weight reduction procedures: such as gastric bypass.
- Hernia repair.
- To see the liver and pancreas for the presence of cancerous tumors.
- To view the abdomen for signs of disease that have been difficult to diagnose (exploratory surgery).
- To see a tumor in the abdomen.
- To check the source of abdominal pain or remove scar tissue.
- To look for the source of internal bleeding or fluid buildup if the patient has normal blood pressure.
- To view injuries after trauma or accident.
Types
Robotic surgery
Advanced robotic systems provide physicians with greater control and vision during surgery, enabling them to perform safe, less invasive, and precise surgical procedures.
During robot-assisted surgery, surgeons operate from a console equipped with two master controllers that maneuver four robotic arms.
By viewing a high definition 3-D image on the console, the surgeon can see the surgical procedure better than ever.
The software takes the place of actual hand movements and can make the movements very precise. This is called “hand-assisted” laparoscopy.
Endoscopy
Minimally invasive non-robotic surgery is also known as endoscopic surgery.
You may also be familiar with terms such as laparoscopic surgery, thoracoscopic surgery, or “keyhole” surgery.
These are minimally invasive procedures that use an endoscope to reach internal organs through very small incisions.
During endoscopic surgery, the surgeon inserts a thin, flexible tube with a video camera through a small incision or a natural opening such as the mouth or nostrils.
The tube has a channel to use small surgical instruments, which the surgeon uses while looking at the organs on a computer monitor.
This technique allows the surgeon to see inside the patient’s body and operate through a much smaller incision than would otherwise be required in traditional open surgery.
In some operations, the surgeon can place the camera and the surgical tool through the same opening in the skin.
But it is more complicated for the surgeon because the instruments are very close together.
Preparation
As with any surgery, food and drink are restricted for eight hours before the procedure, unless the surgery is performed as an emergency.
The patient is asked to sign a consent form that informs them about the procedure and its risks.
Patients need to understand what the surgeon will do during the procedure and understand the answers to their questions.
General anesthesia is provided, which means that the patient is asleep during the procedure.
The anesthesiologist talks with each patient about any drug allergies beforehand.
Recovery time is much shorter with laparoscopy than with regular (open) surgery.
For outpatient surgeries, someone else must come to drive the person who just had surgery home.
Patients are instructed not to wear jewelry or bring expensive items.
Patients planning to have laparoscopy should speak with their doctor a few days before the procedure to ask if they should take their current medications.
This is particularly important for people taking aspirin, blood thinners, or certain herbal supplements that can make it difficult for the blood to clot.
During laparoscopy
With laparoscopy, small fiberoptic instruments are inserted into the body through small surgical openings (hence the name “keyhole”). A person may have one or more small incisions.
A video camera is inserted into the opening, which guides the surgeon who is manipulating the instruments into any other opening.
Sometimes only one incision is used and all the instruments are put into it.
This is called single-incision laparoscopic surgery, or SILS.
At the ends of these instruments are devices such as scissors, surgical staplers, scalpels, and sutures (stitches).
Abdominal laparoscopy involves the following steps:
- Once the patient is asleep, the surgeon makes a small cut near or in the belly button and inserts a thin, hollow tube called a trocar. The tube extends from the inside of the abdomen to the outside.
- Carbon dioxide is injected into the abdomen to expand it and allow the doctor more room to see the organs.
- The laparoscope is inserted into the abdomen through the trocar. The surgeon sees a large image from the camera on a TV screen in the operating room.
- Other instruments are inserted into small incisions. They are manipulated by the surgeon to perform the procedure, whether it is to remove an organ, take a tissue sample, or repair an organ.
- When the surgery is finished, the surgeon removes the instruments.
- The incisions are stitched closed and bandages are placed over them.
Very small incisions may not require stitches, just small strips of sterile tape.
The patient is asleep and does not feel anything during the procedure.
After laparoscopy
- Some pain or throbbing is possible where the small cuts were made. Your doctor may recommend a prescription or over-the-counter pain reliever.
- If stitches were used, a follow-up appointment for stitch removal can be scheduled in a week or two as directed.
- Sometimes carbon dioxide gas can trigger shoulder pain after the procedure. Some of the same nerves that reach the shoulder are present in the diaphragm, and the gas can irritate the diaphragm. The pain goes away with time.
- The pressure of the gas can cause a feeling of needing to urinate more often and more urgently. This feeling disappears with time.
- The doctor will determine when food and drink can be resumed.
- Once a person has sufficiently recovered, he or she can be sent home. Someone else should drive.
Recovery
If the procedure was to diagnose a condition or to view a diseased organ, the patient will meet with the doctor to review the results of the exploratory surgery.
For other procedures, follow up with your doctor as recommended.
Avoid lifting heavy objects or strenuous activities until you have fully recovered.
Complications
Complications are rare, but as with any surgery, infection is a risk.
Bleeding in the abdomen is also possible. Scars can develop.
Anesthesia during surgery can cause heart attack, stroke, and pneumonia , but these consequences are rare.
During laparoscopy, there are the following risks:
- The surgeon can pierce a blood vessel or organ. This could cause bleeding or injury to the organ. If the colon ruptures, its contents can spill into the abdomen.
- Scar tissue from previous operations may present a problem for the trocars to insert properly into the abdomen. The scar tissue may prevent the gas from expanding the abdomen.
If complications develop or are discovered, the surgeon may decide to perform a larger incision and standard surgery instead of laparoscopy. This is a decision made with patient safety in mind.
If complications develop, the surgeon may continue to prescribe:
- Antibiotics for infection control.
- Blood transfusion to replace lost blood.
Laparoscopic surgery in obese people can be complicated. Many doctors advise people to lose weight before surgery, if possible.
However, certain weight loss surgeries are now being performed laparoscopically.
Results
The results depend on the procedure that was performed and what was found.
In most cases, people recover quickly with minimal pain and discomfort because they only have small incisions to heal.
When to seek medical attention for laparoscopy?
If, after a laparoscopic procedure, a person develops any of these problems, a doctor should be contacted:
- Chills or fever
- Nausea or vomiting
- Bleeding, drainage, or redness from any of the small incisions.
- Swelling of the surgical area.
- Inability to urinate
- Pain that cannot be controlled with prescription drugs.
