Laparoscopy: Risks, Procedure, Recovery and Assisted by Robot

Definition:

It is a surgical diagnostic procedure that is used to examine the organs inside the abdomen. It is minimally invasive with low risk that requires only small incisions.

Through an instrument called laparoscope you can observe the abdominal organs. A laparoscope is a long, thin tube with a high intensity light and a high resolution camera in the front.

The instrument is inserted through an incision in the abdominal wall. As you go, the camera sends images to a video monitor.

Laparoscopy allows your doctor to see inside your body in real time, without open surgery. Your doctor may also obtain biopsy samples during this procedure.

Why is laparoscopy performed?

Laparoscopy is often used to identify and diagnose the source of pelvic or abdominal pain. It is usually done when non-invasive methods can not help with the diagnosis.

In many cases, abdominal problems can also be diagnosed with imaging techniques such as:

  • Ultrasound, which uses high frequency sound waves to create images of the body.
  • Computed tomography, which is a series of special x-rays that take cross-sectional images of the body.
  • Magnetic resonance image, which uses magnets and radio waves to produce images of the body.
  • Laparoscopy is performed when these tests do not provide enough information for a diagnosis. The procedure can also be used to take a biopsy or tissue sample of a particular organ in the abdomen.

Your doctor may recommend laparoscopy to examine the following organs:

  • Appendix.
  • Gallbladder.
  • Liver.
  • Pancreas.
  • Small intestine and large intestine (colon).
  • Base.
  • Stomach.
  • Pelvic or reproductive organs.

By observing these areas with a laparoscope, your doctor can detect:

  • An abdominal mass or tumor.
  • Fluid in the abdominal cavity.
  • Liver disease
  • The effectiveness of certain treatments.
  • The degree to which a particular cancer has progressed.

In addition, your doctor may be able to perform an operation to treat your condition immediately after diagnosis.

What are the risks of this procedure?

The most common risks associated with laparoscopy are bleeding, infection and damage to organs in your abdomen. However, it is rare that they occur.

After the procedure, it is important to watch for signs of infection. Contact your doctor if you experience:

  • Fever or chills
  • Abdominal pain that becomes more intense over time.
  • Redness, swelling, bleeding or drainage at the sites of the incision.
  • Continuous nausea or vomiting.
  • Persistent cough
  • Difficulty breathing.
  • Inability to urinate.
  • Daze.

There is a small risk of damage to organs that are examined during laparoscopy. Blood and other fluids can leak into your body if an organ is pierced. In this case, you will need another surgery to repair the damage.

Less common risks include:

  • Complications of general anesthesia.
  • Inflammation of the abdominal wall.
  • A blood clot, which could travel to the pelvis, legs or lungs.

In some circumstances, your surgeon may believe that the risk of a diagnostic laparoscopy is too high to justify the benefits of using a minimally invasive technique.

This situation often occurs for those who have had previous abdominal surgeries, which increases the risk of forming adhesions between the structures in the abdomen.

Performing laparoscopy in the presence of adhesions will take much longer and increases the risk of damaging the organs.

How do I prepare for laparoscopy?

You should tell your doctor about any prescription or over-the-counter medications you are taking. Your doctor will tell you how to use it before and after the procedure.

Your doctor can change the dose of any medication that may affect the result of laparoscopy. These medications include:

  • Anticoagulants
  • Non-steroidal anti-inflammatory drugs, which include aspirin or ibuprofen.
  • Herbal or dietary supplements.
  • Vitamina K.

You should also tell your doctor if you are pregnant or think you might be pregnant. This will reduce the risk of harm to your developing baby.

Before laparoscopy, your doctor can order blood tests, urinalysis, electrocardiogram (EKG or ECG) and chest x-ray. Your doctor may also perform certain imaging tests, such as an ultrasound, a CT scan, or an MRI.

These tests can help your doctor better understand the abnormality that is examined during laparoscopy. The results also give your doctor a visual guide to the inside of your abdomen. This can improve the effectiveness of laparoscopy.

You should probably avoid eating and drinking for at least eight hours before laparoscopy.

You should also arrange for a family member or friend to take you home after the procedure. Laparoscopy is often performed under general anesthesia, which can cause drowsiness and inability to drive for several hours after surgery.

How it is performed?

Laparoscopy is usually performed as an outpatient procedure. This means that you can go home the same day of your surgery. It can be done in a hospital or in an ambulatory surgical center.

You are probably given general anesthesia for this type of surgery. This means that you will sleep during the procedure and you will not feel any pain. To achieve general anesthesia, an intravenous line is inserted into one of your veins.

Through the intravenous route, your anesthesiologist can give you special medications and also provide fluid hydration.

In some cases, local anesthesia is used instead. A local anesthetic numbs the area, therefore, even if you are awake during surgery, you will not feel any pain.

During laparoscopy, the surgeon makes an incision below your navel and then inserts a small tube called a cannula. The cannula is used to inflate your abdomen with carbon dioxide gas. This gas allows your doctor to see your abdominal organs more clearly.

Once your abdomen is inflated, the surgeon inserts the laparoscope through the incision. The camera connected to the laparoscope displays the images on a screen, allowing your organs to be seen in real time.

The number and size of the incisions depend on the specific diseases that the surgeon tries to confirm or discard.

In general, you get one to four incisions that are between 1 and 2 centimeters in length.

These incisions allow other instruments to be inserted. For example, your surgeon may need to use another surgical tool to perform a biopsy. During a biopsy, they take a small sample of tissue from an organ to evaluate.

After the procedure is performed, the instruments are removed. Your incisions are closed with stitches or surgical tape. Bandages can be placed over the incisions.

How long does it take to recover from laparoscopy?

When the surgery is over, you will be observed for several hours before you leave the hospital. Your vital signs, such as your breathing and heart rate, will be monitored closely.

Hospital staff will also check for adverse reactions to the anesthesia or procedure, as well as if there is prolonged bleeding.

The time of its launch will vary and will depend on:

  • Your general physical condition
  • The type of anesthesia used.
  • The reaction of your body to surgery.
  • In some cases, you may have to stay in the hospital at night.

A family member or friend should take you home if you received general anesthesia. The effects of general anesthesia usually take several hours to disappear, so it can be unsafe to drive after the procedure.

In the days after laparoscopy, you may feel moderate pain and palpitations in the areas where the incisions were made. Any pain or discomfort should improve in a few days. Your doctor may prescribe medications to relieve pain.

It is also common to have pain in the shoulder after the procedure. The pain is usually the result of carbon dioxide gas used to inflate your abdomen and create a workspace for surgical instruments.

The gas can irritate your diaphragm, which shares the nerves with your shoulder. It can also cause some swelling. The discomfort should disappear in a couple of days.

In general, you can resume all normal activities in a week. You should attend a follow-up appointment with your doctor approximately two weeks after laparoscopy.

Here are some things you can do to ensure a smoother recovery:

  • Start light activity as soon as you can, in order to reduce the risk of blood clots.
  • Sleep more than usual.
  • Use pills to relieve sore throat.
  • Wear loose clothing.

Results

If a biopsy was taken, a pathologist will examine it. A pathologist is a doctor who specializes in tissue analysis. A detailed report of the results will be sent to your doctor.

The normal results of laparoscopy indicate the absence of abdominal hemorrhage, hernias and intestinal obstructions. It also means that all your organs are healthy.

Abnormal results from laparoscopy indicate certain conditions, which include:

  • Adhesions or surgical scars.
  • Hernias.
  • Appendicitis, an inflammation of the intestines.
  • Fibroids or abnormal growths in the uterus.
  • Cysts or tumors
  • Cancer.
  • Cholecystitis, an inflammation of the gallbladder.
  • Endometriosis, a disorder in which the tissue that forms the lining of the uterus grows outside the uterus.
  • Injury or trauma to a particular organ.
  • Pelvic inflammatory disease, an infection of the reproductive organs.

Your doctor will schedule an appointment with you to review the results. If a serious medical condition was found, your doctor will discuss the appropriate treatment options with you and work with you to develop a plan to treat that condition.

Robot-assisted laparoscopy

A relatively recent development in laparoscopy is the use of robots to help with procedures. This is known as “robot-assisted laparoscopy”.

During robotic-assisted laparoscopy, your surgeon uses a console located in the operating room to perform the procedure by controlling the robotic arms. The robotic arms hold a special camera and surgical equipment.

The robotic system provides a magnified 3D vision and a greater range of motion for the instruments that work within the body.

Robotic assisted laparoscopy allows surgeons to perform complex procedures with greater precision and smaller incisions.

The amount of robot-assisted laparoscopy used in the United Kingdom has increased rapidly in recent years. In particular, assisted robotic surgery for prostate cancer.

There is evidence to suggest that robot-assisted laparoscopy may have a lower risk of complications than regular laparoscopy or open surgery, as well as a shorter recovery time.