Laparoscopy, also known as minimally invasive surgery or keyhole surgery, is a unique type of surgery that allows your doctor (surgeon) to access your abdomen (stomach and intestinal cavity) and/or your pelvis (cavity below your abdomen) without making a large incision in your skin.
Laparoscopy uses an instrument called a laparoscope to avoid these large incisions. This instrument is a small flexible tube with a light and camera at the end. The camera end is inserted into your body through a small hole, which then allows you to visualise the insides of your abdominal or pelvic cavities.
Laparoscopy has a couple of advantages that make it a very useful surgical procedure used routinely for applicable patients. Typically, you will have to:
- Stay for a shorter period in the hospital
- Have less pain
- Less bleeding and low risk of further bleeding
- Reduced scarring
Laparoscopy is a very useful procedure and is indicated in a number of situations. It can be used as a diagnostic as well as a therapeutic tool. Some of the indications of laparoscopy are:
- Acute abdomen – This refers to sudden and severe abdominal pain
- Unpalpable testes
- Recurrent abdominal pain
- Biopsies for the staging of tumours
- Abnormalities associated with genital organs
- Blunt abdominal trauma
- Appendicectomy – removal of appendix
- Splenectomy – removal of spleen
- Hernia repair
- Varicocele repair
- Removal of gallbladder
- Removing a small part or the whole organ – this can include removal prostate, ovaries, liver, colon, kidney, etc. This is usually done if there is cancer present in these cells.
- Hysterectomy – refers to the removing of the uterus.
- Ectopic pregnancy – conception of the embryo in sites other than the uterus can cause life threatening situations. Laparoscopy can be used to remove the ectopic pregnancy.
Risks of the Procedure
As its other names (minimally invasive surgery) suggest, laparoscopy is a minimally damaging procedure and it is quite risk-free. In most cases, there are either no complications or some small risk complications. As with every surgery, there are some major complications, however, they are very rare.
Some minor complications that can occur are:
- Minor bleeding
- Minor bruising at the site of incision
- Feeling of being unwell i.e., vomiting, etc.
Some rare major complications that may occur are:
- Impaired organ function – damage to an organ e.g., your bladder or bowel, resulting in impaired or loss of function
- Damage to an artery – this can cause severe bleeding and can even affect the tissue supplied by that artery
- Gas embolism – laparoscopic surgery uses carbon dioxide gas for inflating purposes. This gas can enter your circulation and can cause obstruction by a gas bubble.
- Allergic reaction or toxicity caused by general anaesthesia – some people are susceptible to reactions like ‘malignant hyperthermia’ with the use of anaesthetics. However, these reactions
- Deep venous thrombosis (DVT) – DVT is a serious complication that can occur in people who are on bed rest after surgery. This can especially occur in gynaecological patients.
You should discuss the benefits and risks of any surgery thoroughly with your doctor.
Patient preparation depends on the type of laparoscopic procedure you are about to go through. Generally, you will be advised to:
- Not eat or drink anything for 6-12 hours before your surgery
- Stop taking any blood-thinning medicines (aspirin, warfarin) a few days before your surgery
- Discontinue smoking before and until after your recovery
- Bring someone with you to accompany you home
You will be given anaesthesia right before your surgery. During the procedure your doctor will:
- Make a small incision (1 to 1.5 cm) near your belly button
- Insert a tube through the incision which pumps carbon dioxide into your abdomen to inflate it
- Insert a laparoscope that allows your doctor to visualise the inside of your body
- Make further incisions for inserting other surgical instruments in case a surgical treatment like appendicectomy
- Carefully place the instrument and carry out the specific task.
The procedure is typically 30 to 60 minutes long. After the procedure, the gas pumped is let out of your abdomen, and incisions are closed using sutures or clips and a dressing (bandage) is applied.
After your laparoscopy, you may feel dizzy or confused due to the effects of anaesthesia. Some people feel sick and may feel like throwing up (vomit).
You’ll have to stay under monitoring for a few hours by the doctor or nurse. After you’re fully awake, you can continue with drinking and eating.
Most people are discharged from the hospital the same day while some patients might require more time to recover (high-risk patients). You will be told to keep your stitches and dressing clean after you go home. You will have to return to the hospital for a follow-up visit in order to make sure everything is fine and/or remove your stitches.
For a couple of days, you may feel pain and discomfort in the area of the incision. Your doctor will give you some pain killers and antibiotics to reduce pain and avoid infections, respectively. The gas used to inflate your abdomen during the procedure may cause you some discomfort like bloating, cramping, or feeling like you need to pass faeces. These symptoms are nothing to worry about.
For minor surgery, it usually takes around 2-3 weeks to recover back to normal. A major surgery like removal of an organ might take up to 12 weeks to recover. A diagnostic laparoscopy usually causes 3-5 days of discomfort and you can resume normal routine after this time.
These times may differ from person to person.
In case of the following symptoms, inform your doctor immediately or seek medical aid:
- High fever and chills
- Severe or continuous episodes of vomiting, especially with blood
- Severe abdominal pain
- Redness, swelling, or pain around your wound
- Pain, swelling, or warmth in one of your legs
- Persistent burning or stinging feeling while urinating
Your doctor will discuss the results of your laparoscopy after a few days. You should discuss all the outcomes and findings of your laparoscopy. You should also take someone with you to help note everything properly.
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