Laparoscopic or “minimally invasive” surgery is the term given to a suite of specialised surgical techniques. Whilst laparoscopy is traditionally used in gynaecologic or gall bladder surgery, the technique has more recently expanded to include intestinal and chest cavity surgery. In this article we will cover the fundamental basics of laparoscopic surgery, including some of the different types of laparoscopy, when it is needed, what to expect and some of the risks associated with it.
What is Laparoscopy?
Laparoscopy is a surgical technique used by a range of specialist surgeons to investigate, diagnose and operate on organs within the abdominal, pelvic or chest cavity of the body. Otherwise known as keyhole surgery or minimally invasive surgery, laparoscopy is performed under general anaesthetic yet only requires a small incision to access the surgical site without the need for a large incision that is usually associated with traditional open surgery. Surgeons use a laparoscope (a small, thin, tube-like instrument with a light source and camera that relays images from inside the patient to a computer monitor) to view internal organs, take biopsies (tissue samples) or treat a presenting medical problem.
The advantages of laparoscopy over more general open surgery are:
- Minimal to no scarring
- Reduced pain and bleeding
- Shorter hospital stays
- Faster recovery times
What are some of the different types of Laparoscopy?
With the ever accelerating advances taking place in modern medicine, laparoscopy continues to expand in its usefulness and application. Below are three of the more common kinds of laparoscopic surgery you may come across:
Diagnostic Laparoscopy allows surgeons to inspect the contents of the abdomen or pelvis. Some of the conditions it can be used to diagnose include: endometriosis, uterine fibroids, ovarian cysts or tumours, ectopic pregnancy, pelvic adhesions, infertility and pelvic inflammatory disease.
Operative Laparoscopy involves the insertion of a laparoscope into the surgical site. Using the laparoscope, the surgeon may insert additional instruments to complete the procedure including probes, scissors, grasping instruments, biopsy forceps, electrosurgical or laser instruments and suture materials.
Some of the procedures that can be completed using operative laparoscopy include: hysterectomy, fibroid removal, endometrial tissue ablation, removal of ovaries and cysts, tubal removal and adhesion removal.
Advanced Laparoscopy (also called robotic surgery) involves a series of mechanical arms attached with surgical instruments and cameras that the surgeon controls while seated at a computer console near the operating table. Hand movements are translated into precise movements within the operative site.
Procedures requiring robotic surgery are usually more complex in nature, these include: coronary artery bypass, surgical removal of cancerous tissue from highly delicate areas including blood vessels, nerves, or vital organs, surgical removal of the gallbladder, hip replacements, hysterectomy, kidney removal and transplantation.
If you present with a diagnostic or treatment-based issue like the ones listed above, your treating Doctor may refer you to a specialised surgeon for further investigation and possible treatment.
What will be covered during my initial appointment with my laparoscopic surgeon?
At your initial appointment your treating surgeon will likely want to:
- Discuss aspects of your medical history
- Schedule any preliminary examinations and tests
- Make sure your surgeon takes the time to listen and address your concerns
- Review the before, during and after of your laparoscopic procedure
What happens during and after Laparoscopic surgery?
Laparoscopic surgical procedures are exclusively performed whilst the patient is under general anaesthetic. This means the patient will not be conscious for the duration of the procedure.
Depending on the surgical site and type of procedure required, the surgical area may be filled with a non-toxic medical gas to provide space and minimise the risk of internal injury to other internal organs. This practice is most common in laparoscopic procedures of the abdomen.
What happens next depends on the type of procedure:
- For diagnostic laparoscopic procedures – the treating surgeon(s) will make a small laparoscopic incision and insert the laparoscope, which transmits images to a screen, giving them a clear view of your organs.
- For Operative and Advanced Laparoscopic procedures – multiple incisions (up to 4) may be made that will enable the surgeon(s) to use a suite of surgical instruments to complete the required procedure.
Once the procedure is over, all instruments are removed and (depending on their location and size) incisions may either be stitched closed or sealed and bandaged.
Once the patient regains consciousness, some common post-operative sensations may include:
- Discomfort around surgical entry points
- Patients who had abdominal procedures completed may feel pain in their shoulder which is caused by the pressure from the non-toxic medical gas used during surgery
- Short-term drowsiness and nausea
Post operative advice: If you are experiencing pain, request some pain relieving medication if it is not already offered. Ensure you have a support person present who can understand the outpatient instructions you will receive relating to pain management, operative site care and dressing. Regardless of your length of stay, arrange to be collected from hospital and have someone stay with you for 24 hours afterwards to ensure your recuperation commences smoothly.
What are the advantages of laparoscopic surgery?
Laparoscopic surgical procedures by their nature use much smaller incisions, are far more targetted and intricate, and are usually less physically traumatic to other organs. For these reasons the benefits of laparoscopic surgery include:
- Minimal blood loss and smaller incision scars
- Reduced risk of hemorrhage and wound infection
- Shorter hospital stays and faster recovery times
- Less expensive hospital bills (due to shorter recovery times)
- Less wound pain during healing and less reliance on pain medication
Post operative advice: Whilst serious complications are rare, you should call your Doctor in the event you continue to or start experiencing:
- chronic nausea, abdominal pain and vomiting
- pus or significant bleeding at your incision site
- fever of 38°C or higher
- pain when you go to the toilet
Laparoscopic surgery is a field of medicine that is advancing rapidly in both applicability and the technology used to conduct it. This means we can look forward to a future where more and more surgical procedures, once requiring more invasive operations, can be completed in ways that will result in shorter recovery times, smaller post operative risks and less pain.
Laparoscopic specialists will usually require a referral to be made so speak to your doctor further about the kinds of surgical approaches relevant to your condition.