Definition & Overview
Laparoscopy is a surgical technique in which a thin fibre optic cable system is passed through small cuts in the skin to gain access to the target surgical site without making a big skin incision, as is required in a traditional open surgery. This technique is performed using a video camera that delivers visuals of the surgical site to a television monitor that the surgeon uses as a guide. Due to this, all procedures performed using laparoscopy are referred to as “minimally invasive” or “keyhole surgery.”
Laparoscopic surgery has significantly been developed since it was first introduced in the early 1990s. It is now considered as the standard technique for many surgical procedures and is being used for a number of more complex surgeries. Its popularity is mainly due to its several benefits, such as less pain, reduced bleeding during and after the procedure, and shorter recovery downtime, among others.
Who Should Undergo and Expected Results
Laparoscopic surgery can be recommended to those who:
- Wish to avoid major risks associated with traditional open surgery
- Only require simple procedures that do not justify an open surgery
- Have existing medical conditions that make an open surgery risky
- Require a diagnostic examination of the internal organs and/or a biopsy
The indications for minimally invasive keyhole surgery, both as a diagnostic and therapeutic procedure, are steadily increasing in number as the technology further advances. This is especially true in the field of abdominal and gastrointestinal procedures.
Laparoscopic procedures offer the following key benefits:
- Reduced pain and less pain medication necessary
- Reduced bleeding during and after the procedure
- Reduced risk of haemorrhage
- Shorter hospital stay
- Shorter recovery downtime
- Lower risk of post-surgical complications
- Minimal post-surgical scarring
In the field of diagnostic medicine, laparoscopy is used to diagnose a number of serious diseases, such as:
- Fluid retention in the abdominal cavity
- Cancer staging
- Liver disease
- Inflammation of the intestines
- Pelvic inflammatory disease
Despite these benefits, there are some situations wherein a laparoscopic procedure is not appropriate, such as in the case of paediatric surgery. In addition, it is associated with some disadvantages, including:
- Reduced dexterity and limited range of motion at the surgical site
- Greater risk of intra-abdominal abscess
- Reduced tactile sensation, which increases the risk of tissue damage
- Limited view of the surgical site, which may limit the surgeon’s ability to adequately assess and address the condition
Despite these disadvantages, keyhole surgery still marks a significant development in the field of surgery. In order to avoid its disadvantages, the technique is currently being used in simpler procedures, while open surgery remains as the primary technique for more complicated surgical cases.
How is the Procedure Performed?
Laparoscopic surgery is usually performed as an outpatient procedure and under either general or local anaesthesia, depending on the scope of the surgery and the severity of the condition.
Laparoscopic surgery gives a surgeon access to the internal organs using a number of small incisions, usually 0.5 to 1.5 cm in size, and a special instrument called a laparoscope, a tube with a high-resolution camera and a light strobe attached to it. The incisions are usually made below the belly button for abdominal surgeries. The camera captures real-time images of the internal organs and sends it to a video monitor to give the surgeon visual guidance throughout the procedure. This allows the surgeon to see and perform surgeries inside a patient’s body without resorting to open surgery.
If necessary, the patient’s abdomen is also inflated using carbon dioxide gas passed through a small tube (cannula) to get better visuals of the abdominal organs.
After the procedure, the surgeon will close up the incisions with stitches or surgical tape and then apply a sterile dressing for protection. Although the stitches are very minimal, they may still cause mild to moderate pain or discomfort during the first few days after surgery. Patients can expect to be able to resume normal activities within a week after the procedure. Surgeons typically schedule a follow-up visit after two weeks to ensure that the patient is recovering well.
Possible Risks and Complications
Laparoscopic surgery is not without risks, with bleeding and infection being the most common. However, they occur less frequently when compared to open surgeries. Other risks and their possible symptoms, include:
- Stomach pain
- Drainage at the sites of the incisions
- Allergic reaction to the anaesthesia used
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Bonjer HJ, Deijen CL, Abis GA, Cuesta MA, Martjin HGM, et al. “A randomized trial of laparoscopic versus open surgery for rectal cancer.” The New England Journal of Medicine. 2015; 372:1324-1332. http://www.nejm.org/doi/full/10.1056/NEJMoa1414882#t=article
Marcoux S., Maheux R., Berube S. “Laparoscopic surgery in infertile women with minimal or mild endometriosis.” The New England Journal of Medicine 1997; 337:217-222. http://www.nejm.org/doi/full/10.1056/NEJM199707243370401#t=article