Definition and Overview

All patients who have undergone laparoscopic surgery are scheduled for a follow-up consultation. The goals of the visit are to assess the patient’s condition following the procedure, evaluate the effects of surgery, and make sure that complications and adverse effects have not occurred. Although laparoscopic procedures are best known for their increased safety compared to traditional surgery, there are still some risks to take into consideration.

Who Should Undergo and Expected Results

This follow-up visit is required for all patients who undergo laparoscopic surgery. The doctor’s goal during the said visit is to gauge whether the surgery has been successful.

Also known as keyhole or minimally invasive surgery, laparoscopic surgery is a modern surgical technique that uses two or more small incisions rather than one large incision that is commonly used in traditional surgery. The surgeon uses a laparoscope, which is a tube-like instrument with an attached camera and light source that illuminates the surgical site and sends images to a computer monitor. The surgeon performs the surgery using tools that are small enough to pass through the small incisions while relying on the computer monitor for a visual guide.

Keyhole surgery has a lot of advantages over traditional surgery. Since the incisions are significantly smaller, the patient experiences less bleeding and pain (both during and after surgery). The procedure also shortens the patient’s hospital stay and recovery period. Best of all, there is very little to no scarring after the procedure.

Laparoscopic surgeries, which can be performed as a diagnostic and therapeutic procedure, are most commonly used in gastroenterology, gynaecology and urology. Thus, patients who will benefit from a follow-up consultation include those who undergo laparoscopic intestinal surgery such as:

Gastrointestinal

  • Proctosigmoidectomy
  • Right colectomy
  • Total abdominal colectomy – This can be used to treat a wide range of intestinal issues involving the large intestines, such as chronic constipation, Crohn’s disease and ulcerative colitis, among many others.
  • Proctocolectomy
  • Abdominoperineal resection


Gynecological

  • Ovarian cyst removal
  • Tubal ligation
  • Hysterectomy
  • Myomectomy, or the removal of uterine fibroids
  • Laparoscopic removal of endometriosis


Urological

  • Nephrectomy
  • Renal cyst removal
  • Renal biopsy
  • Pyeloplasty
  • Ureteropyeloscopy
  • Adrenalectomy


At the end of the follow-up visit, the following questions should be answered:

  • Did the operation go as expected? Did it yield the expected results?
  • How did the surgery affect the patient’s overall condition?
  • Is the patient recovering well?
  • Is the patient experiencing some side effects or symptoms? If so, how should these be managed?
  • Given the results of the surgery, what are the next steps for the patient?


A follow-up will also be required for patients who undergo diagnostic laparoscopy, or when a laparoscopic procedure is performed mainly to determine what causes the patient’s symptoms. In this case, the goal of the follow-up is to discuss the findings and existing treatment options with the patient.

How the Procedure Works

A laparoscopic surgery follow-up is usually scheduled by the surgeon or the patient’s attending physician about one to two weeks after the said procedure. If long-term follow-up is necessary, the patient may be asked to return after a month or for one or two visits every year.

During the follow-up visit, the doctor will check the small incisions or scars left from the surgery to make sure the wounds are healing well. He will also assess the patient’s general condition and check the effects of the procedure to determine whether it was successful or if it has achieved the expected results. If necessary, the doctor may order some post-surgical imaging scans or basic lab tests to get an up-to-date assessment of the patient’s condition.

This is also the patient’s opportunity to talk to their doctor about any concerns they may have about the surgery, such as any adverse effects or unusual symptoms they may be feeling. Other than that, the doctor will also check for warning signs that may indicate possible complications.

If the surgery was performed as part of a long-term treatment plan, the doctor will also discuss the next steps the patient may take.

Possible Risks and Complications

During a follow-up visit, the patient is not expected to undergo any major tests, so there is no risk involved. In fact, the visit itself plays an important role in ensuring that the patient does not suffer from delayed reactions or other complications. Although significantly safer than traditional surgery, laparoscopy is not without risks, the most common of which include:

  • Infection
  • Bruising around the incisions
  • Blood clots
  • Allergic reaction to anaesthesia


There are also more serious risks, such as organ damage, loss of organ function, or artery damage, but these are very rare and are estimated to occur in only 1 out of 1,000 procedures. There is also a small risk associated with the use of carbon dioxide during the procedure as this can cause gas bubbles inside the patient’s veins and arteries. If there is a blood clot, there is also a risk of deep vein thrombosis (when the clot occurs in the legs) or pulmonary embolism (when the clot occurs in the lungs). These rare complications may need to be treated with another surgery.
References:

  • Eichel L, McDougall EM, Clayman RV. Fundamentals of laparoscopic and robotic urologic surgery. In: Wein AJ, ed. Campbell-Walsh Urology. 10th ed. Philadelphia, PA: Elsevier Saunders; 2011:chap 9.

  • Hu JC, Gu X, Lipsitz SR, Barry MJ, D'Amico AV, Weinberg AC, et al. Comparative effectiveness of minimally invasive vs. open radical prostatectomy. JAMA. 2009;302(14):1557-64. PMID: 19826025 www.ncbi.nlm.nih.gov/pubmed/19826025.

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