Laparoscopy - Uses, Procedure, Benefits, Complications and Recent Advances

What Is Laparoscopy?

Laparoscopy is a minimally invasive, diagnostic surgical procedure that allows access to the internal organs of the body. It is also known as key-hole surgery. In this procedure, a tiny incision is made through which the camera and certain instruments are guided in the body, which allows to visualize the internal organs and treat them at the same time. Laparoscopy is considered a very safe procedure. The incision made is relatively small when compared to traditional surgery. Considering its many advantages, laparoscopy is by far the first choice amongst doctors and patients.

What Are the Uses of Laparoscopy?

Laparoscopy can be used to diagnose many medical conditions and also treat them simultaneously. Ideally, laparoscopy is used as a diagnostic aid when other tests such as ultrasound and x-ray are inconclusive.

Diagnostic Laparoscopy:

Laparoscopy is mainly used in the abdomen and pelvic regions to evaluate organs like the liver, spleen, pancreas, stomach, uterus, ovaries, fallopian tubes, and gallbladder.

It is used to diagnose:

1. Any tumors or growth

2. Any infection

3. Unexplained bleeding

4. Cases of infertility

5. Pain and blockages

6. Ovarian cysts, fibroids, and endometriosis

Operative Laparoscopy:

Operative Laparoscopy may be used in the following condition:

1. It can be used to obtain a biopsy of suspected tissue.

2. Appendicitis surgery.

3. Endometriosis.

4. Removal of ectopic pregnancy.

5. Blocked fallopian tubes.

6. Hysterectomy, where the uterus needs to be removed due to underlying medical conditions.

7. Hernia repair.

8. Removal of the gallbladder (often due to gallstones).

9. Ruptured stomach ulcers

10. Digestive disorders such as Crohn’s disease are unresponsive to medications.

11. Bariatric surgery.

12. Removal of cancer-affected organs.

How Are Patients Prepared Before Laparoscopy?

• A laparoscopic procedure is usually performed under general anesthesia; hence the patients will be required to fast (do not eat or drink) for a period of 8 to 12 hours.

• Anticoagulants or blood thinner medications may have to be stopped, or the dose is adjusted as per the doctor’s advice before the procedure. This is done to prevent excessive bleeding during the surgery.

• Patients should refrain from smoking as it would delay the healing process.

• The patient should inform the doctor if they have taken any prescription or over-the-counter medicine.

• Any history of allergy should be informed.

• Some surgeries may require an enema before the procedure.

• Patients will be advised to wear comfortable loose clothing.

• Any jewelry or valuables should be removed.

• Doctors may advise certain additional tests such as ultrasound, blood investigation, urine routine, or X-rays before laparoscopy.

How Is Laparoscopy Done?

• Laparoscopy is generally carried out as an outpatient procedure.

• Patients will be asked to put on the hospital gown and made to lie on the operating table.

• General anesthesia would be given through an I.V (Intravenous) line.

• A small incision of 1 to 1.5 cm is usually made below the belly button.

• First, carbon dioxide gas is pumped in through a tube to inflate the abdomen. This helps in better visualization and offers increased workspace.

• Once the abdomen is inflated, a laparoscope is inserted. A laparoscope is a thin tubular device with a camera and light attached to its end.

• The laparoscope can be moved around, and the images can be viewed on the attached screen.

• If an operative laparoscopy has to be performed, more small incisions will have to be made in the same area.

• These incisions will guide the surgical instruments along with the laparoscope, thereby enabling the surgeons to perform the required treatment.

• After completing the procedure, the instruments will be removed, and gas will be let out.

• Incisions will be closed using sutures and staples.

• The patient will be shifted to the recovery room.

• Diagnostic laparoscopy usually takes 30 to 60 minutes but may take longer if any surgical intervention is required.

How Is the Recovery?

As Laparoscopy is a minimally invasive procedure, patients generally tend to recover faster. Recovery time following a diagnostic laparoscopy is usually 2 to 3 days, but an operative laparoscopy may range from anywhere between 3 to 12 weeks, depending on the surgical procedure performed. After Laparoscopy, patients may feel sleepy and disoriented due to the effects of general anesthesia. Patients are therefore advised not to drive back home post-surgery. Mild pain and discomfort may be present at the surgical site, which can be taken care of by analgesics. The most common complaint after laparoscopy is shoulder pain. The gas which is used to inflate the abdomen irritates the diaphragm, which can disrupt the shoulder nerve endings. However, this may resolve in a few days. Patients will be advised on how to keep the wound dressing clean and how to take a bath. Staples and sutures will be removed on a follow-up visit.

What Are the Complications?

Just like any other surgery, Laparoscopy may also be associated with minor complications. Major complications are, however, very rare. They are as mentioned below:

• Minor Complications:

1. Bleeding

2. Infection

3. Blood clot

4. Complications arising due to general anesthesia

• Major Complications:

1. Organ damage resulting in loss of organ function

2. Vessel damage

3. An embolus (dislodged blood clot) can block the blood vessels of the lungs or leg, resulting in pulmonary embolism or deep vein thrombosis.

4. Severe allergic reactions

5. Complication due to Carbon dioxide bubbles entering any major artery or vein; however, this is very rare.

When to Seek Medical Advice?

1. If the pain is worsening

2. Associated fevers and chills

3. Increasing shoulder pain

4. Unsettled bleeding

5. Any redness, discharge, or swelling in the wound site

6. Difficulty while breathing

7. Difficulty while urinating

8. Constant coughing

9. Continuous Vomiting

What Are the Benefits of Laparoscopy?

• It is minimally invasive

• The surgical incision made is very small and hence less scarring

• Shorter hospital stay

• Less painful

• Faster recovery

What Are the Recent Advancements in Laparoscopy?

Recent advancement in laparoscopy is also known as “Robotic-assisted laparoscopy.” In this procedure, robots are used to assist the procedure. The camera and other surgical instruments are attached to the robotic arms, which in turn are operated by the surgeon with the help of computer consoles. This procedure has found extensive usage in prostate surgeries. Complex surgeries may be carried out with more precision using this procedure. The image is obtained as a magnified, high-resolution 3-dimensional image. Also, it lowers the risk of any complications.

Conclusion:

The use of laparoscopy has revolutionized the field of surgery in many ways. Recent advances in this field, such as robotic laparoscopy, seem promising, yet their high maintenance cost still proves a barrier to their usage widely. Laparoscopy is considered the gold standard for most abdominal and pelvic surgical procedures. The possibility of diagnosing and treating the condition at the same time, along with its many benefits, has rendered laparoscopy a first-choice surgical procedure.