Laparoscopy
Laparoscopy is a minimally invasive surgical technique used to examine and treat conditions involving the abdominal organs. Utilizing a laparoscope, which is a flexible tube equipped with fiber optics, surgeons can visualize and operate within the abdominal cavity through small incisions, usually around the navel. This method is commonly used for a variety of procedures, including gallbladder removal, assessment of endometriosis, and female sterilization, among others. One significant advantage of laparoscopy is its ability to reduce recovery time and minimize surgical trauma due to the smaller incisions required compared to traditional surgery.
Patients typically receive either local or general anesthesia based on the procedure's complexity, and many can return home within hours of surgery. Laparoscopy has evolved significantly since the 1970s, expanding from exploratory purposes to a wide range of surgical applications, spurred by advancements in technology and instrumentation. However, it is important to note that certain conditions, such as advanced abdominal wall cancer or severe respiratory issues, may contraindicate its use. As the medical field continues to innovate, laparoscopic techniques are expected to become increasingly prevalent in future surgeries, reflecting a growing preference for quicker recovery and enhanced patient outcomes.
Laparoscopy
Anatomy or system affected: Abdomen, gallbladder, gastrointestinal system, intestines, kidneys, reproductive system, urinary system, uterus
Definition: The examination of the abdominal organs with a laparoscope, a fiber-optic tube that can also be used to perform surgery to correct several disease conditions.
Indications and Procedures
Laparoscopy is a surgical technique for examining the abdominal organs and for surgically treating many diseases of these organs. The instrument used is called a laparoscope. It is a flexible tube that contains fiber optics for visualization purposes and a channel through which physicians can pass special surgical instruments into the abdominal cavity.
Upon insertion of a laparoscope into the abdomen through a small surgical incision (usually near the navel), physicians can observe the liver, kidneys, gallbladder, pancreas, spleen, and exterior aspects of the intestines in both sexes. Hence the technique is useful for detecting cirrhosis of the liver, the presence of stones and tumors, and many other diseases of the abdominal organs. The female reproductive organs can also be examined in this manner.
Before laparoscopy can be carried out, the patient must fast for at least twelve hours. The patient is given a local or general anesthetic, depending on the purpose of the procedure. In exploratory abdominal examinations, the instrument is inserted into the abdomen through a small incision in the abdominal wall after local anesthesia has numbed it. Often, especially when extensive surgery is anticipated, the procedure begins after general anesthesia produces unconsciousness. Upon the completion of exploration or surgery, the laparoscope is withdrawn, and the incision is closed.
Laparoscopic abdominal examination is often used to detect endometriosis, the presence of endometrial cells outside the uterus. This procedure begins with the administration of local anesthesia when only exploration or biopsy is planned. General anesthesia is used when the removal of implants (endometrial tissue) is anticipated. The entry incision is made near the navel, and the laparoscope is inserted. The fiber-optics system is used to search the abdominal organs for implants. Visibility of the abdominal organs is usually enhanced by pumping in a harmless gas, such as carbon dioxide, to distend the abdomen. After the confirmation of endometriosis, surgical implant removal is carried out immediately unless the decision is made to institute drug therapy instead. Full recovery from this surgery requires only a day of postoperative bed rest and a week of curtailing activities.
Laparoscopy can also be employed for female sterilization. The patient is given a general anesthetic. After laparoscopic visualization of the Fallopian tubes in the gas-distended abdomen is achieved, surgical instruments for tube cauterization or cutting are introduced, and the sterilization is carried out. The entire procedure often requires only thirty minutes, which is one reason for its popularity. In addition, patients can go home in a few hours and have fully recovered after a day or two of bed rest and seven to ten days of curtailing activities.
Uses and Complications
Common laparoscopic surgeries are cholecystectomy (the removal of the gallbladder), the removal of gallstones and kidney stones, tumor resection, female sterilization by cutting or blocking the Fallopian tubes, the treatment of endometriosis through the removal of implants from abdominal organs, and the removal of biopsy samples from abdominal organs. Traditional uses of laparoscopy in female reproductive surgery are to identify and correct pelvic pain resulting from endometriosis, ectopic pregnancy, and pelvic tumors. Laparoscopy is also used in the treatment of cysts, fibroids, and polyps.
Laparoscopy has several advantages. There is rarely a need for patients on chronic drug therapy to discontinue medication before laparoscopy. In addition, the use of laparoscopy dramatically lowers surgical incision size, surgical trauma, length of hospital stay, and recovery time. Laparoscopy should be avoided, however, in cases of advanced abdominal wall cancer, severe respiratory or cardiovascular disease, or tuberculosis. Extreme obesity does not disqualify a patient from undergoing laparoscopy but makes the procedure much more difficult to perform.
As laparoscopic surgery has increased in scope, more procedures yield surgical tissues that are larger in size than the laparoscope channel (for example, the removal of gallbladders, gallstones, and ovaries). In many cases, these organs and structures are cut into small pieces for removal. If potentially dangerous items are involved—such as malignancies that can spread on dissection—larger, more conventional incisions are often combined with laparoscopy.
Perspective and Prospects
Since the 1970s, the uses of laparoscopy have constantly expanded. Once confined to the exploratory examination of the abdomen, the methodology has been applied to a large number of different types of surgery in addition to those already mentioned. Such versatility is attributable to the development of better laparoscopes, advanced instrumentation for diverse surgeries, and improved fiber-optic and video technologies.
As a consequence of these advances, many surgeons predict that most future abdominal surgery will be laparoscopic. The driving force for such innovation includes the public demand for quicker recovery times. Laparoscopy provides faster recovery times with better patient outcomes. In the United States, this desire is intensified by the requirements of insurance companies, employers, and the federal government for shorter hospital stays. Both changes are made possible by decreased severity of surgical trauma in laparoscopy when compared to traditional surgery, a result of the smaller incisions. The dramatic trend toward laparoscopy can be seen with cholecystectomies: of those done in 1992, 70 percent were laparoscopic, compared to less than 1 percent in 1989; according to a 2010 report, about 75 percent of cholecystectomies are done with laparoscopic surgery, and since then, the rate has only increased with 90 percent of cholecystectomies performed laparoscopically by 2023.
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