Laparoscopy and laparoscopic surgery
Laparoscopy, often referred to as keyhole or minimally invasive surgery, is a medical procedure that allows physicians to examine the abdominal or pelvic cavities using a laparoscope, a small tube equipped with a camera. Since its introduction in 1973, laparoscopy has been employed for both diagnostic and therapeutic purposes, particularly in the treatment and diagnosis of various cancers, such as those of the cervical, colorectal, ovarian, and prostate regions. This technique is generally associated with lower risks compared to traditional open abdominal surgery, as it involves smaller incisions, which can lead to quicker patient recovery and reduced infection rates.
During the procedure, patients are typically placed under general anesthesia, and the abdominal cavity is inflated with gas to provide better visibility of the organs. Surgical instruments may be inserted through small incisions to remove tissue or organs as needed. Although laparoscopy can offer significant advantages, it also presents risks, including potential infection and damage to internal organs. The complexity of the procedure necessitates skilled surgeons, as their expertise largely influences the outcomes. Post-operative care may involve managing mild discomfort from gas used during the procedure, and patients should be aware of signs indicating complications. Overall, laparoscopy is a valuable technique in modern surgery, particularly for patients looking for less invasive options.
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Subject Terms
Laparoscopy and laparoscopic surgery
ALSO KNOWN AS: Keyhole surgery, minimally invasive surgery (MIS), pinhole surgery
DEFINITION: Laparoscopy is a procedure that allows doctors to look inside the abdominal or pelvic cavities using a laparoscopesmall tube attached to a camera and video monitor. This procedure has been used since 1973 to diagnose and treat various conditions, including certain types of cancer.
Cancers diagnosed or treated: Cervical, colorectal, gallbladder, kidney, liver, ovarian, pancreatic, prostate, stomach, and uterine cancers
Why performed: There is some evidence that laparoscopy may involve less risk than open abdominal surgery because it uses only a small in the abdomen. Although the procedure can take longer than conventional surgery, most patients recover more quickly from laparoscopy and have a lower risk of infections. This procedure can also be used to diagnose some medical conditions.
Patient preparation: No food or liquids are allowed for twelve hours before the procedure, and medical staff will ensure that the patient’s bladder and colon are empty. The hospital may provide specific instructions to help patients prepare for the procedure.
Steps of the procedure: Healthcare providers usually give patients general anesthesia, but other types of anesthesia may sometimes be used. Following anesthesia, when the patient is unconscious, the abdominal area is cleaned and shaved. A small tube (catheter) may be inserted through the urethra into the bladder to collect urine that may be discharged during the procedure. A cannula may be inserted through the vagina into the uterus of a female patient to help doctors move the uterus and ovaries and obtain a better view of other organs. Then, a short incision (0.5 to 1 inch) is made, usually in the navel area. A hollow needle is inserted into this incision, and gas (either carbon dioxide or nitrous oxide) is slowly pumped through the needle. The gas inflates the abdominal cavity, lifting it away from the organs to allow doctors to see them. Next, thin tubes called trochars are inserted into the abdominal cavity through the incision. A camera located on the eyepiece of the laparoscope transmits images to a video monitor, enabling the surgeon to see into the abdominal and pelvic areas. Other small incisions may be made in the abdomen to insert instruments used to remove organs or collect tissue samples. A robotic arm may assist the surgeon. The scope is removed after the procedure, and the gas is released from the abdominal cavity. The incision is closed, usually with stitches that dissolve within several days.
New hand-access devices can now enable surgeons to place a hand into the abdomen during laparoscopy and use it for different functions, which used to be possible only with open abdominal surgery.
After the procedure: Patients return home or remain in the hospital depending on the procedures and their outcomes. Patients may feel some abdominal bloating or shoulder pain caused by the effects of the gas on the diaphragm. Patients should contact their doctor if they experience bleeding, redness, swelling, or discharge at the incision site or if they develop a fever, hoarseness that lasts more than a few days, or severe abdominal pain.
Risks: The risks and benefits of this procedure are still being studied. The laparoscopic procedure is technically complex for the surgeon because it involves restricted vision, a limited working area, and hand-eye coordination when working with the instruments. The risks for the patient may include infection in the abdominal cavity, damage to internal organs, failure to eradicate the cancerous tissue or organs, or damage to blood vessels that cause internal bleeding. Patients with existing lung problems may be unable to tolerate the increased carbon dioxide in the abdominal cavity.
Deciding whether to use laparoscopy rather than open abdominal surgery to diagnose and treat certain cancers (for example, ovarian cancer) should be made according to the patient’s overall risk factors as determined by additional tests, such as ultrasound. Open abdominal surgery allows the doctor to look inside organs for tumors and to remove cancerous organs or tissue during the same procedure. There are concerns that laparoscopy may limit doctors’ ability to detect and eradicate such tissue. Patients must discuss these concerns with their doctors. Research shows that the length of hospital stay and risk for infection are reduced with laparoscopy, but the procedure's success depends on the surgeon's training and skill.
Results: The results of laparoscopy vary according to the procedures performed and the type and stage of cancer. The scar from the incision is very small and should heal quickly, depending on the patient’s general health.
Bibliography
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