Laparoscopy

Posted in Disease Information

Introduction

A laparoscopy is a type of surgical procedure that allows a surgeon to access the inside of the abdomen and pelvis without having to make large incisions in the skin. It is also known as keyhole surgery.

Laparoscopy is minimally invasive. This is made possible with an instrument called a laparoscope.

Laparoscope

A laparoscope is a small tube that consists of a ligh

t source and a camera. The camera relays images of the inside of the abdomen or pelvis to a television monitor.

The advantages of this technique over traditional open surgery are that people who have a laparoscopy have:

• A faster recovery time
• Less pain after the operation
• Minimal scarring

What is a laparoscopy used for?

A laparoscopy can be used to help diagnose a wide range of conditions that develop inside the abdomen or pelvis, such as:

• Pelvic inflammatory disease
• Endometriosis
• Liver cancer

As well as being used to see clearly inside the body, laparoscopies can also be used to carry out surgical procedures. Small surgical instruments and devices, such as lasers, can be passed through incisions in the skin. They are used to perform procedures including removing a damaged or diseased organ, such as an appendix, or to take a biopsy.

Laparoscopy is most commonly used in:

• Gynaecology – the study and treatment of conditions that affect the female reproductive system
• Gastroenterology – the study and treatment of conditions that affect the digestive system

Safety

Laparoscopic surgery is very common and is generally regarded as very safe. Serious complications as a result of surgery are rare and occur in an estimated 1 in 1,000 cases.

Possible complications of a laparoscopy include:

• Damage to organs, such as the bladder or bowel
• Injury to a major artery

When a laparoscopy is used

A laparoscopy may be used to diagnose or treat many different conditions.

Small surgical instruments and devices can be attached to the laparoscope to perform surgical procedures.

Diagnosing conditions

It is often possible to diagnose a condition using non-invasive methods, such as an ultrasound scan, a computerised tomography (CT) scan or magnetic resonance imaging (MRI) scan. However, sometimes the only way to confirm a diagnosis is to directly study the affected part of the body using a laparoscope.

Laparoscopies are now widely used to diagnose many different conditions and investigate certain symptoms. For example, they may be used in cases such as:

• Pelvic inflammatory disease (PID)
• Endometriosis
• Ectopic pregnancy (a pregnancy that develops outside the womb)
• Female infertility
• Ovarian cyst
• Unexplained pelvic or abdominal pain

A laparoscopy can also be used to diagnose certain types of cancers. In such cases, the laparoscope is used to obtain a sample of suspected cancerous tissue so that it can be sent to a laboratory for testing. This is known as a biopsy.

Cancers that can be diagnosed using a laparoscopy include:

• Liver cancer
• Pancreatic cancer
• Ovarian cancer
• Cancer of the bile duct
• Cancer of the gallbladder

Treating conditions

Types of laparoscopic surgery used to treat certain conditions include:

• Removal of an inflamed appendix in cases of appendicitis, where it is thought that the risk of the appendix bursting is high
• Removing the gallbladder, which is often used to treat gallstones
• Removing a section of the intestine, which is often used to treat digestive conditions, such as Crohn’s disease or diverticulitis, that do not respond to medication
• Repairing hernias
• Repairing bleeding stomach ulcers
• Carrying out a female sterilisation
• Treating ectopic pregnancy (it is usually necessary to remove the embryo to prevent damage to the fallopian tubes)
• Treating fibroids (non-cancerous growths on or inside the womb)
• Removing the womb (hysterectomy), which is sometimes used to treat pelvic inflammatory disease (PID), endometriosis, heavy periods or painful periods
• Removing some or all of an organ that has been affected by cancer, such as the ovaries, prostate, liver, colon, kidney or bladder

How a laparoscopy is performed

A laparoscopy is performed under general anaesthetic, so you will be unconscious throughout the procedure and have no memory of it. You should be able to go home on the same day.

Preparation

Depending on the type of laparoscopic surgery being performed, you will usually be asked not to eat or drink anything for 6 to 12 hours before the operation.

If you are taking blood-thinning medication (anticoagulants), such as aspirin or warfarin, you may be asked to stop taking it a number of days before surgery. This is to prevent excessive bleeding during the operation.

Most people can leave hospital either on the day of the surgery or the following day. You will usually be advised not to drive for at least 24 hours after surgery, so you will need to arrange for someone to drive you home.

The procedure

Dr. B C Shah will make a small incision of around 1–1.5cm (0.4–0.6 inches) near your belly button.

A tube is inserted through the incision and carbon dioxide gas is pumped through the tube to inflate your abdomen. Inflating your abdomen allows him to see your organs more clearly, and gives him more room to work.

A second small incision will be made so that the laparoscope can be inserted into your abdomen or pelvis. The laparoscope will relay images to a television monitor in the operating theatre, giving Dr. B C Shah a clear view of the whole area.

If the laparoscopy is used to carry out a surgical treatment, such as removing your appendix, further incisions will be made in your abdomen. Small, surgical instruments can be inserted through the incision, and Dr. B C Shah can guide them to the right place using the view from the laparoscope. Once in place, the instruments can be used to carry out the required treatment.

After the procedure, the carbon dioxide is let out of your abdomen, the incisions are closed using stitches and a dressing is applied.

Laparoscopy used to diagnose a condition usually takes 30–60 minutes to perform. It will take longer if Dr. B C Shah is treating a condition, usually 30–90 minutes, depending on the type of surgery being carried out.

Recovery

After a laparoscopy, you will feel groggy and disorientated as you recover from the effects of the anaesthetic. Some people experience symptoms of nausea and vomiting. These are common side effects of the anaesthetic and should pass quickly.

You are likely to feel mild pain at the site of the incisions in your abdomen, so you will be given painkilling medication.

Some of the carbon dioxide gas used to inflate your abdomen can remain inside your abdomen, which can cause:

• Bloating
• Cramps
• Shoulder pain, as the gas can irritate your diaphragm (the muscle you use to breathe), which in turn can irritate nerve endings in your shoulder

These symptoms are nothing to worry about and should pass after a day or so once your body has absorbed the remaining carbon dioxide.

Before you leave hospital, you will be told how to keep your wounds clean and when to return for a follow-up appointment or to have your stitches removed (although dissolvable stitches are now often used).

It is usually recommended that you have someone stay with you for the first 24 hours after your surgery. This is in case you experience any problems, such as symptoms that may suggest you have a post-operative infection. Such symptoms could include:

• A high temperature of 38C (100.4F) or above
• Chills
• Abdominal pain

If you have had a diagnostic laparoscopy, you will usually be able to resume your normal activities within five days. The recovery period after a therapeutic laparoscopy depends on the type of treatment.

After minor surgery, such as appendix removal, you may be able to resume normal activities within two weeks. Following major surgery, such as removal of your ovaries or kidney due to cancer, the recovery time may be as long as 12 weeks.

Dr. B C Shah can give you more information about when you will be able to resume normal activities.

Complications of a laparoscopy

Laparoscopy is a commonly performed procedure and complications are generally rare.

Minor complications

Minor complications occur in an estimated one or two cases in every 100 after a laparoscopy. They include:

• Post-operative infection
• Minor bleeding and bruising around the site of the incision
• Nausea and vomiting

Major complications

Major complications after a laparoscopy are rare. They occur in an estimated 1 in every 1,000 cases and include:

• Damage to an organ, such as your bowel or bladder, which could result in the loss of organ function
• Damage to a major artery
• Damage to the nerves in your pelvis, which could lead to erectile dysfunction in men
• Complications arising from the use of carbon dioxide during the procedure, such as the gas bubbles entering your veins or arteries
• A serious allergic reaction to the general anaesthetic

Further surgery is usually required to treat these major complications.