What is a Laparoscopy?
A laparoscopy is a minimally invasive alternative to conventional open abdominal surgery, a laparotomy. In this procedure, a small camera (laparoscope) is used to see inside the patient’s abdomen. This is less invasive than a laparotomy from a physiological and medical point of view.
Its prevalence has increased significantly in recent years from 5% to 29% of all colorectal procedures. It’s a popular method because of its low invasiveness and high success rate. A gynecologic laparoscopy results in gastric damage in 1 in 33,000 cases.
Calculating the exact uses of this procedure globally is almost impossible. However, specialists estimate that 5000 people undergo it to address obesity each year. Based on these figures, it’s worth noting that laparoscopy is on the rise in the surgical world because of its many benefits.
Read on to learn more about it!
What is a laparoscopy?
A laparoscopy is a type of abdominal surgery in which the practitioner can access the inside of the abdomen without having to make very large incisions through the skin. As indicated in a publication in the National Health Service (NHS), this has multiple benefits compared to a traditional laparotomy.
Among them are the following:
- The patient spends less time in the hospital and their recovery is faster.
- There’s less bleeding and pain after the operation.
- The marks and scars are much smaller than in traditional surgery.
However, the fact that it’s a minimally invasive surgery doesn’t mean that it’s risk-free. Every patient should be aware that the procedure has access to vital organs that may be affected. Therefore, there’s a certain chance that something could go wrong. We’ll explore this concept in just a few minutes.
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Who needs a laparoscopy?
On its website, the American Cancer Society details the candidates for a laparoscopy. Below, we’ll tell you the clinical fronts in which it is usually most useful.
1. The patient has a suspicious area that could be cancer
A laparoscopy can be used to remove or biopsy (obtain tissue samples) from lymph nodes in the pelvis and abdomen. For this reason, specialists recommend it for patients with gynecological cancers, such as cervical, ovarian, and endometrial cancers.
2. There’s an intestinal obstruction
An intestinal occlusion or obstruction occurs when the contents of the bowel cannot pass through or leave the patient’s body. When the obstruction is total, the individual is in a medical emergency requiring immediate surgical intervention.
Depending on the severity of the situation, laparoscopy or laparotomy may be performed. However, larger incisions are sometimes necessary to remove the blockage and to remove or repair any damaged areas of the bowel.
3. Diseases specific to women
Many issues can be solved using laparoscopy in women since they’re more prone to present affections in the pelvic area. This surgical procedure can be used to treat fibroids, ovarian cysts, endometriosis, pelvic prolapse, among other conditions related to the women.
4. Other processes
The National Library of Medicine of the United States details some accessory processes that can be approached with laparoscopy.
Among them, we find the following:
- Removing an ectopic pregnancy: This is a pregnancy that grows outside the uterus. For a pregnant woman, it can be fatal, so it’s necessary to use a surgical approach quickly to solve it.
- Hysterectomy: This is the removal of the uterus. It can be useful in some cancers, deformities, excessive bleeding, and other clinical conditions.
- Tubal ligation: This is a procedure to prevent pregnancy by blocking the fallopian tubes.
- Treatment of urinary incontinence.
What happens in a laparoscopy?
The total procedure usually lasts between 30 and 45 minutes under general anesthesia, so it’s perfectly feasible to perform it in an outpatient clinic in many cases.
We’ll tell you the steps in detail in the following lines.
Before the procedure
If the person is going to receive general anesthesia (as is usually the case), they may not be able to eat or drink for 6 hours before the procedure. In addition to this, in most cases, the patient must bring a companion, since grogginess occurs after the operation.
Doctors also recommend wearing loose-fitting clothing, since the abdomen may hurt a little after the laparoscopy.
During the procedure
The journal Progresos de Obstetricia y Ginecología (Progress in Obstetrics and Gynecology) describes the procedure followed to perform a laparoscopy in detail. It begins with the following key points in mind:
- The patient should be placed in the lithotomy position (legs up and body lying down). The patient’s buttocks should be located on the edge of the table, to allow good management of the uterine mobilizer.
- The patient should be cannulated (a line should be placed) in the right arm.
- It’s advisable to empty the bladder beforehand, either by urination or catheterization when deemed necessary.
After these considerations, doctors insert a Veress-Palmer needle into the patient. Typically, 35-40 % of complications in endoscopic surgeries occur at this point, so exceptional care must be taken. A medical professional usually introduces this via the umbilical route.
Peritoneal insufflation allows surgeons to maneuver correctly in the patient’s abdomen without damaging vital organs. Once performed and after cutting the pertinent incisions, the professionals use the laparoscope to observe the abdominal cavity and make the necessary diagnosis.
If the doctor has to perform any type of surgical procedure, more incisions may be necessary for the introduction of instruments. In any case, these wounds don’t usually exceed 0.5-1 centimeter in length, as indicated by the Clínica Universidad Navarra (CUN).
A laparotomy requires an incision of 15 to 20 centimeters in length. A laparoscopy is much less invasive.
After the procedure
Once the procedure is complete, the patient requires close follow-up in the hours following the procedure to check that everything has gone well. In addition, they won’t be allowed to consume any food or drink while the numbness from the sedation lasts.
If the procedure was done as an outpatient, they’ll be able to return home within a few hours in most cases. Even so, after a laparoscopy, it’s always necessary to make further medical appointments with the relevant professionals to discuss and address the results obtained.
Possible risks of a laparoscopy
This method involves several delicate organs, so it’s not without risk. Diagnostic laparoscopy presents a risk of intestinal injury of 0.08%. In turn, in medium and more complex surgeries, this value rises to 0.33%. Even so, the following may occur:
- Infection of the surgical incision or internal organs. In the worst cases, this can lead to life-threatening bacteremia and septicemia.
- Bleeding of the surgical incision or internal organs.
- Poor healing of the incision. After all, the abdominal tissue is quite delicate.
- Allergy to drugs used during the procedure (sedatives and anesthetics).
- Anaphylactic shock (seldom happens).
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What should I remember about laparoscopies?
A laparoscopy is an excellent alternative to laparotomy. Since the incisions of this procedure are much smaller, the patient recovers faster and the chances of something going wrong are very low.
However, not all patients are suitable for a laparoscopy. Those with a tumor that has spread to the abdominal cavity, bleeding problems, chronic tuberculosis, and other conditions cannot undergo a laparoscopy. In these cases, doctors must use other types of procedures.