Laparoscopy is a diagnostic procedure to examine the organs inside the abdomen by using a laparoscope. A laparoscopy may be done to diagnose the cause of symptoms such as abdominal pain, abdominal mass or tumour, fluid in the abdominal cavity, liver problems, pelvic pain or swelling of the abdomen or pelvic region. During the process, organs like appendix, gallbladder, liver, pancreas, small and large bowel, spleen, stomach, pelvic or reproductive organs are examined. The procedure also can be used to take a biopsy. Laparoscopy is a minimally invasive procedure by way of small incisions. Laparoscopic Surgery is usually performed, sequel to the failure of non-invasive imaging techniques such as ultrasound, MRI and CT Scans, to provide enough data for diagnosis. Laparoscopy uses an equipment called laparoscope.
The laparoscope is a long thin tube with a high-intensity light and a high-resolution camera at the front. The instrument is inserted through an incision in the abdominal wall. As it moves along, the camera relays images to a video monitor. Laparoscopy allows the physician to see inside a person's body, in real time without open surgery. By this laparoscopic surgery procedure, surgeons use to cut or trim tissues, perform sample-taking (biopsies), grasp organs, etc, inside the abdomen. This laparoscopic surgery is also sometimes known as 'keyhole surgery' or 'minimally invasive surgery' (MIS) or 'bandaid surgery'.
Laparoscopic surgery can be used for various procedures.
Some commonly performed operations include:
The Laparoscopic surgery extends multiple benefits like:
Preparations for a laparoscopy are similar to those for any surgery. Patient should inform physician about general fitness and daily medications being taken and act according to physician's advice. In case a female patient is pregnant, physician should be informed about it. This will reduce the risk of harm to the developing baby. As a matter of planning to conduct laparoscopy, physician may require a blood test, urinalysis, an electrocardiogram (EKG or ECG), chest X-ray, ultrasound, MRI and CT Scan. The data from the imaging study can help surgeon to understand better, the abnormality and may act as a visual guide about the abdomen status of the person involved, to ascertain effectiveness of planned laparoscopy. Prior to carrying out laparoscopy, at least eight hours fasting from food and drink needs to be adhered to. In case the patient is given a sedative to take at home prior to surgery, self driving of vehicle to be avoided to the surgical site. The person who is allergic to anaesthesia should inform the physician / surgeon about the allergy in advance, to facilitate surgeon to take appropriate precautions.
Laparoscopic surgery is in general advocated as an outpatient procedure in a hospital or an outpatient surgical centre. Laparoscopy or laparoscopic surgery is generally carried out under general anaesthesia. Sequel to getting into surgery attire, general anaesthesia is administered to the patient. The patient would fall asleep soon throughout and would not feel any pain. In some cases, local anaesthesia with sedation would be used instead. Patient will still not feel any pain due to the numbness in the laparoscopic site, but can be woken up, if needed.
There are a number of advantages to the patient with laparoscopic surgery over the more common, open procedure. Pain and haemorrhaging are reduced due to smaller incisions and recovery time would be shorter. The key element in laparoscopic surgery is the use of a laparoscope, a long fiber optic cable system which allows viewing of the affected area by moving the cable from a more distant, but more easily accessible location.
There are two types of laparoscope: (1) a telescopic rod lens system, that is usually connected to a video camera (single chip or three chip), or (2) a digital laparoscope where the charge-coupled device is placed at the end of the laparoscope. Also attached is a fibre optic cable system connected to a 'cold' light source (halogen or xenon), to illuminate the operative field, which is inserted through a 5 mm or 10 mm cannula or trocar. The abdominal skin is cleaned. The laparoscopic surgeon makes a small 1 to 2 cm long incision near the navel. The abdomen is usually insufflated with carbon dioxide gas. This elevates the abdominal wall above the internal organs to create a working view space. Carbon dioxide gas is used because it is common to the human body and tissue-absorbent and would get removed by the respiratory system. It is also non-flammable, to align with the electrosurgical devices which are generally used in laparoscopic procedures. Laparoscopic surgery includes operations within the abdominal or pelvic cavities. Specific surgical instruments used in a laparoscopic surgery include forceps, scissors, probes, dissectors, hooks, retractors and more.
Through the surgical procedure, one or more separate small incisions would be made in the abdominal skin. These allow thin instruments to be pushed into the abdominal cavity. The surgeon can see the ends of these instruments with the laparoscope and can perform the required procedures. These procedures are in general used to cut or trim tissues, perform sample-taking (biopsies), grasp organs, etc, inside the abdomen. A more recent technique called single-port laparoscopy involves operating through the same incision through which the laparoscope is passed-through and does not require additional incisions to the abdomen. On completion of the surgery, the laparoscope and other instruments are removed. The incisions are stitched and clinically dressed-up.
On completion of the laparoscopic surgery, the patient would be taken to a recovery room and would be kept under observation for several hours, monitoring vital signs, prior to discharge from the hospital. The discharge from hospital would depend on patient's overall physical condition, the type of anaesthesia used and reaction of patient's body. In some cases, overnight stay-put, would be prescribed for some patients. Based on the wearing-off of the anaesthesia-effect, patient would be discharged from the hospital, but would be strictly advised not to self-drive any vehicle to get back home. Sequel to the laparoscopic surgery, patient might feel little pain and throbbing at the surgical site. The pain and discomfort level would recede day by day. During this time, the medicines prescribed by the physician shall be taken scrupulously for pain relief. It would not be uncommon to suffer from shoulder pain after the surgery, due to the irritation in diaphragm and bloating caused by carbon-dioxide gas. Patient would be advised not to lift heavy objects for a week's time and can start having normal diet. Patient can resume all normal activities within a week and would consult the physician in about two weeks. In the meantime, if the patient feels anything abnormal of any sort, it is advised to consult the physician immediately.
The surgeon who performed laparoscopy would analyze the findings. If a biopsy was taken, it would be examined by a pathologist (physician specialized in tissue analysis). A report detailing the results would be sent to the physician concerned. Normal results indicate the absence of abdominal bleeding, hernias, and intestinal blockages. They also mean that all the organs are healthy in appearance and size.
Abnormal results from a laparoscopy would indicate any one of the following numerous conditions: