Laparoscopy and Laparoscopic Surgery
Laparoscopy is a surgical procedure which uses a special surgical instrument called a laparoscope to look inside the body or to perform certain operations.
When compared with traditional surgery, laparoscopic surgery usually has:
- Less pain following the procedure.
- Lower risk of complications.
- A shorter hospital stay and a quicker recovery.
- A much smaller scar.
Note: the information below is a general guide only. The arrangements, and the way tests are performed, may vary between different hospitals. Always follow the instructions given by your doctor or local hospital.
What is a laparoscopy?
Laparoscopy is a procedure to look inside your tummy (abdomen) by using a laparoscope. A laparoscope is like a thin telescope with a light source. It is used to light up and magnify the structures inside the abdomen. A laparoscope is passed into the abdomen through a small cut in the skin.
A laparoscopy may be done to find the cause of symptoms such as abdominal pain, pelvic pain or swelling of the abdomen or pelvic region. It may also be done if a previous test (such as an X-ray or scan) has identified a problem. A laparoscopy enables a doctor to see clearly inside your abdomen. Some common conditions which can be seen by laparoscopy include:
What might happen after a laparoscopy?
The length of time to recover can vary. It depends on why the procedure was done and what operations were performed. A simple investigation to 'look around' will leave you a little uncomfortable for a few days.
You may need a day or so to feel completely well after the general anaesthetic. You may take longer to feel well if you were under anaesthetic for a long time.
You are able to eat and drink as normal after laparoscopy. Laparoscopic surgery may take longer to recover your normal bowel function.
You are able to drive only if you are able to operate the vehicle safely, ie not be distracted by pain or nausea. This includes being able to perform an emergency stop.
You may have some pain in your shoulder tip. This is caused by the gas that was pumped inside. It can irritate your diaphragm which has the same nerve supply as the shoulder tip and makes it feel as though your shoulder hurts. This soon wears off.
What are other possible complications?
There may be some minor bleeding or bruising around the skin incisions. Otherwise, in most cases a laparoscopy just to look inside goes without any problem.
Possible problems which may occur include the following:
- Accidental damage to structures inside your tummy (abdomen), such as the intestines or blood vessels. This is rare but if it occurs, an emergency traditional operation may be needed to repair the damage.
- As with any operation, there is a small risk of complications of anaesthesia.
- Occasionally the incision becomes infected which may require a course of antibiotics.
If you have laparoscopic surgery, the risk of complications may increase, depending on what operation is performed.
What is laparoscopic surgery?
As well as simply looking inside, a doctor can use fine instruments to operate. These are passed into the tummy (abdomen) through another small cut in the skin. These instruments are used to cut or trim tissues, perform biopsies, grasp organs, etc, inside the abdomen. This laparoscopic surgery is sometimes called 'keyhole surgery' or 'minimally invasive surgery'.
Laparoscopic surgery
By Samuel Bendet, US Air Force, via Wikimedia Commons
Laparoscopic surgery can be used for various procedures which include:
- Removal of the gallbladder. This is sometimes called a laparoscopic cholecystectomy, or 'lap choly', for short. It is now the most common way for a gallbladder to be removed, usually for gallstones which are causing pain.
- Removal of the appendix.
- Removal of patches of endometriosis.
- Removal of parts of the intestines.
- Female sterilisation.
- Treating ectopic pregnancy.
- Taking a biopsy of various structures inside the abdomen, which can be looked at under the microscope and/or tested in other ways.
The key advantages of laparoscopic surgery are the quicker recovery time and reduced need for pain relief, compared to traditional (open) surgery.
How is laparoscopy done?
Laparoscopy and laparoscopic surgery are usually done whilst you are asleep under general anaesthesia. The skin over the tummy is cleaned. The surgeon or gynaecologist then makes a small cut about 1-2 cm long near to the belly button. Some gas is injected through the cut to 'blow out' the abdominal wall slightly. This makes it easier to see the internal organs with the laparoscope which is gently pushed through the incision into the abdominal cavity. The operator then looks down the laparoscope, or looks at pictures on a TV monitor connected to the laparoscope.
If you have a surgical procedure, one or more separate small incisions may 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 so can perform procedures. A more recent technique called single-port laparoscopy involves operating through the same incision through which the laparoscope was passed and does not require additional cuts to the abdomen.
When the surgeon has finished, the laparoscope and other instruments are removed. The incisions are stitched and dressings are applied. The dressings will cover the incisions and should be kept on until the incisions have healed.
What preparation might I need?
As you will usually be under a general anaesthetic, your hospital should give you instructions about not eating or drinking before the operation.
Depending on the reason for your operation, there may be other, more specific instructions. Your doctor will give you this information if necessary.
Further reading and references
Ahmad G, Gent D, Henderson D, et al; Laparoscopic entry techniques. Cochrane Database Syst Rev. 2015 Aug 318:CD006583. doi: 10.1002/14651858.CD006583.pub4.
Rockall TA, Demartines N; Laparoscopy in the era of enhanced recovery. Best Pract Res Clin Gastroenterol. 2014 Feb28(1):133-42. doi: 10.1016/j.bpg.2013.11.001. Epub 2013 Dec 1.
Ozkardes AB, Tokac M, Dumlu EG, et al; Early versus delayed laparoscopic cholecystectomy for acute cholecystitis: a prospective, randomized study. Int Surg. 2014 Jan-Feb99(1):56-61. doi: 10.9738/INTSURG-D-13-00068.1.
Rao PP, Rao PP, Bhagwat S; Single-incision laparoscopic surgery - current status and controversies. J Minim Access Surg. 2011 Jan7(1):6-16. doi: 10.4103/0972-9941.72360.