Laparoscopy

Definition

Laparoscopy describes a group of operations performed with the aid of a camera placed in the abdomen.

The laparascope was first combined with a video camera in the 1980s, an accomplishment that helped free up the surgeons' hands, so they could better work with their instruments. The laparoscope also allows doctors to perform minor surgery with just a small cut in the abdomen.This technique is known as laparoscopic-assisted surgery.

Initially, laparoscopy was used for procedures such as tubal ligation, a sterilization operation also known as tying the tubes.

The first laparoscopic gallbladder removal was performed in 1985 in France. Soon, the technique was being used to remove the appendix. Today, exploratory laparoscopy is used after abdominal injury, and in cases of abdominal or pelvic illness. Surgeons use laparoscopic-assisted surgery to remove the colon or the kidney during live donor transplants. Weight-reducing procedures such as gastric bypass and vertical banding gastroplasty (VBG) can also be done laparoscopically. Surgeons may start large operations on the liver or pancreas with laparoscopy to check for additional tumors.

How the test is performed

The procedure is usually done in the hospital under general anesthesia. A catheter (a small flexible tube) is inserted through the urethra into the bladder. An additional tube may be passed through the nostril and into the stomach (NG tube). The skin of the abdomen is cleaned, and sterile drapes are applied.

After a small cut is made above or below the bellybutton (navel), a tube is inserted. A tiny video camera passes through the tube. Carbon dioxide gas is injected into the abdomen to lift the abdominal wall, making a larger space to work in. This allows for easier viewing and moving of the organs.

The laparoscope is then inserted, and the organs of the pelvis and abdomen are examined. Additional small openings are made for instruments that let the surgeon to move, cut, stitch, and staple structures during the operation.

After the examination, the laparoscope is removed, all openings are stitched closed, and bandages are applied. Depending on the operation performed, a tube may be left through one of the cuts to let fluids drain.

How to prepare for the test

You cannot have any food or fluid for 8 hours before the test. You must sign a consent form.

How the test will feel

With general anesthesia, you will feel no pain during the procedure. However, the stitched cuts may throb and be slightly painful afterward. Your doctor may give you a pain reliever.

With local anesthesia, you may feel a prick and a burning sensation when the anesthetic is given. Pain may occur at the operation site. Afterward, the stitched cuts may throb and be slightly painful. A pain reliever will be given by your doctor.

You may experience shoulder pain for a few days, because the gas can irritate the diaphragm, the large muscle at the top of the belly. Some of the nerves in the diaphragm also go to the shoulder.

Finally, you may experience an increased urge to urinate, because the gas can put pressure on the bladder.

You will not be able to drink liquids or eat solid foods until your doctor tells you it is safe to do so.

Why the test is performed

Laparocopic operations are performed for the same reasons that open (laparotomy) procedures are performed.

What abnormal results mean

Abnormal results depend on the operation.

What the risks are

There is a risk of puncturing an organ, which could cause leakage of intestinal contents, or bleeding into the abdominal cavity. This often happens when the doctor switches from laparoscopy to an open surgical procedure. Severe injury may result in infection or the need for blood transfusion.

Special considerations

Your ability to have laparoscopic surgery may be limited by previous abdominal surgery. Often surgery makes scars form, which prevents the safe passage of the instruments into the abdomen. It may also prevent the abdominal wall from being properly lifted by the gas.

For complex laparoscopic operations, patients should consult with their doctor to find the best center for the specific operation.

References

Townsend CM, Beauchamp RD, Evers BM, Mattox KL, Sabiston Textbook of Surgery, 17th ed. St. Louis, MO: WB Saunders; 2004:445-464.

Illustrations

Pelvic laparoscopy

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