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Laparoscopy

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Laparoscopy



Introduction 

Laparoscopy is a type of surgical procedure that allows a surgeon to access the inside of the abdomen (tummy) and pelvis without having to make large incisions in the skin.

This procedure is also known as keyhole surgery or minimally invasive surgery.

Large incisions can be avoided during laparoscopy because the surgeon uses an instrument called a laparoscope. This is a small tube that has a light source and a camera, which relays images of the inside of the abdomen or pelvis to a television monitor.

The advantages of this technique over traditional open surgery include:


a shorter hospital stay and faster recovery time

less pain and bleeding after the operation

reduced scarring


How laparoscopy is carried out

Laparoscopy is carried out under general anaesthetic, so you will not feel any pain during the procedure.

During laparoscopy, the surgeon makes one or more small incisions in the abdomen. These allow the surgeon to insert the laparoscope, small surgical tools and a tube, which is used to pump gas into the abdomen – this makes it easier for the surgeon to look around and operate.

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

You can often go home on the same day you have laparoscopy, although you may need to stay in hospital overnight.

When laparoscopy is used

Laparoscopy can be used to help diagnose a wide range of conditions that develop inside the abdomen or pelvis. It can also be used to carry out surgical procedures, such as removing a damaged or diseased organ, or removing a tissue sample for further testing (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) and urology (the study and treatment of conditions that affect the urinary system).

Safety

Laparoscopic surgery is very common and  generally regarded as safe. Serious complications are rare, occurring in just one in 1,000 cases, according to estimates.

Possible complications include:


damage to organs, such as the bladder or bowel

injury to a major artery

damage to nerves in the pelvis


When laparoscopy is used 

Laparoscopy is used to diagnose or treat numerous conditions.

During the procedure, small surgical instruments and devices are inserted through small incisions. This helps your surgeon perform whatever surgical procedure needs to be carried out.

Diagnosing conditions

It's often possible to diagnose a condition using non-invasive methods, such as an ultrasound scan, a computerised tomography (CT) scan ormagnetic resonance imaging (MRI) scan. Sometimes, however, 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 for:


pelvic inflammatory disease (PID) –  a bacterial infection of the female upper genital tract, including the womb, fallopian tubes and ovaries

endometriosis – where small pieces of the womb lining (the endometrium) are found outside the womb

ectopic pregnancy – a pregnancy that develops outside the womb

ovarian cyst – a fluid-filled sac that develops on a woman’s ovary

fibroids – non-cancerous tumours that grow in or around the womb (uterus)

female infertility

undescended testicles – a common childhood condition where a boy is born without one or both testicles in their scrotum

appendicitis – a painful swelling of the appendix (a small pouch connected to the large intestine)

unexplained pelvic or abdominal pain


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 laparoscopy include:


liver cancer

pancreatic cancer

ovarian cancer

cancer of the bile duct

cancer of the gallbladder


Treating conditions

Laparoscopic surgery can be used to treat a number of different conditions, including:


the removal of an inflamed appendix in cases of appendicitis where there is a high risk of the appendix bursting

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, such as those found in the groin

repairing burst or bleeding stomach ulcers

performing weight loss surgery

removing some or all of an organ that has been affected by cancer, such as the ovaries, prostate, liver, colon, kidney or bladder

treating ectopic pregnancy (it's usually necessary to remove the embryo to prevent damage to the fallopian tubes)

removing fibroids

removing the womb (hysterectomy), which is sometimes used to treat pelvic inflammatory disease (PID), endometriosis, heavy periods or painful periods


How laparoscopy is performed 

Laparoscopy is performed under general anaesthetic, so you will be unconscious throughout the procedure and have no memory of it. You can often go home on the same day.

Preparation

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

If you're taking blood-thinning medication (anticoagulants), such as aspirin or warfarin, you may be asked to stop taking it a few days beforehand. This is to prevent excessive bleeding during the operation.

If you smoke, you may be advised to stop during the lead-up to the operation. This is because smoking can delay healing after surgery and increase the risk of complications such as infection.

Most people can leave hospital either on the day of the procedure or the following day. Before the procedure, you will need to arrange for someone to drive you home because you will be advised not to drive for at least 24 hours afterwards.

The procedure

During laparoscopy, the surgeon will make a small cut (incision) of around 1-1.5cm (0.4-0.6 inches), which is usually placed near your belly button.

A tube is inserted through the incision, and carbon dioxide gas is pumped through the tube to inflate your tummy (abdomen). Inflating your abdomen allows the surgeon to see your organs more clearly and gives them more room to work. A laparoscope is then inserted through this tube. The laparoscope will relay images to a television monitor in the operating theatre, giving the surgeon 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 these incisions, and the surgeon 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 or clips and a dressing is applied.

When laparoscopy is used to diagnose a condition, the procedure usually takes 30-60 minutes. It will take longer if the surgeon is treating a condition, depending on the type of surgery being carried out.

Recovery

After laparoscopy, you may feel groggy and disorientated as you recover from the effects of the anaesthetic. Some people feel sick or vomit. These are common side effects of the anaesthetic and should pass quickly.

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

For a few days after the procedure, you're likely to feel some pain and discomfort where the incisions were made, and you may also have a sore throat if a breathing tube was used. You will be given painkilling medication to help ease the pain.

Some of the gas used to inflate your abdomen can remain inside your abdomen after the procedure, 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 gas.

In the days or weeks after the procedure, you will probably feel more tired than usual, as your body is using a lot of energy to heal itself. Taking regular naps may help.

Recovery times

The time it takes to recover from laparoscopy is different for everybody. It depends on factors such as the reason the procedure was carried out (whether it was used to diagnose or treat a condition), your general health and if any complications develop.

If you have had laparoscopy to diagnose a condition, you will probably be able to resume your normal activities within five days.

The recovery period after laparoscopy to treat a condition 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.

When to seek medical advice

It's usually recommended that someone stays with you for the first 24 hours after surgery. This is in case you experience any symptoms that suggest there could be a problem, such as:


a high temperature of 38°C (100.4°F) or above

chills

increasing abdominal pain

redness, pain, swelling and discharge around your wounds

pain and swelling in one of your legs

a burning or stinging sensation when urinating


If you experience any of these symptoms during your recovery, you should contact either the hospital where the procedure was carried out, your GP or  111 for advice.

Complications of laparoscopy 

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

Minor complications

It is estimated that minor complications occur in one or two out of every 100 cases, following laparoscopy. They include:


post-operative infection

minor bleeding and bruising around the incision

feeling sick and vomiting


Serious complications

Serious complications after laparoscopy are rare, occurring in one out of every 1,000 cases, it is estimated. These 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

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

a blood clot developing in a vein, usually in one of the legs (deep vein thrombosis or DVT), which can break off and block the blood flow in one of the blood vessels in the lungs (pulmonary embolism)


Further surgery is often required to treat many of these more serious complications.
 


Laparoscopy