Laparoscopic Surgery

Definition

Laparoscopic surgery is a type of surgery that is performed through several small holes in the abdomen. A specialized camera with fiber-optic fibers is inserted through one of these openings to visualize the inside of the abdomen. In the other opening surgical instruments are introduced so that the procedure can be performed.

Placement of the laparoscopic instruments is done under general anesthetic.

Parts of the body that are involved:

• The abdomen
• Female reproductive system

Reasons for the procedure:

• Diseases that cause acute or chronic pain in the abdomen or pelvis
• Visualization of suspicious changes in the stomach and taking of samples (biopsy) for histopathological examination
• Examination of the causes of sterility
• Examination of the causes of accumulation of fluid in the abdomen
• Staging certain types of tumors

Many surgeries today are performed laparoscopically, among these are:

• Hernia
• Taking samples (biopsy) from the abdominal organs
• Appendectomy (appendix operation)
• Colectomy (removal of small part or all of the colon)
• Cholecystectomy (gallbladder removal)
• Operations on the fallopian tubes
• Surgery of an ectopic pregnancy
• Operation for in-vitro fertilization
• Hysterectomy (uterus removal)
• Removal of various types of tumors
• Suprarenal gland removal
• Hepatectomy and liver resection (removal of liver parts)
• Splenectomy (spleen removal)
• Adhesiolysis (removal of adhesions from the abdomen)
• Endometriosis surgery
• Ovarian cysts operation
• Incontinence procedures

Risk factors for complications during the procedure:

• Heart and lung diseases
• Obesity
• Previous abdominal surgery

What should you expect before the procedure

Depending on the diagnosis, your doctor will probably do some of the following exams:

• Physical examination and data on medications you are or have been taking.
• Laboratory blood analysis.
• Laboratory urine analysis.
• Abdominal ultrasound (test that can partially examine the inside the abdomen)
• Computerized tomography, CT (type of x-ray examination which precisely visualizes the structure of the abdominal wall and intra-abdominal organs)
• MRI (magnetic resonance imaging)

A few days before surgery

• Do not take aspirin or other anti-inflammatory drugs for one week before surgery, unless your doctor advised you otherwise. Also, you may need to stop taking other medicines that reduce blood clotting (anticoagulants) such as: clopidogrel (Plavix), warfarin (Coumadin), or ticlopidine (Ticlid). Talk to your doctor if you are taking any of these medications.
• Depending on the type of surgery you may need to get an enema and / or take some laxative medicines
• Arrange home transport
• The night before the surgery eat a light meal. No food or drink after midnight.

Anesthesia

General or local with sedation.

Description of the procedure

The surgeon makes a small opening in the abdomen. Usually, this hole is located in the vicinity of the navel and lower abdomen. Through this hole a core needle is inserted and CO2 is injected into the belly, thus inflating the abdomen and creating a space in which to achieve good visualization and the ability to work. Then, through one of the holes in the abdomen a specialized camera is placed. The camera illuminates the inside of the abdomen, and enhances the image of the cable system, which is transferred to the screen in the operating theater. Then the organs can be inspected.

If necessary, several small incisions are made on the stomach, through which instruments are inserted in order to take tissue samples or perform surgery. After completion of the surgery the wound in the abdomen is closed with stitches.

After the surgery

If it was an operation to take samples of tissue or fluid these are then sent for histopathological analysis. It takes a few days to complete this analysis.

How long does the operation take?

Depending on the procedure, from half an hour to several hours.

Is the procedure painful?

Anesthesia prevents the occurrence of pain during surgery. After the surgery, during the first few days you can feel minor pain, but you will receive pain medication. You may feel swelling or pain in the shoulder, which are the consequences of the gas which was blown into the abdomen during surgery. This may last a few days, until the gas is completely absorbed.

Possible complications:

• Infection
• Gas embolism
• Excessive bleeding
• Damage to blood vessels or tissue that sometimes needs immediate re-operation
• Problems associated with general anesthesia
• Possibility of classical re-operations

The average hospital stay

If the procedure is performed for diagnostic purposes, you will leave the hospital the same day. But if you are having an operation, you will have to stay in the hospital between 2 to 5 days.

Post-operative care
When you get home, follow the advice given by your doctor, such as:
• Remove the bandage the morning after surgery
• Avoid lifting heavy objects
• Drinking carbonated beverages is prohibited for two days after surgery

The outcome

Depending on the procedure, you will probably be able to return to your daily activities in a week. If the procedure is performed to establish a diagnosis, your doctor will give you further details of the treatment. The results of a biopsy may take from 3 to 5 days to come back from the laboratory.