Comprehensive Insight into Laparoscopy Procedure

What is Laparoscopy?

Laparoscopy is a minimally invasive surgery that is done to diagnose and treat certain medical conditions in the pelvis and abdominal cavity. 

During laparoscopic surgery, the surgeon can look directly inside your abdominal or pelvic cavities to make a diagnosis. They can also remove growths, obtain tissue samples, or fix something such as a hernia. 

A laparoscopic surgical procedure is done using a tool called a laparoscope. This is a telescopic rod with a tiny video camera at its tip. This and other surgical instruments are inserted through small incisions (small cuts) in the abdominal wall. 

Laparoscopic surgery, also called keyhole surgery, is less invasive and generally safer than traditional open abdominal surgery (called laparotomy). Keyhole surgery also has a faster recovery time.

Endoscopy is also a minimally invasive procedure, but it is different from laparoscopy in that the surgical tool (endoscope) is inserted through a natural opening in the body. For example, the esophagus (food pipe) to examine the digestive tract.

Types of Laparoscopy

Diagnostic vs Therapeutic Applications  

Diagnostic laparoscopy is used to diagnose conditions in the abdominal or pelvic cavities. Therapeutic laparoscopic surgery is done to treat medical conditions. 

What is Laparoscopy Surgery For?

Common Conditions Diagnosed with Laparoscopy

A laparoscopy may be done when the results of your physical examination, laboratory tests, and imaging tests (X-ray, ultrasound, or CT scan) do not allow your healthcare provider to make a diagnosis. The Laparoscopy can provide more information to healthcare providers, for example, about: 

• Bleeding 

• Injuries

• Infections

• Blockages

• Unexplained pain

• Benign or malignant tumors

• Staging of cancer

Common Conditions Treated with Laparoscopic Surgery

Some of the surgical procedures that can be done laparoscopically include:

• Cyst, fibroid, stone, small tumor, or polyp removals from the abdominal or pelvic cavities

• Biopsies to obtain tissue samples

• Appendectomy (appendix removal)

• Cholecystectomy (gallbladder removal)

• Hernia repair surgery

• Fundoplication (acid reflux surgery)

• Gastric bypass or gastric sleeve surgery (to treat obesity)

• Orchiopexy (testicular surgery)

• Rectopexy (surgery for rectal prolapse)

• Colposuspension (reconstruction of the pelvic floor)

Why Would A Woman Need A Laparoscopy?

In women, a diagnostic laparoscopy may be used to find out information about a woman’s pelvic organs and potential gynecologic conditions, such as:

• Pelvic pain

• Fibroids

• Ovarian cysts

• Endometriosis

• Problems with the fallopian tubes

Why Would A Woman Need Laparoscopic Surgery?

Some types of gynecologic surgery can be done laparoscopically in women, including:

• Tubal ligation and reversal

• Endometriosis surgery

• Surgical removal of an ectopic pregnancy

• Reconstruction surgery on the vagina or urethra

Is A Laparoscopy A Major Surgery?

Laparoscopic surgery can be a major surgery in some cases. It is a minimally invasive surgery and is less invasive than traditional open surgery. However, some laparoscopic procedures are still major surgical procedures. If your laparoscopic surgery is a major surgery, your surgeon will give you detailed information on how to prepare for it and what to expect after discharge from the hospital.

Preparing for a Laparoscopy  

Preoperative Testing Requirements  

Before undergoing laparoscopic surgery, you will undergo a comprehensive medical evaluation, including a physical examination, laboratory tests, and imaging studies. The goal of this evaluation is to assess your overall health status and identify any underlying conditions that could complicate the laparoscopic surgery or affect your recovery. Your surgeon may ask you to temporarily stop taking certain medications, such as blood thinning medicines, before laparoscopy.

Some of the tests that may be done before laparoscopic surgery include:

• Chest x-ray

• Electrocardiogram (ECG)

• Complete blood count 

• Blood glucose

• Electrolytes (sodium, potassium)

• Urinalysis

• Other diagnostic tests, such as coagulation studies (PT/PTT, INR)

Patient Considerations

Your surgical team will give you detailed instructions for preparation before laparoscopic surgery. General guidelines are as follows: 

• Don’t eat or drink anything after midnight on the day before your surgery. You may take your prescribed medications with a couple of sips of water.

• Wear comfortable, loose-fitting clothes and low-heeled shoes. You may have some tenderness in the abdominal or pelvic area and be drowsy or unsteady from the effects of anesthesia. 

• Leave all jewelry at home (except your wedding ring). 

• Arrange for someone to drive you home after the procedure.

The Laparoscopic Procedure  

Steps Involved  

1. You lay flat on the operating table with your head tilted slightly below your feet. 

2. The anesthesiologist induces general anesthesia. (You will remain asleep during the procedure and won’t feel pain). 

3. They may place a urinary catheter to drain urine.

4. To perform surgery, the surgeon starts by making a small incision (small cut) in your abdominal wall, typically measuring less than 1/2 inch, near the belly button or under the ribcage. 

5. The surgeon inserts a gas tube through this incision and fills your belly with carbon dioxide gas. Having the belly full of CO2 gas makes it easier to see the internal organs and structures. 

6. The surgeon then removes the gas tube and inserts the laparoscope. The laparoscope has a tiny video camera at its tip that projects images of the inside of your belly on a computer monitor in real-time. The surgeon uses these images to watch their hands performing the procedure in real-time. 

7. Some surgeries can be done with a single incision, or the surgeon may make up to three more incisions to insert additional surgical instruments or take biopsy samples.

8. Once the laparoscopic surgery is finished, the surgeon allows the gas out of your belly and closes the incisions. 

9. The entire procedure takes 30-60 minutes for a diagnostic laparoscopy and a few hours (usually 1-3 hours) for laparoscopic surgery, depending on the complexity of the surgery. 

10. Sometimes, if the surgeon is unable to safely perform the procedure laparoscopically through smaller incisions, they may switch to open surgery by making a larger incision.

Medical Professionals Involved

You may be referred for laparoscopy or laparoscopic surgery by a healthcare provider such as a gastroenterologist or obstetrician and gynecologist (OB/GYN). Similar to other types of surgery, the surgical team for a laparoscopic surgery typically includes:

• Surgeon

• Anesthesiologist

• Certified registered nurse anesthetist (CRNA)

• Operating room nurse or circulating nurse

• Surgical tech

• Fellows, residents, and medical students 

• Physician Assistant or Nurse Practitioner

General Anesthesia and Equipment Used

Laparoscopic surgery is usually performed under general anesthesia. Equipment used during the procedure includes:

• Laparoscope, which is a telescopic surgical instrument with a video camera at its tip.

• Trocar, a pen-like instrument with a sharp triangular point, used to gain entry into the body and serve as a conduit for introducing other surgical instruments into the abdominal or pelvic cavities.

• Insufflator, to regulate the flow of gas into the abdominal cavity.

• Other surgical instruments such as bowel graspers, needle drivers, scissors, forceps, scalpels, and suction irrigators.

Benefits and Possible Risks of Laparoscopy  

Advantages Over Traditional Surgery  

Some of the advantages of laparoscopic surgery over traditional surgery include:

• Less surgical trauma 

• Reduced risk of postoperative complications

• Less blood loss and lower risk of bleeding

• Less scar tissue and smaller scars

• Lower risk of infection

• Less pain and less need for pain medication

• Shorter hospital stay

• Shorter recovery time

• Less expensive due to shorter hospital stay

Possible Complications and Risks

Laparoscopic surgery is very safe, and serious complications are rare. However, it is still considered a major surgery and carries certain risks, such as:

• Bleeding

• Infection

• Injury to a blood vessel or nearby organs

• Risks related to anesthesia

• Blood clots 

• Abdominal swelling

Recovery and Aftercare  

Immediate Post-Operative Care  

You will be watched closely in the recovery room for about one hour after laparoscopic surgery. You may have some pain and abdominal discomfort from the gas left in your abdomen. Many people also develop shoulder pain or neck pain. Your healthcare team will give you pain medication to keep you comfortable. 

Long-Term Recovery: How Long Does It Take To Heal From Laparoscopic Surgery?

How long it takes to heal from laparoscopic surgery depends on the type of procedure and can range from a few days to a few weeks. For example, if you are having a minor surgery or outpatient surgery such as a diagnostic laparoscopy, you will likely be able to go home the same day and back to work and normal activities within a week. On the other hand, if you are having a complex gynecologic laparoscopy, you may need to stay in the hospital for a few days, and full recovery may take 6-8 weeks.

General time frames are as follows:

• Diagnostic laparoscopy: Recovery can take up to 5 days. 

• Simple laparoscopic surgery: Return to work within 1-2 weeks. 

• Complex laparoscopic procedure: Full recovery can take 6 to 8 weeks. 

When to Call Your Surgeon

Call your surgeon or healthcare team right away if you develop the following symptoms after a laparoscopic surgery:

• Fever or chills

• Increasing pain, redness, or swelling at the surgical site

• Unusual discharge or bleeding at the incision site

• Vomiting

• Trouble urinating

Tips for Effective Healing

• Have someone stay with you overnight, at least for a day or two.

• Take it easy for a few days.

• Do not drink alcohol during recovery from laparoscopic surgery, especially in the first 24-48 hours.

• Keep your incisions clean and dry.

• Follow your surgeon’s recommendations on when to start bathing and showering, return to work, and return to other normal activities for your daily routine.

• Keep all your follow-up appointments.