Laparoscopic Surgery: Everything You Need to Know

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Laparoscopic surgery, also referred to as minimally invasive surgery (MIS) or laparoscopy, is a surgical technique in which a thin, camera-equipped surgical device is inserted into the abdomen or pelvis through one or more small incisions. The camera relays a real-time video of the internal organs on a monitor for surgical guidance, and the operation is done through the small incisions.

Laparoscopy can be used for many different types of surgeries, such as hernia repair, hysterectomy, stomach ulcer surgery, and weight loss surgery.

What Is Laparoscopic Surgery?

Laparoscopic procedures are surgeries that require incisions. They are described as minimally invasive because they are done with small incisions that measure a quarter to a half-inch in length.

A laparoscope is placed into the surgical incisions to project the body's structures on a screen. Rather than seeing the internal organs directly when operating, the surgeon performs the entire procedure using the visualization projected on the monitor by the scope.

There are several types of laparoscopic devices, and they range in length, width, and degree of flexibility or rigidity. They generally include a camera, a light source, and surgical tools.

The tools your surgeon will select are based on your specific situation and may include:

  • Scissors or other cutting instruments
  • Forceps
  • Graspers
  • Needle drivers to hold surgical needles
  • Attachments for electrocautery, applying heat or hemostasis (controlling bleeding)
  • Sensors to help identify the texture of the organs and tissues

Robotic surgery is a type of laparoscopic surgery that involves specialized equipment for enhanced visibility and highly adjustable surgical tools.

You will need pain control during laparoscopic surgery, usually with general anesthesia. You might be able to go home on the day of your surgery, or you may need to stay in the hospital for one or more nights, depending on the specific procedure that you're having.

Laparoscopic surgery is a type of minimally invasive surgery for abdominal and pelvic procedures. Minimally invasive surgeries in other areas of the body are not described as laparoscopic.

Contraindications

Laparoscopic surgery isn't for everyone. Some problems can't be repaired with this technique, and certain conditions can lead to serious complications if such an operation is done without access for a quick repair.

Some contraindications to laparoscopic surgery:

  • Unlikely to be effective: If your surgeon won't be able to reach your areas of disease through a few incisions, this surgery isn't right for you. For example, sometimes the location of a bowel obstruction might be inaccessible using a laparoscope.
  • Vague diagnosis: At times, the cause of medical problems like severe abdominal pain can be hard to pinpoint with standard diagnostic tests. This would make it difficult to find the area that needs to be treated with a laparoscope. In fact, an exploratory laparotomy, in which a large abdominal or pelvic incision is made for visualizing and identifying a problem, might be the right solution.
  • Risk of complications: If you have an abdominal or pelvic abscess or a high likelihood of bleeding, rectifying urgent issues that may occur during surgery might not be possible with a laparoscopic approach.
  • Complicated procedure: If your procedure requires several distinct and complicated steps, or if you also have scar tissue from previous surgeries, a laparoscopic approach might not be right for you.

Potential Risks

Minimally invasive surgery involves the standard risks that accompany any surgical procedure. This type of surgery also involves additional risks that may not be as common with open laparotomy.

Potential complications of laparoscopic surgery:

  • Excessive bleeding that can't be controlled
  • Unrepaired/undetected lesions
  • Organ or tissue injuries during surgery

Because of the small surgical opening(s) and dependence on the camera, injuries or bleeding might not be detected during surgery.

Laparoscopic surgery can lead to adhesions, which are post-surgical scars. Adhesions can lead to problems like abdominal pain, infertility, or bowel obstruction several years after the surgery.

If a surgical procedure is planned as minimally invasive, it may need to be converted to an open procedure during the operation if:

  • A serious issue that needs to be quickly alleviated arises during the procedure
  • The disease is found to be more extensive than expected after the incisions are made and the internal organs are viewed (e.g., when there are multiple cancer metastasis that can't be reached laparoscopically)

Purpose of Laparoscopic Surgery

Laparoscopic surgery is used to surgically repair a problem in the pelvis or abdomen. Among the many uses for this type of surgery are:

  • Removal of a cyst, polyp, or abscess
  • Biopsy
  • Controlling a bleeding blood vessel
  • Removing a blood clot
  • Tear repair
  • Tumor resection
  • Removal of an inflamed gallbladder
  • Obstruction relief
  • Elective care such as tubal ligation or vasectomy
  • Exploratory surgery to observe structures for diagnostic purposes

Healing is generally faster after laparoscopic surgery than with open laparotomy, making the minimally invasive approach advantageous when it's possible.

Beyond this, a laparoscopic technique may be selected for a number of other reasons. For example, when a lesion is small but deep in the pelvic or abdominal cavity, a laparoscopic approach might be the best way to reach the surgical area and cause less disruption to the surrounding organs.

The key procedural issues that guide the decision to opt for laparoscopic surgery or open laparotomy are:

  • The organs are viewed on a monitor during laparoscopy but are viewed directly through a large, open incision during laparotomy.
  • Surgery is performed through a small hole during laparoscopy and performed with direct, open access during laparotomy.

Usually, there is minimal pain after laparoscopic surgery. It generally has a low risk of bleeding, which means a reduced chance of needing a blood transfusion, and thus a low risk of blood transfusion complications.

Laparoscopic surgery is also associated with minimal risk of contamination and infection, as well as a lower overall cost of care and shorter hospitalization.

You and your doctor will discuss the different options for treating your abdominal or pelvic problem, including the pros and cons of a laparoscopic approach.

How to Prepare

Before your surgery, you will have diagnostic tests for surgical planning. This can include non-invasive imaging tests and invasive tests like endoscopy, colonoscopy, or hysteroscopy.

Your pre-operative testing might include complete blood count (CBC), blood chemistry tests, blood liver enzyme tests, electrocardiogram (EKG), and chest X-ray.

Your doctor will discuss your procedure with you, including the location of your incisions, your anticipated healing and recovery time, and any activity limitations that you'll need to follow during your recovery.

Location

You will have your surgery in an operating room that's located in a hospital or a surgical center.

What to Wear

You can wear anything comfortable to your surgery appointment. You might need to wear loose clothes when you leave the hospital to go home.

If you will have a surgical drain placed, your doctor might recommend that you wear a loose shirt or a button-down shirt for access to your drain.

Food and Drink

You will have to abstain from food or drink the night before your surgery.

Medications

You may need to decrease or stop taking blood thinners or anti-inflammatory medications for several days before your surgery. You may need to do the same or adjust the doses of other medications you take as well.

Depending on your procedure, you might need to take oral antibiotics at home before your operation.

Your doctor will give you specific instructions regarding medication use before your laparoscopic procedure.

What to Bring

When you go to your surgery appointment, you need to bring a form of identification, your insurance information, and payment for any portion of your operation that you are required to pay.

You should also have someone with you who can drive you home when you are discharged after your surgery.

Pre-Op Lifestyle Changes

There are many types of laparoscopic surgery. Your pre-op lifestyle changes are guided by the type of surgery you will have.

For example, if you are having a laparoscopic weight loss surgery, you may need to lose weight before your operation. And if you're having a laparoscopic surgery for relief of recurrent partial bowel obstruction, you might need to abstain from certain foods before your surgery.

What to Expect on the Day of Surgery

When you go to your surgery appointment, you will need to register and sign a surgical consent form.

You will go to a pre-operative area to change into a hospital gown. Your temperature, blood pressure, pulse, respiration, and oxygen level will be monitored prior to your surgery. You will have an intravenous (IV, in a vein) line placed in your hand or arm.

You might have same-day surgical testing, such as CBC, blood chemistry tests, and urinalysis. You may also have a chest X-ray and other imaging tests, like an ultrasound, for visualization of your surgical area.

You will likely see your surgeon and anesthesiologist before you go to the operating room.

Before the Surgery

Once you are in the operating room, you will have anesthetic medication placed in your IV. This medicine will control pain, paralyze your muscles, and put you to sleep.

You will also have a tube placed into your throat for breathing assistance during your surgery, and you might have a urinary catheter placed for urine collection as well.

Your abdomen or pelvis will be draped with a surgical drape and the area of skin where your incisions will be placed will be exposed. The skin will be cleaned with a disinfectant solution to prepare for surgery.

During the Surgery

Your surgery will begin with one or more incisions into your skin. Then, deeper incisions will be made into your mesothelium, which is the layer of tissue between your skin and your abdominal and pelvic organs. Additional incisions might be placed into your stomach, esophagus, small intestine, colon, uterus, or other regions where you will have surgical treatment.

Your doctor will insert the laparoscope in your surgical area for optimal visualization. Your surgical team will be able to see your internal structures on a monitor in the operating room. Sometimes the abdominal or pelvic cavity is gently inflated with pressurized carbon dioxide (CO2) to allow for better visibility.

Your surgeon will then proceed with the surgical procedure. This can include steps like stitching a tear, removing a tumor, or cutting out areas that are affected by disease. Your surgery can involve a few steps or many steps.

Depending on the specific procedure you are having, you might have an imaging test, like computerized tomography (CT) scan, to assess the surgical repairs while you are still in the operating room.

Sometimes a temporary surgical drain is placed in the abdominal or pelvic cavity. This tube extends outside the body through a very small opening to collect fluid, such as inflammatory or gastric fluid. It should remain in place for several days or weeks after your surgery, per your doctor's recommendations.

After your procedure is complete, the laparoscope will be removed and your deep and superficial incisions will be closed with staples or sutures.

Your wound will be covered with surgical dressing and your anesthesia will be reversed. Your breathing tube will be removed and the team will confirm that you are breathing adequately on your own before you are taken to the post-operative recovery area.

After the Surgery

You will go to a postoperative recovery area as you are waking up from your surgery. Your blood pressure, pulse, respiratory rate, and oxygen will continue to be monitored. You might receive medication for pain control. And if you have a drain, your medical team will make sure it is working properly.

If you have a urinary catheter, it will be removed. Once you wake up, you might need to use the toilet. You may need assistance walking the first time you get up, and a nurse can assist with this.

You will be able to start drinking clear fluids. If you had surgery on your stomach, esophagus, or intestines, you will need to advance your food and drink slowly over several days. If you had pelvic surgery, you might be able to advance your diet more quickly. Your nurses will explain your dietary restrictions and give you instructions about what to expect and how to proceed in the coming days.

Depending on your specific procedure and what was done, you might be able to go home on the day of your surgery or you may need to stay in the hospital for a few days. When you are discharged from the hospital, you will receive specific instructions about when to see your doctor next and how to take care of yourself as you recover.

Recovery

Your recovery depends on your type of laparoscopic surgery. Even though laparoscopic surgery is minimally invasive, your wound and organs still need time to heal.

You will need to have a follow-up appointment with your surgeon. Your doctor will remove your sutures and drain and you might have imaging tests to monitor your healing.

Healing

During your post-operative healing period, you might have some pain. You can use pain medication prescribed by your doctor during this time. The pain should improve over the first few days; worsening pain is a sign that you should call your surgeon's office.

You need to keep your wound and drain clean and dry. Even though your incision or incisions are small, they need to be taken care of.

If you have a drain, you will need to empty your drain periodically. Your surgeon will let you know what normal drainage looks like.

Don't wait to contact your doctor if you experience any of these symptoms, which could indicate an issue requiring urgent treatment:

  • Persistent pain
  • Swelling
  • Abdominal or pelvic distension (enlargement)
  • Bleeding or seeping fluid or pus around the wound
  • Redness around the wound
  • Fever
  • Nausea or vomiting

Coping With Recovery

It can take several days before you feel ready to walk around after your surgery, and you might need to avoid strenuous physical activities for several weeks.

Constipation can occur after gastrointestinal surgery or as a side effect of opioid pain medications. Depending on the type of laparoscopic surgery, you might be given dietary strategies or a prescription for medication to prevent constipation.

You may also have other problems, including difficulty sleeping, soreness, and tiredness. Be sure to call your doctor's office if these issues don't improve within a few weeks.

Long-Term Care

If your healing is uncomplicated, you shouldn't need any special long-term care as a result of having had a laparoscopic operation.

You will continue to need care for the condition that's treated by laparoscopic surgery, however. For instance, if you had your surgery for the removal of a tumor, you may need to maintain monitoring for recurrence and systemic cancer treatment after your surgery.

Possible Future Surgeries

You might need to have future surgeries as a result of your laparoscopic surgery, regardless of the specific procedure you had. For example, if you had laparoscopic surgery for removal of a polyp in your colon, you might need surgery in the future if you develop bowel obstruction due to post-surgical adhesions.

Lifestyle Adjustments

Generally, lifestyle adjustments after laparoscopic surgery are focused on managing the medical problem that necessitated surgical intervention in the first place. This may mean that you need to take medication, follow a restricted diet, or avoid things that exacerbate certain gastrointestinal conditions (like smoking or alcohol).

A Word From Verywell

Laparoscopic surgery is a common technique that is used to minimize the size of surgical incisions and shorten recovery time. However, this surgical approach doesn't necessarily reduce the risk of operative or postoperative complications, and a conversion to open surgery might be necessary if complications arise during surgery. Your surgeon will advise you regarding the best surgical approach for optimizing your recovery in your specific situation.

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