What Is A Laparoscopy?

Laparoscopy is the minimally invasive alternative to conventional open abdomen surgery, laparotomy. In this intervention – less cumbersome from a physiological and medical point of view – a small camera (laparoscope) is used to see inside the patient’s abdomen.

Its prevalence has increased significantly in recent years, since it has gone from occupying 5% to 29% of all colorectal procedures, in just a couple of years. It is a popular method due to its low invasiveness and high success rate; a gynecologic laparoscopy causes gastric damage in 1 in 33,000 cases.

Calculating the exact uses of this procedure on a global level is almost impossible. However, an estimated 5,000 people undergo it to tackle obesity each year. Based on these figures, it should be noted that  laparoscopy is on the rise in the surgical world due to its multiple benefits. Read on to find out more about it.

What is a laparoscopy?

Laparoscopy is a type of abdominal surgery in which the professional is able to access the interior of the abdomen without having to make very large incisions through the skin. As a publication in the National Health Service (NHS) indicates, this has multiple benefits compared to a traditional laparotomy. Among them, we find the following:

• The patient spends less time in the hospital and his recovery is faster.
• There is less bleeding and pain after the operation.
• The marks and scars are much smaller than in traditional surgery.

However, the fact that it is a minimally invasive surgery does not indicate that it is risk-free. Every patient must bear in mind that the procedure has access to vital organs that may be affected. Therefore, there is a certain chance that something will go wrong. We will explore this concept later.

Who needs it?

Through its website, the American Cancer Society lists who are the candidates for a laparoscopy. Next, we will tell you the clinical fronts in which it is usually most useful.

1. The patient has a suspicious area that could be cancer

Laparoscopy can be used to remove or biopsy (obtain tissue samples) of the lymph nodes in the pelvis and abdomen. For this reason, it is recommended in patients with gynecological cancers, such as cervical (CCU), ovarian and endometrial cancers.

2. There is an intestinal obstruction

A bowel obstruction or obstruction occurs when the contents of the intestine cannot pass or leave the patient’s body. When the obstruction is total, the individual finds himself in a medical emergency that requires immediate surgical intervention.

Depending on the severity of the situation, a laparoscopy or laparotomy may be performed. However, sometimes larger incisions are needed to remove the blockage and remove or repair any areas of the intestine that have been damaged.

3. Diseases specific to women

There are many pathologies that can be solved by laparoscopy in women, as they tend to be more prone to having affectations in the pelvic area. This surgical procedure can be used to address fibroids, ovarian cysts, endometriosis, pelvic prolapses, among other conditions linked to the female gender.

4. Other processes

The United States National Library of Medicine details some accessory processes that can be approached with a laparoscopy. Among them, we find the following:

• Remove an ectopic pregnancy: This is a pregnancy that grows outside the uterus. For a pregnant woman it can be fatal, so it is necessary to use a surgical approach quickly to solve it.
• Hysterectomy: This is the removal of the uterus. It can be useful in some cancers, deformities, excessive bleeding and other clinical pictures.
• Tubal ligation: a procedure to prevent pregnancy by blocking the fallopian tubes.

• Treatment of urinary incontinence.

What happens in a laparoscopy?

The total procedure usually takes between 30 and 45 minutes under general anesthesia, so it is perfectly feasible to perform it in an outpatient clinic in many cases. We tell you the steps in detail in the following lines.

Before the procedure

If the person is to receive general anesthesia (as is often the case), the person may not be able to consume food or drink for a period of 6 hours before the procedure. In addition to this, it is necessary to go in most cases with a companion, since there is lightheadedness after the operation.

During the procedure

The journal Progresos de Obstetricia y Ginecología collects in detail the procedure followed to perform a laparoscopy. It begins with the following key points in mind:

1. It is necessary to place the patient in the lithotomy position (with the legs raised and the body lying down). Your buttock should be located on the edge of the table, in order to allow good handling of the uterine mobilizer.
2. The patient should be channeled (a line placed) in the right arm.
3. It is recommended in previous bladder emptying, either by urination or by catheterization, when it is considered necessary.

Following these considerations, a Veress-Palmer needle, essential to inflate the abdominal cavity with CO2 gas (something known as pneumoperitoneum), should be introduced into the patient. 35-40% of complications in endoscopic surgeries occur at this point, so exceptional care must be taken. This is usually introduced umbilically.

Peritoneal insufflation allows surgeons to maneuver correctly in the abdomen of the patient without damaging their vital organs. Once performed and after cutting the relevant incisions, professionals use the laparoscope to observe the abdominal cavity and make the necessary diagnosis.

If some type of surgical procedure is to be performed, more incisions may be necessary for the introduction of instruments. In any case, these wounds do not usually exceed 0.5-1 centimeter in extension, as indicated by the Navarra University Clinic (CUN).

After the procedure

Once the intervention is finished, the patient requires a rigorous follow-up in the following hours to verify that everything has gone well. In addition, you will not be allowed to consume any type of food or drink while the numbness from the sedation lasts.

If you had the procedure as an outpatient, you will be able to go home in a few hours in most cases. Even so, after laparoscopy it is always necessary to make new medical appointments with the relevant professionals, in order to discuss and address the results obtained.

Possible risks of laparoscopy

This method involves a series of delicate organs, so it is not without risks. Diagnostic laparoscopy presents a risk of intestinal injury of 0.08%. In turn, in medium-sized and more complex surgeries, this value amounts to 0.33%. However, the following can occur:

• Infection of the surgical incision or internal organs. In the worst cases, this can lead to bacteremia and septicemia, which are life-threatening.
• Bleeding from the surgical incision or internal organs.
• Poor wound healing. The abdominal tissue is quite delicate.
• Allergy to drugs used during the procedure (sedatives and anesthetics).
• Anaphylactic shock (rare, almost never happens).

What to remember about laparoscopy?

Laparoscopy is an excellent alternative to laparotomy, as the incisions made during this procedure are much smaller, the patient recovers faster, and the chances of something going wrong are very low.

However, not all patients are suitable for laparoscopy. Those with a tumor that has spread to the abdominal cavity, bleeding problems, chronic tuberculosis, and other conditions cannot undergo it. In these cases, you have to go to other types of procedures.