Laparoscopic surgery: Why and when is it needed?

Laparoscopic surgery is also known as minimally invasive surgery or keyhole surgery.

Laparoscopic surgery or laparoscopy is a type of surgical procedure that allows the surgeon access to the inside of the abdomen (tummy) and pelvis without requiring major incisions in the skin. A small tube equipped with a light source and camera transmits images of the inside of the abdomen or pelvis to a television monitor.

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When is laparoscopy used?

Laparoscopy can be performed to aid in the diagnosis of a wide range of abdominal and pelvic conditions. It can also be used to conduct surgical procedures, such as the removal of a damaged or diseased organ or the extraction of a tissue sample for further analysis (biopsy).

Laparoscopy is commonly used in:

• Gynaecology: The study and treatment of disorders that affect the female reproductive system, which includes the fallopian tube, uterus, and ovaries
• Gastroenterology: The study and treatment of disorders that affect the digestive system, which includes the pancreas, liver, stomach, gallbladder, colon, and small intestine
• Urology: The study and treatment of disorders that affect the urinary system, which includes kidneys, bladder, ureters, and urethra

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What are surgeries that can be performed laparoscopically?

Numerous common surgeries can be performed laparoscopically. Due to the improved patient outcome, laparoscopic surgery is becoming the preferred approach for most surgeries and the surgeries include:

• Cholecystectomy (gallbladder removal) – treatment for gallstones
• Appendicectomy (appendix removal) – treatment for appendicitis
• Colectomy (bowel resection surgery)
• Hernia repair surgery
• Nephrectomy (partial or complete removal of kidney)
• Hysterectomy (uterus removal)
• Oophorectomy (removal of one or both ovaries)
• Treating ectopic pregnancy
• Removal of fibroids
• Removal of the organ affected by cancer

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How is laparoscopy performed?

Laparoscopy is a minimally invasive surgical procedure usually performed under general anaesthesia. Therefore, you would be unconscious throughout the surgery. You are mostly allowed to return home on the same day of the surgery or the next day.

Before laparoscopy

• You be required to refrain from eating or drinking anything from 6 to 12 hours prior to surgery.
• Blood thinning medications (anticoagulants) such as warfarin or aspirin may need to be stopped in the days leading to the surgery in order to prevent excessive bleeding during the procedure.
• You may also be required to refrain from smoking a few days before the surgery, as smoking can delay recovery post-surgery and increase the likelihood of complications such as infection.

During laparoscopy

• The surgeon makes a small cut (incision) of approximately 1 to 1.5cm, typically near your belly button (umbilicus).
• Through the incision, a tube is introduced, and carbon dioxide gas is pumped through the tube to expand your abdomen. By inflating the abdomen, the surgeon can view your organs more clearly and has greater room to work. This tube is then used to insert a laparoscope.
• The laparoscope relays images to a television monitor providing the surgeon a greater view of the operating site.
• Further abdominal incisions will be required if the laparoscopy is utilised to perform a surgical procedure, such as appendix removal.
• The surgeon can insert small surgical instruments through these incisions and guide them to the right location using the image from the laparoscope. The instruments can then be used to carry out the required surgery.
• After the surgery, carbon dioxide is released from the abdomen, the incisions are closed with stitches or clips, and a dressing is applied.

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What is the recovery time of laparoscopic surgery?

After laparoscopy

• You may feel drowsy and disoriented as you recover from the effects of the anaesthesia given during laparoscopy. Some individuals experience nausea and vomiting. These are typical side effects of anaesthesia and would subside quickly.
• A nurse will observe you for several hours until you are fully conscious and able to eat, drink, and pass urine.

Before leaving the hospital

• You will be taught methods to clean the wound.
• You would also be informed when to return for a follow-up visit or remove your stitches.

You may experience pain and discomfort at the incision site for a few days following the procedure, and if a breathing tube was used, you might have a sore throat. Your doctor may prescribe you analgesics (painkillers) to relieve pain.

Since gas is used to inflate the abdomen, some of it could remain in the abdomen and cause bloating, cramps or shoulder pain because it irritates the diaphragm (the muscle you use to breathe), which in turn irritates the nerve endings in the shoulder.

These symptoms are harmless and should subside within a day or two once the body has absorbed the remaining gas.

You will likely feel more exhausted in the days or weeks following the surgery. Remember to rest and take regular naps. The recovery period differs for everyone. Speak to your doctor to know how long it would take for you to recover following your procedure.

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What are the advantages of laparoscopy?

There are many advantages to laparoscopic surgery over conventional ones and they include the following:

• Smaller external scars
• Minimally invasive
• Less pain
• Minimal blood loss
• Reduced risk of infection
• A shorter length of inpatient stay
• Faster recovery

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What are the complications of laparoscopy?

Laparoscopy is a frequently performed safe procedure with a low incidence of serious complications.

Minor complications

• Bruising or minor bleeding from the incision site
• Infection
• Nausea and vomiting

Serious complications

• Organ damage (bowel or bladder) which can cause loss of organ function
• Damage to the major artery
• Air bubbles entering your arteries and veins due to the usage of carbon dioxide
• Allergic reaction to general anaesthesia

Serious complications may require further surgery to address the issue.

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What are the future developments in laparoscopy?

Laparoscopic surgery has evolved considerably within the last decade. Many hospitals around the globe now use robots to assist with procedures and this is known as robotic-assisted laparoscopy.

Your surgeon controls robotic arms during robotic-assisted laparoscopy via a console in the operating room. The robotic arms are equipped with a specialised camera and surgical instruments.

The robotic system delivers enhanced 3D vision and a wider range of motion for instruments operating in the body. Using robotic-assisted laparoscopy, doctors may perform intricate procedures with greater precision and through smaller incisions.

Robotic-assisted laparoscopy may have a shorter recovery time and reduced risk of complications compared to traditional laparoscopy or open surgery.

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Book an appointment at Pantai Hospitals

Get in touch with us to book an appointment today if you would like to know more about minimally invasive surgeries. The caring and multidisciplinary team of healthcare professionals are available for consultation and to provide the best care. We assure you the best possible care tailored to your specific needs.

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