Laparoscopy
Laparoscopy is a term given to a group of operations that are
performed with the aid of a camera placed in the abdomen. Originally, the laparoscope was
used during surgical removal of the gallbladder (laparoscopic cholecystectomy) and
appendix (laparoscopic appendectomy). Additionally, exploratory laparoscopy has often been
used for diagnostic purposes to view the abdomen after abdominal trauma and in cases of
abdominal illness.
Now the laparoscope also allows physicians to perform minimally invasive surgery with
just a small incision in the abdomen. This technology, known as laparoscopic assisted
surgery, enables the minimally invasive removal of the colon, the kidney (for living
donors in kidney transplants), and weight reducing procedures such as gastric bypass and
vertical banding gastroplasty (VBG).
Finally, large operations such as liver and pancreatic resections may begin with
laparoscopy to exclude the presence of additional tumors
(metastatic disease) that would preclude curative resection. For complex laparoscopic
operations, patients should consult with their primary health care provider to find a
center of excellence in the specific operation.
How a Laparoscopy is performed
The procedure is usually done in the hospital, under general
anesthesia, and after informed consent has been obtained. A catheter (a small flexible
tube) is inserted through the urethra into the bladder. An additional tube may be passed
through the nostril and into the stomach to remove intestinal contents (N-G tube). The
skin of the abdomen is cleansed, and sterile drapes are applied.
A small incision is made above or below the navel to allow the insertion of a trocar
(essentially a tube extending from inside the abdomen to the outside), which allows
passage of a video camera. Prior to insertion of the trocar, a needle is inserted into the
incision and carbon dioxide gas is injected to elevate the abdominal wall, and thereby
create a larger space to work in. This allows for easier viewing and manipulation of the
organs.
After an adequate amount of gas is instilled, the laparoscope is inserted, and the
organs of the pelvis and abdomen are examined. Additional small incisions are made for
instruments that allow the surgeon to move the abdominal organs, cut tissue, suture, and
staple structures to safely and effectively perform the necessary procedure.
Following the examination, the laparoscope is then removed, the incisions are closed
with sutures, and bandages are applied. Depending upon the operation performed, a drain
may be left through one of the incisions to allow for removal of accumulated fluid.
What the risks are when having a Laparoscopy
There is a risk of puncturing an organ, which could cause
leakage of intestinal contents, or bleeding into the abdominal cavity. These complications
often result in the conversion of laparoscopy to laparotomy. Severe injury may result in
infection and/or a requirement for blood transfusion.
Special considerations when having a
Laparoscopy
The ability to perform laparoscopic surgery is limited by the
presence of previous abdominal surgery. Often prior surgery induces scar formation, which
prevents the safe passage of the trocars into the abdomen, and may prevent the abdominal
wall from being effectively distended by the gas instillation. |