Laparoscopic surgery also referred to as minimally invasive surgery is a modern surgical technique in which operations in the abdomen are performed through small incisions as opposed to one large incision. The key element used in laparoscopic surgery is a laparoscope. The laparoscope is equipped with a camera on the end of it, which allows the surgeon to see inside the abdomen. There is also a video cable that connects the laparoscope to a video screen. Also attached is a fiber optic cable system connected to a light source, to illuminate the operative field, inserted through a cannula or trocar in the abdominal wall to view the operative field. The abdomen is inflated with carbon dioxide. This elevates the abdominal wall above the internal organs like a dome providing the necessary space to perform and properly visualize the operation. Carbon dioxide is used because it is common to the body and can be absorbed by the body and removed by the respiratory system.
By using multiple small incisions, each a few centimeters long, the surgeon inserts instrumentation, including the laparoscope as described above, through the abdominal wall via the small incisions and performs the surgery while visualizing it on a video screen. Laparoscopic surgery is used for many types of surgery with the short-term advantages of less pain, less cutting of skin and tissue, fewer wound complications, quicker post-operative recovery, and shorter hospital stays.
The technique of hand-assisted laparoscopy uses a combination of laparoscopy with a short incision that allows just one hand to be placed in the abdomen. This technique has the advantage that it allows the surgeon to make a smaller incision, and utilizes the laparoscopic approach. In certain operations, the shorter incision is required to allow an internal organ or portion of an organ to be removed from the abdomen. This hand-assisted laparoscopy technique is often required in cases where a portion of the colon or the spleen is removed.
The most common laparoscopic procedure utilizing minimally invasive surgery is a laparoscopic cholecystectomy. In this procedure, surgical instruments can be introduced by the surgeon into the abdomen through trocars (hollow tubes with a seal to keep the CO2 from leaking). The gallbladder is removed in this procedure through a small incision in the umbilical region. This procedure has popularized the use of a laparoscopic approach to surgery.
Another procedure called a Laparoscopic Nissen Fundoplication is rising in popularity. Laparoscopic Nissen Fundoplication is a minimally invasive procedure performed to treat gastroesophageal reflux disease (GERD) or a hiatal hernia. In GERD, the procedure is usually performed when medical therapy has failed. In a paraesophageal hernia, it is the first approach in treatment.
Other surgeries that can be performing using a laparoscopic approach include:
- Laparoscopic Ventral Hernia Repair – repair of an abdominal hernia
- Laparoscopic Umbilical Hernia Repair – repair of a hernia at the umbilicus (belly button)
- Laparoscopic Inguinal Hernia Repair – repair of a right, left or bilateral groin hernias
- Laparoscopic Low Anterior Resection - removal of the lower sigmoid colon or rectum usually Performed for rectal cancer
- Laparoscopic Sigmoid Resection – removal of the sigmoid colon most often performed for recurrent diverticular disease
- Laparoscopic Right Colon Resection – removal of a portion or entire ascending (right) colon performed for a mass, tumor, or cancer
- Laparoscopic Appendectomy – removal of the appendix
- Laparoscopic Splenectomy – removal of the spleen often performed for a ruptured spleen secondary to trauma or splenomegaly (enlarged spleen).
In any laparoscopic surgery, your surgeon will have told you that there is a chance of “conversion” to an open procedure. This means that a laparoscopic approach has to be changed to an open operation. The indication to do so may be one of two scenarios. The first is that there are findings (scarring, unexpected anatomy) that prevent the surgeon from completing the procedure effectively or safely. The second is that there is a problem during laparoscopy that the surgeon feels might be more effectively handled through a larger incision. Conversion is a decision made by the surgeon that is in the patient’s best interest, and should not be considered to be a complication. It simply means that your surgery will be completed in the open approach.
Even though laparoscopic surgery is consider minimally invasive, general anesthesia is required for the operation. There is also a recovery period and that will depend on the individual and the type of laparoscopic surgery that is performed. In addition, even though there is less pain associated with laparoscopic surgery, there is still pain and discomfort during the recovery period that may require the use of pain medications such as narcotics.
The decision to perform an operation using a laparoscopic approach is individualized per patient. Certain factors such as a patient’s past medical history, prior surgeries and a patient’s general health are factors that affect the decision to perform a surgery laparoscopically.