What Is a Laparoscopy?

Overview

Laparoscopy is a diagnostic surgical procedure where the healthcare professional can view the inside of the patient’s body, specifically the abdominal and reproductive organs. It helps a doctor diagnose the disease or condition and make treatment decisions.¹ 

Laparoscopy is a minimally invasive surgical technique also known as keyhole surgery. The procedure can help the health professional to take samples for testing (biopsy), and remove damaged tissue or a small organ e.g. gallbladder. 

The laparoscopy procedure uses a thin flexible video camera attached to a laparoscope tube. Two small incisions are made on the belly. The Doctor can see the video images for investigative or treatment purposes. This procedure takes less time than open surgery and results in a faster recovery.

• Gynaecological laparoscopy (examination and treatment of disease/conditions affecting the female reproductive system) 
• Gastroenterological laparoscopy (examination and treatment of disease conditions affecting the digestive system)
• Urological laparoscopy (examination and treatment of conditions affecting the urinary tract)²

Purpose - diagnosing symptoms or abnormalities

Laparoscopy provides information about internal organs and surrounding tissue, to investigate or treat a symptom or problem when ultrasound or x-ray cannot confirm the cause. Using laparoscopy, a doctor can directly view the external aspects of the uterus, ovaries, fallopian tubes, liver, pancreas, gallbladder, spleen and stomach. 

The following conditions may require a laparoscopic investigation to find the cause of symptoms: 

• Pelvic inflammatory disease: An infection that affects the uterus (womb), fallopian tubes or ovaries. Bacteria from untreated sexually transmitted infection (STI) can cause pelvic inflammatory disease. Common symptoms include lower abdominal pain, irregular vaginal discharge and painful sex
• Dysmenorrhoea: A Term used to describe painful menstruation. Menstrual cramps, the day before or first day of a period are common. However, some women have severe pain during menstruation along with nausea, fatigue and diarrhoea. Sometimes pain can interfere with day-to-day activity. There is medication and other treatment available to treat painful periods
• Endometriosis: The endometrium is the inner lining of the uterus and is shed during a menstrual period. In endometriosis, endometrial tissue grows outside the uterus and other structures. These tissues are sensitive and become inflamed during a menstrual period. Endometriosis may cause fertility problems³
• Dyspareunia: The term used for painful intercourse. The causes of painful intercourse are multifactorial, including:
  • Pain on entry during sexual intercourse
  • Pain during deep penetration 
  • Pain may also be linked to emotional responses and sexual intercourse 
• Infertility: The condition which may prevent people from conceiving a baby. Infertility has many causes and can affect anyone
• Ovarian cyst: The ovaries are located on each side of the uterus, where the egg (ovum) develops, matures, and is released during a monthly cycle (ovulation). Ovarian cysts are common, cause discomfort, and cannot be resolved without treatment. However, in some instances the cyst bursts open (ruptures) and can cause serious complications
• Cervical cancer: Ovarian cancer is caused by human papillomavirus (HPV)⁴
• Ovarian cancer: A type of cancer affecting the ovaries. Ovaries are attached to either side of the uterus, where the ovum (egg) is stored
• Biopsy: A biopsy is a procedure to remove cells, tissues, or fluid (specimen) from an abnormal area or organ of the body. A pathologist examines the specimen to confirm a diagnosis. A biopsy is used to diagnose cancer

Reasons for using laparoscopic surgery

Today laparoscopic surgery is used for numerous procedures. The rationale for using laparoscopic surgery depends on the disease stage or condition, and patient outcome. Some conditions require open surgery. 

The following conditions may be suitable for the laparoscopic approach: 

• Ectopic pregnancy excision (removal): A condition in which a fertilised egg implants (attaches) outside the uterus, commonly in the fallopian tube. The fallopian tube cannot accommodate a growing embryo
• Endometriosis surgery: A condition in which tissue similar to the inner lining of the uterus grows outside. It can impact daily life and may make getting pregnant difficult
• Hysterectomy: A surgical procedure to remove the uterus
• Hernia repair: This is a condition in which the inside part of the body bulges through an opening or weakness in the muscle tissue. A hernia can occur due to injury, surgery, or a birth disorder. Surgical repair may be needed in severe forms of hernia, where the herniated tissue is pushed back into place and a barrier is formed with surgical mesh
• Injury affecting the abdomen, causing internal bleeding⁵
• Cholecystectomy: A surgical procedure to remove the gallbladder where gallstones cause inflammation, pain or infection
• Appendectomy: Is a surgical procedure to remove the appendix, when there is inflammation, it may lead to rupture, a surgical emergency
• Cystectomy: Known as bladder removal surgery. The surgeon removes the partial or entire part of the diseased bladder. This type of surgery treats bladder cancer or benign conditions affecting the bladder or urinary system
• Liver resection: Hepatectomy is a surgical procedure to remove a small part of a diseased liver. When a small part of the liver is removed, it can grow back to its average size. If the entire liver is removed, then the patient needs a liver transplant
• Nephrectomy: A surgical procedure to remove partial or complete kidney. In the case of kidney failure or cancer nephrectomy can be a life-saving procedure

Laparoscopic procedure 

Before surgery

A Surgeon takes a complete medical history, and if the patient is on any regular medication, advises to stop or lower the dosage for a few days. This is a preventative measure to reduce the risk of complications during or after surgery.

In certain cases, a doctor will suggest hospital admission the day before the surgery. The doctor conducts blood or imaging tests to make sure the patient is in good health. The patient will be advised not to have any food for 6 or 8 hours before surgery. 

Day of surgery

On the day of surgery, the patient’s vital signs will be recorded. The patient is given general anaesthesia to ensure the patient is unconscious and prevent pain following surgery. A breathing tube is placed in the throat to administer the anaesthetic and ensure clear, open airways are maintained throughout surgery.

During laparoscopy 

During laparoscopy, the surgeon makes one or two incisions (cut) near the belly button. 

Then a trocar is inserted and used as a port for surgical instruments to be inserted. The abdominal wall is inflated with gas to see and separate organs. A laparoscope is connected to a TV monitor on which the images of the organs and the affected site can be clearly visualised. 

The surgeon will then excise tissue, organ or abnormality. After the procedure the gas, and carbon dioxide are released from the abdomen, the incisions are then closed using stitches (dissolvable stitches are commonly used) or clips and a dressing covers the incisions. 

Robotic-assisted laparoscopy

In this procedure, robots assist the surgeon. The surgeon uses a console located in the operation theatre to control the robot's arms for performing the procedure. Robotic-assisted laparoscopy helps the surgeon to perform complex procedures with high precision and smaller incisions. This method has a lower chance of complications and a faster recovery.⁶

Recovery

After laparoscopy, the patient may feel disoriented, nauseous or vomit. These are the side effects of the anaesthetic and a health professional monitors the patient until they are fully awake and able to eat, drink and pass urine. Recovery time is different for each individual and it depends upon the disease/condition for which the laparoscopy was completed. After five days, the patient will be able to carry out normal daily activities. Full recovery may take between 3 to 12 weeks.

Advantages of laparoscopic surgery

• Less scarring from an open wound
• Reduced blood loss
• Reduced risk for infection
• Shorter hospital stay
• Faster recovery

Risk factors

• Injuries by the trocar
• Pneumothorax (collapsed lungs): This happens when the space between the chest wall and lung is filled with air, increasing pressure between these organs and causing the lung to collapse
• Accidental damage to the inner structures/organs which may require further open surgery

FAQs

What is laparoscopy used for?

Laparoscopy is used as a diagnostic procedure or therapeutic treatment of disease affecting the abdominal or pelvic region. During the procedure tissue samples are collected and examined under a microscope (biopsy). This surgical procedure may also be used to remove a diseased or damaged organ.

Is laparoscopy a major or minor surgical procedure?

Most laparoscopic procedures are major procedures. Due to the need for general anaesthetic surgeries are classified as major or minor, depending on the disease condition.

How long will a laparoscopy take?

The duration of a laparoscopy procedure depends upon the disease/condition being treated. Usually, it takes 30-60 minutes.

When should I consult a doctor after a laparoscopy?

If a patient experiences any of the following symptoms, it’s recommended to consult the doctor as soon as possible. 

• Severe vomiting
• Fever with chills
• Increased abdominal pain
• Burning sensation while urinating
• Swelling in the legs
• Pain, swelling, pus formation or bleeding around the site of surgery

How long will the stomach be inflamed after laparoscopy?

Abdominal swelling may last several days after the surgery. The patient may also feel a sore throat due to the tube insertion during the procedure.

Summary

Laparoscopy is a minimally invasive surgery, known as keyhole surgery. It can help Doctors take samples for testing or remove an affected organ. A Laparoscopy is used to check abdominal organs and investigate or treat a problem when ultrasound and x-ray cannot confirm the cause of the disease. A laparoscopy takes less time than open surgery and has a faster recovery.