What is laparoscopy?

Laparoscopy has transformed the landscape of surgery since its inception, changing how a number of conditions are diagnosed and treated.

Here, Mr George Goumalatsos, renowned consultant gynaecologist and laparoscopic surgeon, delves into the intricacies of laparoscopy, exploring its application in the obstetrics and gynaecology specialty, as well as its numerous benefits.

When is laparoscopy recommended?

Laparoscopy, also known as keyhole surgery or minimally invasive surgery, is a surgical technique that enables access to the inside of the abdominal (tummy) and pelvic regions without the need for large incisions in the skin.

Laparoscopy serves a dual purpose in diagnosing and treating a wide range of conditions within the abdomen or pelvis.

These include:

• Endometriosis: A condition in which tissue similar to the lining of the womb (called endometrium) grows outside the womb, in other organs of the body.
• Pelvic inflammatory disease: A bacterial infection that affects the reproductive organs, including the uterus, fallopian tubes, and ovaries.
• Ectopic pregnancy: A pregnancy that occurs when a fertilised egg implants and begins to grow outside the womb.
• Ovarian cysts: Fluid-filled sacs that develops on the ovaries.

Additionally:

• Fibroids: Non-cancerous growths that develops in the muscular wall of the uterus.
• Adhesions: Scar tissue from prior surgical procedures or infections.
• Appendicitis: A condition that occurs due to inflammation of the appendix, which is a small, finger-shaped pouch attached to the large intestine.
• Unexplained abdominal or pelvic pain
• A range of female subfertility investigations

Laparoscopy also facilitates surgical procedures, including the removal of damaged organs and the removal of tissue samples for biopsy, aiding in comprehensive medical management.

What are the benefits of laparoscopy?

Laparoscopy eliminates the need for large incisions by using a surgical instrument known as a laparoscope. The laparoscope is a small, flexible tube equipped with a light source and a high-resolution camera at its tip, enabling the real-time display of internal body images on a television monitor.

Compared to traditional open surgery, laparoscopy entails smaller incisions, leading to reduced hospitalisation, reduced postoperative pain and bleeding, reduced scarring, and a quicker recovery period.

How is a laparoscopic procedure performed?

Laparoscopic procedures are typically performed under general anaesthesia. Often, patients will be discharged on the same day of the procedure or on the following day. Depending on the specific procedure, patients will be instructed to fast (no eating or drinking) for a period of 6 to 8 hours prior.

If patients are taking blood-thinning medications, we will ask them to discontinue their usage several days before surgery to minimise the risk of excessive bleeding. Similarly, patients who smoke will be asked to quit smoking during the lead-up to the procedure to reduce the risk of delayed healing and other complications like infections.

Prior to the operation, it’s also important that patients arrange for a companion to stay at home with them for the initial 24 hours post-surgery, as driving isn’t advised during this period.

During laparoscopy, the surgeon will start by making a small incision in the belly button, typically ranging from 0.5 to 1.5cm. The surgeon will then insert a small tube through the incision, facilitating the infusion of carbon dioxide gas into the abdomen. The inflation of the abdomen will provide a clear view of the organs and give the surgeon more room to work.

Subsequently, the surgeon will introduce the laparoscope through the tube. The laparoscope will relay real-time images of the whole area to the television monitor in the operating theatre. Depending on the purpose of the operation the surgeon will make additional incisions in the abdomen, typically ranging from 0.3 to 10mm. The surgeon will then pass small surgical instruments through these incisions to examine the internal organs and carry out any necessary treatment.

Lastly, the carbon dioxide will be released from your abdomen and the incisions will be closed using dissolvable stitches. A dressing will also be applied.

If laparoscopy is used for diagnostic purposes, the procedure typically lasts around half an hour. If a specific condition needs to be addressed, the duration of the procedure will vary depending on the complexity of the surgery being performed.

What are the potential risks and complications?

Laparoscopic procedures are very common, with rare occurrences of serious complications.

Minor complications occur in 1 or 2 out of every 100 cases following laparoscopy. These may include:

• Bladder, wound, or chest infections
• Minor bleeding and bruising around the incision site
• Nausea and vomiting

Serious complications occur in 1 out of every 1,000 cases following laparoscopy. These may include:

• Organ damage, such as damage to the bowel or bladder, which potentially leads to loss of organ function necessitating further surgical intervention
• Conversion to an open procedure, involving a larger incision on the abdomen
• Severe allergic reactions to general anaesthesia
• Development of a blood clot in a vein, typically in the legs (called deep vein thrombosis), which could dislodge and obstruct blood flow in the pulmonary vessels (called pulmonary embolism)

What is recovery like after laparoscopy?

Following a laparoscopic procedure, patients may experience grogginess and disorientation as they recover from the effects of the anaesthesia. Nausea and vomiting are also common side of anaesthesia, but these should subside quickly. Patients will be monitored for several hours until they are fully awake and capable of eating, drinking, and passing urine.

In the days after laparoscopy, patients may experience some pain and discomfort at the incision sites, along with a sore throat if a breathing tube was used. Simple pain relievers will be provided to alleviate any discomfort.

Residual carbon dioxide gas in the abdomen post-procedure can also cause bloating, cramping, and shoulder pain. However, these symptoms typically resolve within a day as the body absorbs the remaining gas.

The recovery time is different for every patient, depending on factors such as the purpose of the procedure (diagnostic or therapeutic), the patient’s overall health, and the development of any complications.

For a diagnostic laparoscopy, resuming normal activities usually takes 5 to 7 days. For a therapeutic laparoscopy, a longer recovery period is involved, between 2 weeks for minor surgery such as sterilisation to 6 weeks for a laparoscopic hysterectomy. Before discharge, patients will be provided with instructions on wound care and when to return for their follow-up appointment, as well as personalised advice on their expected recovery time.

If you would like to consult your options with an expert, schedule a consultation with Mr George Goumalatsos via his Top Doctors profile today.