Laparoscopy

A laparoscopy, also known as keyhole surgery, is a way to access the abdominal and pelvic cavities for surgical procedures using small surgical incisions.

 It is done using long and thin telescopes with powerful optical systems, precise surgical instruments with small tips and energy sources that allow safe dissection of internal organs and sealing of blood vessels.

Most common gynaecological operations such as hysterectomies, removal of fibroids, removal of ovaries and ovarian cysts, to name a few, are now usually done via laparoscopy.

 An important concept to understand is that a laparoscopy is not the operation itself. It is only the way to get access to the inside of the abdomen and pelvis to perform surgery.

How is a laparoscopy done?

A laparoscopy is done under general anaesthesia. It may require 1 to 4 surgical incisions of about 0.5 cm each. The first one is done inside the umbilicus. The camera is passed through this incision and gas is pumped inside the abdomen to distend it and create room for the instruments. Depending on the complexity of the surgery being done, up to three other incision are made on the sides. A hollow plastic cylinder, called a surgical port or trochar, is inserted in each of the incisions. Through those, instruments can be inserted and removed as required. There is a large variety of ports, instruments and accessories that can be used depending on the requirements of each case.

 What are the benefits of a laparoscopy?

A laparoscopy provides better visualisation of the abdomen and pelvis than open surgery. The camera can get very close to all areas and magnify the image. The small surgical incisions mean less surgical trauma. The implications are: less pain after surgery, smaller scars, less time spent in hospital, quicker recovery, reduced use of pain killers, less bleeding and lower risk of infections. Laparoscopy is a very well established and safe mode of access to the abdominal cavity with clear advantages over laparotomy (open surgery).

Whenever possible, accessing the abdomen and pelvis via laparoscopy should be the preferred option.

 What are the downsides of a laparoscopy?

A laparoscopy requires more specialised surgical skills and therefore longer training periods and learning curves. Some diseases are more difficult to treat via laparoscopy. One example is very large and heavy tumours such as fibroids or big ovarian cysts, other is advanced cancer. In some cases, a laparoscopy is not possible and in others it can last considerably longer than open surgery increasing the surgical and anaesthetic times.

 What to expect when having a laparoscopy?

Most laparoscopies are day procedures, meaning one is admitted in the morning of the surgery and is discharged a few hours later. Once the operation is over, you will be taken to a recovery room where you stay while waking up from the anesthetic. A nurse will monitors pulse, blood pressure, pain, etc.

Once reasonably awake and once you had something to eat/drink and passed urine, you will be ready for discharge. You would need to arrange for someone to pick you up from the hospital and drive you home. It is advisable to have a friend or family stay with you for the first 24 hours. As it takes time for the anaesthetic to wear off, please do not drink alcohol, drive or operate machinery for 48 hours after your operation. You should expect some pain, enough to require pain kilelrs for a few days. You can do basic self care activities such as showering, getting dressed, etc on your own. Most women take 7 to 10 days of work afterwards. This varies according to the operation done, type of work and individual recovery.

It is also common to have irregular vaginal bleeding for a few days.

 What are the risks of laparoscopy?

The procedure is generally safe, but all operations have risks associated with them. General risks of all laparoscopic surgeries are:

• Wound infection: Signs include redness, swelling, discharge from the wound, raised temperature and increasing pain. It can be treated with antibiotics.

• Increased Bleeding: When this occurs, it is usually at the time of operation.  The surgeon will stop the bleeding before the procedure finishes. In worst case scenarios, it may require a blood transfusion. Late bleeding, hours or days after the operation is over can happen, but is very rare.

• Damage to internal organs: Structures such as the bladder, bowel, ureters or large blood vessels can be cut accidentally or intentionally when necessary. This can be a significant complication and may require involvement of other specialists such as general surgeons, urologists and colo-rectal surgeons. It may require more surgery to repair the damage and prolonged stay in hospital.

• Laparotomy: In rare circumstances, an open incision may be required either to finish the proposed operation or to repair any injury.

• Deep venous thrombosis and embolism: Clots can form inside blood veins, usually in the legs. Sometimes these clots can detach and migrate through the blood vessels to other areas causing blockage of the blood supply and infarct of other organs such as the lungs.

 Factors that increase surgical risk are:

• Complex disease such as cancer or advanced endometriosis.

• Other medical conditions such as hypertension, diabetes, heart disease and propensity for blood clots.

• Obesity

• Emergency surgery

 Planned, elective laparoscopies in otherwise healthy women, when performed by experienced surgeons in good hospitals are usually very safe. Complications, although always possible, are very rare.