Laparoscopic Surgery involves an ingenious method to perform a surgical procedure to reach parts of the body, minimizing the use of very large cuts, and so it’s also known as Minimal Invasive Surgery. It is also called KEY HOLE SURGERY since large cuts are replaced by small 0.5-1cm cuts, through which a thin telescope is introduced, this is navigated using a small digital camera that is attached to the end of the scope. The camera captures the inside of the abdomen and is displayed on a big screen or TV monitor. Abdomen is extended with gas to provide working space. The procedure is performed through slender instruments
The stepwise procedure of a laparoscopy is as below
- General anesthetic is administered.
- If the bladder is full, it is emptied using a catheter.
- An instrument is introduced through the cervix into the womb so that it can be moved as required to help visualize the pelvic organs.
- A tiny cut (0.5- 1cm) is made inside the umbilicus.
- A needle is brought in through the small cut into the abdominal cavity, to fill the abdomen with gas.
- The telescope is inserted.
- Up to 1-3 small(0.5 cm) cuts may be made, to introduce other slender instruments which are useful for surgery into the abdominal cavity depending on the operation.
- Gas is removed at the end & the cuts may or may not be closed with stitches depending on the case.
A conventional surgery, necessitates a long incision to gain entry into the abdominal cavity and operate, as such the procedure poses the following concern areas.
1. Post- operative level of pain is much higher.
2. Period of hospital stay is extended.
3. Recovery of the patient slows down.
4. Extensive scarring is seen.
5. Respiratory problems arise, which hinder normal breathing.
6. Greater chance of the wound being infected.
7. Possible chance of developing incisional hernia.
8. Post- surgical feeding is delayed.
9. Laparoscopic surgery overcomes majority of the above concerns.
In comparison to the conventional surgery, laparoscopic surgery have the following advantages.
1. Small incisions –better cosmesis
2. Lesser pain - need less postoperative pain medication
3. Faster mobilization
4. Shorter hospital stay
5. Significantly faster recovery
6. Can get back to the work earlier
7. Less chances of wound infection
8. Less formation scar tissue inside the abdomen that may cause pain, or bowel
9. Less occurrence of hernias.
Normally, any laparoscopic procedure results in some kind of discomfort. Common complaints of shoulder pain, neck and abdominal pain are reported. However these symptoms usually resolve within 12-24 hours. Nausea can also be experienced.Post laparoscopic procedure, one can usually get up move around, by the end of 4-6 hrs.
Almost all open surgeries are nowadays being performed laparoscopically.
• Evaluation of infertility problems
• Diagnosis of abdominal pain.
• Family planning surgeries.
• Removal of ovarian cysts.
• Treatment of endometriosis.
• Removal of fibroids irrespective of its size
• Removal of uterus, even if the size is too large.
• Cancer surgeries (oncological procedures).
In the past there had been concern raised about the safety of laparoscopic surgery for cancer surgeries. Several studies in recent years have been conducted involving hundreds of patients and have shown that laparoscopic surgery is completely safe option for cancer surgeries, besides having the advantages over conventional surgeries.
Laparoscopic Surgery and widely practiced open surgery are both equally same as far as safety is concerned.
Laparoscopy is essentially a safe procedure. Although the risks are very rare, some risk should be expected with any procedure. General anesthesia might pose some risk which is the same for open surgeries too. There is chance of infection and bleeding in area of incision. The abdominal organs, intestines, or blood vessels may be damaged if surgeon is not experienced. But with experienced surgeons the complication rates are very low.
Not really .The equipment maintenance for correct working of the surgery and procedure are more expensive but as the reduced hospital stay and the lower intake of drugs compensate for the same, as thus it is actually the same as open surgery.
Laparoscopic surgery is commonly being done in almost all medically reputed establishments.
But it is better to get it done in a centre where many laparoscopic surgeries are done every day & it is very important that the surgeon has lot of experience in doing laparoscopic surgeries.
Yes, children too are eligible for many laparoscopic procedures.
- Admission letter instructions must be followed with diligence.
- As per surgeon instructions eating and drinking must to stopped at the correct time. Ideally, you should not eat or drink for six to eight hours before the procedure.
- If you are taking any medication on a daily basis, inform this to your surgeon who will ensure the medications are taken with a minimum quantity of water. If you are prescribed aspirin, blood thinners or arthritis medication, inform this too to your surgeon.
- Patient should have had a shower on the evening before the day of surgery or on the day of the surgery. Cleaning of umbilicus ("belly button") with antiseptic soap, water, and an ear bud is important.
- Vaginal Preparation or removal of pubic hair is usually not required.
- Nail enamel, beauty products and ornaments should be removed the night before surgery.
- If it’s a minor procedure, enema might be excluded. But if it is an major surgery you may be given peglec powder in 2 litres of water the previous evening to empty the bowel You may pass motion many times though this is unpleasant, this procedure minimizes the risk of surgical complications from bowel injury during your surgery.
- Investigation reports is a must before surgery.
- You should report to the hospital at the correct time as advised.
Immediately Before Surgery
- After Hospital formalities are finished, the nurse will call you into the changing room.
- Completely sterilised gown, robe and footwear are provided by the hospital and are the only things to be worn by the patient.
- A doctor will ask you questions about your medications, allergies, your health status and other information prior to your surgery.
- Signature for an informed written consent form is needed. At the time of signing, all questions and concerns you may have is advised to be asked.
- A completely empty bladder is an important requirement prior to surgery.
- Correction spectacles, Contact lenses, removable dentures and any ornaments should be removed.
- The hospital will not be answerable for any of the valuables. So, keep them at home, or with the attendant accompanying you.
Either a nurse or the anesthesiologist will walk you into the OT. Medication for drowsiness is given, which also makes it difficult for you to see. After this, you will drift off under effects of anesthesia (fall asleep).
You should experience much less pain after laparoscopic surgery than you would expect after a traditional operation. But you must not expect a completely pain free procedure. At the time of going home you may still be feeling some lower abdominal discomfort and possibly some shoulder tip pain. Such discomfort is likened to a period pain and should be relieved by the medication you have been given by the hospital or by simple remedies such as paracetamol or aspirin. The pain may seem more severe at some times than others but it should progressively improve with time. Please contact your doctor if the pain gets suddenly or progressively more severe. Pain after keyhole surgery should never get worse and you should seek help if it does.
Gas pains are nothing but residue of carbon dioxide that may remain in your abdomen following the procedure. This pain usually presents as pain in the shoulder or sharp pain beneath your diaphragm. The pain is usually short-term and will disappear in a few days. Being mobile and moving around during these pain attacks helps reduce it, and also if you drink either hot water or hot tea with fresh lemon will also reduce it. Hot massages and exercise can also help to assuage this pain.
If the surgery is a success, without any complication, feeding can be started on the same day provided the patient has recovered completely from the effects of anesthesia, usually after 4-6 hrs. But take note that no procedure should have been performed on the bowel. In general, start with clear liquids (juices, soups or both) later you may advance your diet if there is no vomiting. Eat light, easily digested food for a day or two.
You will be allowed to go home a few hours after the minor lap surgeries, provided no complications are present. When on empty bladder, no severe pain or active bleeding should be experienced. After uterus removal surgery, or any other major operation, you can be discharged on the next day if no complications are seen.