What is laparoscopy?

Indications and Procedures

Laparoscopy
is a surgical technique for examining the abdominal organs and for treating surgically many diseases of these organs. The instrument used is called a laparoscope. It is a flexible tube that contains fiber optics for visualization purposes and a channel through which physicians can pass special surgical instruments into the abdominal cavity.

Upon insertion of a laparoscope into the abdomen through a small surgical incision (usually near the navel), physicians can observe the liver, kidneys, gallbladder, pancreas, spleen, and exterior aspects of the intestines in both sexes. Hence the technique is useful for detecting cirrhosis of the liver, the presence of stones and tumors, and many other diseases of the abdominal organs. The female reproductive organs can also be examined in this manner.

Before laparoscopy can be carried out, the patient must fast for at least twelve hours. The patient is given a local or general anesthetic, depending on the purpose of the procedure. In exploratory abdominal examinations, the instrument is inserted into the abdomen through a small incision in the abdominal wall after local anesthesia has numbed it. Often, especially when extensive surgery is anticipated, the procedure begins after general anesthesia produces unconsciousness. Upon the completion of exploration or surgery, the laparoscope is withdrawn and the incision is closed.

Laparoscopic abdominal examination is often used to detect
endometriosis, the presence of endometrial cells outside the uterus. This procedure begins with the administration of local anesthesia when only exploration or biopsy is planned. General anesthesia is used when the removal of implants (endometrial tissue) is anticipated. The entry incision is made near the navel, and the laparoscope is inserted. The fiber-optics system is used to search the abdominal organs for implants. Visibility of the abdominal organs is usually enhanced by pumping in a harmless gas, such as carbon dioxide, to distend the abdomen. After the confirmation of endometriosis, surgical implant removal is carried out immediately, unless the decision is made to institute drug therapy instead. Full recovery from this surgery requires only a day of postoperative bed rest and a week of curtailing activities.

Laparoscopy can also be employed for female sterilization. The patient is given a general anesthetic. After laparoscopic visualization of the Fallopian tubes in the gas-distended abdomen is achieved, surgical instruments for tube cauterization or cutting are introduced and the sterilization is carried out. The entire procedure often requires only thirty minutes, which is one reason for its popularity. In addition, patients can go home in a few hours and have fully recovered after a day or two of bed rest and seven to ten days of curtailing activities.

Uses and Complications

Common laparoscopic surgeries are
cholecystectomy (the removal of the gallbladder), the removal of gallstones and kidney stones, tumor resection, female sterilization by cutting or blocking the Fallopian tubes, the treatment of endometriosis through the removal of implants from abdominal organs, and the removal of
biopsy samples from abdominal organs. Traditional uses of laparoscopy in female reproductive surgery are to identify and correct pelvic pain resulting from endometriosis, ectopic pregnancy, and pelvic tumors.

Laparoscopy has several advantages. There is rarely a need for patients on chronic drug therapy to discontinue medication before laparoscopy. In addition, the use of laparoscopy dramatically lowers surgical incision size, surgical trauma, length of hospital stay, and recovery time. Laparoscopy should be avoided, however, in cases of advanced abdominal wall cancer, severe respiratory or cardiovascular
disease, or tuberculosis. Extreme obesity does not disqualify a patient from undergoing laparoscopy but makes the procedure much more difficult to perform.

As laparoscopic surgery has increased in scope, more procedures yield surgical tissues that are larger in size than the laparoscope channel (for example, the removal of gallbladders, gallstones, and ovaries). In many cases these organs and structures are cut into small pieces for removal. If potentially dangerous items are involved—such as malignancies that can spread on dissection—larger, more conventional incisions are often combined with laparoscopy.

Perspective and Prospects

Since the 1970s, the uses of laparoscopy have constantly expanded. Once confined to the exploratory examination of the abdomen, the methodology has been applied to a large number of different types of surgery in addition to those already mentioned. Such versatility is attributable to the development of better laparoscopes, advanced instrumentation for diverse surgeries, and improved fiber-optic and video technologies.

As a consequence of these advances, many surgeons predict that most future abdominal surgery will be laparoscopic. The driving force for such innovation includes the public demand for quicker recovery times. In the United States, this desire is intensified by the requirements of insurance companies, employers, and the federal government for shorter hospital stays. Both changes are made possible by decreased severity of surgical trauma in laparoscopy when compared to traditional surgery, a result of the smaller incisions. The dramatic trend toward laparoscopy can be seen with cholecystectomies: Of those done in 1992, 70 percent were laparoscopic, compared to less than 1 percent in 1989; according to a 2010 report, about 75 percent of cholecystectomies are done with laparoscopic surgery.

Bibliography

Graber, John N., et al., eds. Laparoscopic Abdominal Surgery. New York: McGraw-Hill, 1993.

Henderson, Lorraine, and Ros Wood. Explaining Endometriosis. 2d ed. St. Leonards, N.S.W.: Allen and Unwin, 2000.

Kapadia, Cyrus R., James M. Crawford, and Caroline Taylor. An Atlas of Gastroenterology: A Guide to Diagnosis and Differential Diagnosis. Boca Raton, Fla.: Pantheon, 2003.

Ost, Michael C. Robotic and Laparoscopic Reconstructive Surgery in Children and Adults. New York: Humana Press, 2011.

Reddick, Eddie Joe, ed. An Atlas of Laparoscopic Surgery. New York: Raven Press, 1993.

Terzić, Hana. Laparoscopy: New Developments, Procedures, and Risks. Hauppauge, N.Y.: Nova Science, 2012.

Zollinger, Robert M., Jr., and Robert M. Zollinger, Sr. Zollinger’s Atlas of Surgical Operations. 9th ed. New York: McGraw-Hill, 2011.

Zucker, Karl A., ed. Surgical Laparoscopy. 2d ed. Philadelphia: Lippincott Williams & Wilkins, 2001.