A weekly column prepared by Dr. Balwant Singh’s Hospital Inc.
Key ‘whole’ surgery: changing with the times
By Dr Anirban Banerjee, MS (General & Laparoscopic Surgeon)
Laparoscopy and
laparoscopic surgery
Laparoscopy, also known as minimal invasive or keyhole surgery is a procedure used to examine the abdominal (belly) and pelvic organs and also to remove the diseased organ from the abdomen.
What is a laparoscopy?
Laparoscopy is a procedure to look inside your abdomen by using a laparoscope. A laparoscope is a thin telescope with a light source. It is used to light up and magnify the structures inside the abdomen. A laparoscope is passed into the abdomen through a small nick (cut) in the belly button, which is usually not visible.
A laparoscopy may be done to find the cause of symptoms such as abdominal (belly) pain, pelvic pain, or swelling of the abdomen or pelvic region. It may also be done if a previous test such as an x-ray or ultra- sound scan has identified a problem within the abdomen or pelvis. Some common conditions which can be seen by laparoscopy include:
* Endometriosis ( abdominal pain, heavy bleeding during and after menses)
* Pelvic inflammatory disease (abdominal pain and fever and backache)
* Ectopic pregnancy
* Ovarian cysts
* Appendicitis
What is laparoscopic surgery?
In addition to simply looking inside, a doctor can use fine instruments which are also passed into the abdomen. Surgeons have to be skilled to handle these instruments. Laparoscopic surgery can be used for various procedures.
Some commonly performed
operations include:
Removal of the gallbladder. This is called a laparoscopic cholecystectomy. It is now the most common way to remove the gallbladder.
* Removal of the appendix. * Removal of patches of endometriosis.
* Removal of parts of the intestines. * Female sterilization.
* Treating ectopic pregnancy
* Taking a biopsy (small sample) of various structures inside the abdomen for disease
identification
What are the advantages of laparoscopic surgery over regular surgeries?
In general, compared to traditional surgery, with laparoscopic surgery there is usually
* Less pain following the procedure * Less risk of complications
* A shorter hospital stay * A quicker recovery
* A much smaller scar * Early return to work
How is it done?
Laparoscopy and laparoscopic surgery are usually done whilst you are asleep under general anaesthesia. The skin over the abdomen is cleaned. The surgeon then makes a small incision (cut) about 1-2cm long near to the navel (belly button). Some gas is injected through the cut to slightly ‘blow out’ the abdominal wall. This makes it easier to see the internal organs with the laparoscope which is gently pushed through the incision into the abdominal cavity. The surgeon then looks down the laparoscope or looks at pictures on a TV monitor connected to the laparoscope.
If you have a surgical procedure, one or more separate small cuts are made in the abdominal skin. These allow thin, specially designed instruments to be pushed into the abdominal cavity. The surgeon can see the ends of these instruments with the laparoscope and so can perform the required procedure.
When the procedure is finished, the laparoscope and other instruments are removed. The incisions are stitched and dressings are applied.
After a laparoscopy?
You may feel a little sore around the incisions. You may have some pain in your shoulder tip. This is caused by the gas which had been pumped inside during the procedure. This pain soon passes off. The length of time to recover can vary, depending on the procedure.
Are there any possible complications from a laparoscopy?
There may be some minor bleeding or bruising around the skin incisions. Otherwise, in most cases a laparoscopy to just ‘look inside’ goes without any problem. Possible problems which may occur include the following:
* Accidental damage to structures inside the abdomen such as the intestines or certain blood vessels. This is rare, but if it occurs an emergency traditional operation may be needed to correct the damage.
* As with any operation, there is a small risk of complications of anaesthesia.
What to do if there is any problem
Please contact your doctor if you have:
* Increased pain
* An offensive discharge from the instrument puncture site after surgery
* A raised temperature * Heavy bleeding * Any other concerns
Follow-up
Your doctor may arrange to see you in the Outpatients Department a few weeks after the procedure.