Operative Laparoscopy : Indications | Process | Complications

Overview of Operative Laparoscopy surgery

When laparoscopy is used to treat a problem or relieve certain symptoms, it is called operative laparoscopy. Operative laparoscopy has become the standard method for most surgeries like appendectomy, adrenalectomy, cholecystectomy, splenectomy, etc.

Laparoscopy provides a view of abdominal organs and the insides of the abdominal cavity. To achieve this, a laparoscope is inserted into the abdominal cavity through a cut made in the abdominal wall, and the image recording by the camera is analyzed on a monitor. A laparoscope is a long thin tube having a high-resolution camera and high-intensity light at the front.

To insert a laparoscope, a small incision is made through the belly button, and the telescope is inserted via this cut. As the instrument moves inside, the camera sends the images of insides to the video monitor. It is a minimally invasive surgery.

Laparoscopy is used to diagnose and treat as well as the cause of pelvic or abdominal pain. According to the aim of performing the procedure, it is divided into two types.

  • Diagnostic Laparoscopy: When laparoscopy is done only to view the insides or to take a biopsy, it is called diagnostic laparoscopy. It does not aim to treat the symptoms, it just diagnoses the cause of problems or symptoms.

  • Operative Laparoscopy: When laparoscopy is performed to treat a specific problem or to assist a particular surgery, it is called operative laparoscopy.  It aims to treat the problem or relieve the symptoms.

The technology has been so improved that almost all surgeries can be performed laparoscopically. Laparoscopically performed operations have many benefits like shorter hospitalization, fast recovery, less postoperative risks, etc. Now we are explaining the Indications, Process, and Complications of Operative Laparoscopy.

Indications for Operative Laparoscopy

Almost any gynecologic surgery can be performed with operative laparoscopy. Operative laparoscopy can be used to treat ectopic pregnancy, removing or draining the ovarian cyst, tubectomy, treatment of endometriosis.

The benefit of operative laparoscopy is that it is less invasive as compared to conventional open surgery. The cuts included are much smaller. This causes less pain, less scarring, shorter hospital stay, and faster recovery.

Few of the surgeries which are performed laparoscopically are:

  • Tubectomy: It is a surgical process for female sterilization. In this process, fallopian tubes are blocked.

  • Endometriosis: Endometriotic spots and pelvic adhesions can be removed laparoscopically.

  • Ovarian Cysts Removal: Ovarian cyst or the whole ovary can be removed laparoscopically.

  • Uterine Suspension: This surgery is required when the uterus is leaning toward the backbone instead of leaning toward the bladder. This is called retroverted uterus. A laparoscopic uterine suspension can fix this problem.

  • Myomectomy: It is the surgical removal of uterine fibroids.

  • Hysterectomy: This is the process of removing the uterus. It can be removed along with the ovaries or alone. After detaching the uterus laparoscopically, it is removed via the vagina.

  • Removing Of Any Abdominal Organ: The surgeries to remove abdominal organs are done laparoscopically. This provides a better view and reduces the risks of the surgery. These are the few laparoscopically performed surgeries for organ removal.

    • Cholecystectomy: Removal of the gallbladder

    • Appendectomy: removing of the appendix

    • Splenectomy: removing of the spleen

    • Adrenalectomy: removing of the adrenal gland

  • Oncologic Procedures: laparoscopic surgeries are used to treat several types of cancers. Gastrointestinal stromal tumors and other sarcomas in the abdomen can be removed with laparoscopically performed operations.

Laparoscopic Cystectomy is a surgical procedure to treat bladder cancer by removing a portion of the bladder or the entire bladder.

Laparoscopic Colectomy is a surgical procedure to treat colorectal cancer by removing the cancerous portion of the colon and nearby tissue.

Process of Operative Laparoscopy

Operative laparoscopy is performed to treat a specific problem diagnosed in diagnostic laparoscopy or other test reports. The procedure of operative laparoscopy varies from condition to condition.

Before the procedure of laparoscopy, the doctor provides certain instructions to get prepared for the process.

Doctor asks the detail of medications that the patient takes and go through medical history. The doctor instructs the patient when to stop or start taking medicines like, blood thinners, anti-inflammatory drugs, medications that affect blood clottings and herbal or dietary supplements.

A pregnancy test should always be performed before laparoscopy so that the doctors take precautions and reduce the risk of harm to the growing baby.

Before laparoscopy, various tests and scans are performed. These include a blood test, Urine test, Electrocardiogram (ECG), X-ray, Ultrasound, CT Scan, and MRI. These tests and imaging are conducted to better understand the available abnormality.  These tests improve the effectiveness of the laparoscopy as it provides a guide inside of the abdomen.

The patient is instructed not to eat or drink anything for at least 8 hours before laparoscopy.

This surgery is performed under general anesthesia. First of all, general anesthesia is given to the patient.

General anesthesia causes complete unconsciousness, i.e. the patient will remain asleep during the procedure and will not feel any pain during the process. An anesthesiologist intravenously gives anesthesia as well as fluid to keep the patient hydrated. In some cases local anesthesia is used, it numbs the area of treatment and the patient is awake during the process but will not feel any pain.

During laparoscopy, the doctor makes a small cut below the belly button and inserts a cannula in it. A cannula is used to inflate the abdomen with carbon dioxide (CO2). This allows the doctor to see the abdominal organs clearly.

After inflating the abdomen, the surgeon inserts the laparoscope through the incision. The camera of laparoscope record the images of the inside of the abdominal cavity and transfer it to the video monitor.

More than one incisions are made to insert other instruments as in the case of biopsy, surgical instruments are inserted to extract a tissue sample. The number and size of cuts vary according to the disease to be treated. Generally, number of incisions ranges between 1 to 4.

Post Procedure

After the procedure, instruments are removed and, incisions are closed with stitches and covered with bandages.

The patient is observed for several hours, vital signs such as heart rate and breathing are monitored until the patient is awake.

Throbbing and pain in incisions will be there, and the degree of pain will vary according to the type of surgery. So painkillers are given to the patient to relieve pain.

When the patient is awake, a cup of water or tea is offered, and light food is given before release. The release time of the patient depends upon some factors like physical health, type of anesthesia used, etc.

Complications of Operative Laparoscopy

Complications of the procedure vary according to the type of surgery done. Most common risks associated with laparoscopy are:

  • Infection: There is a chance of infection after laparoscopy. The patient should contact the surgeon if, signs of infections are observable. Signs of infection are fever, redness/ swelling/ bleeding of incision, nausea or vomiting, abdominal pain, pelvic pain, breathing problems, problems in urinating and persistent cough.

  • Organs Damage: there is a risk of puncture or damage to an organ. If this happens blood and other fluids may leak in your body. In such a case, additional surgery is required to repair the damage.

  • Internal Bleeding: Blood clots may be formed inside the body, which can travel to legs, pelvis or lungs.

  • Pain In Incisions: for a few days after laparoscopy, the patient will feel pain and throbbing in the incisions. Usually, this pain fades away with time. Doctors prescribe some pain medications to deal with it.

  • Shoulder Pain: This is commonly seen after the procedure. This happens due to the carbon dioxide gas used to inflate the abdomen. This causes irritation to the diaphragm which affects the shoulder nerves.

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