Surgical methods have evolved tremendously over time and much newer safer and better surgical methods have arrived which have increased the quality of life for a surgical patient; laparoscopic surgery is one of them. It is also known as minimally invasive surgery. Laparoscopic surgery is performed for the operations of the abdomen with 6 to 12 inch long cuts. That’s why, it’s sometimes called keyhole surgery. As the name suggests this process have a laparoscope, a lean slender shaped tool with tiny video camera and light on the tip. With few millimeters long small incisions, the surgeon inserts different instruments, including the laparoscope through the abdominal wall, and performs the surgery while visualizing it on a video screen. Laparoscopic surgery is used for many surgeries. It has the advantages of less pain, less cutting of skin and tissue, fewer wound complications, quicker post-operative recovery, and shorter duration of hospital stay. The surgeons can perform laparoscopic procedures in many illnesses today, some of them being:
- Abdominal surgeries to treat appendicitis, Crohn’s disease, Duodenal Perforation, Ulcerative Colitis, Diverticulitis, Cancer, Rectal Prolapsed, and Chronic Constipation.
- Gallbladder procedures.
- Gynaecologic surgeries such as hysterectomies.
- Hernia surgeries.
Benefits of Laparoscopic surgery:
There are several advantages of laparoscopic surgery in comparison to the previous old fashioned surgeries methods.
- Very small scars.
- Stay for fewer days in the hospital (in traditional methods, the recovery time of a patient was 4 to 8 weeks and hospital stay was of 1 or more than a week, but in laparoscopic surgery, recovery time is 2 to 3 weeks and hospital stay is of only 2 nights).
- Less tissue cutting.
- Less pain while scar heals – lesser use of pain medications.
- Get back to normal life sooner.
- Quick healing as the scar is small.
- As exposure of internal organs gets reduced for external contaminants, hence the risk of infections reduced.
Disadvantages of Laparoscopic surgery:
Although laparoscopic surgery is of great advantage for a patient, there are few disadvantages too which are as follows:
- The surgeon has a limited range of movement from a tiny invasion hole.
- Poor depth perception.
- The surgeon has difficulty feeling tissue, hence unable to judge the force needs to be applied.
- It is a non-intuitive motor skill that is difficult to learn.
Risks of Laparoscopic surgery:
Some of the risks are as follows:
- The most severe risk is Trocar injuries, which occur during insertion into the abdominal cavity. This type of injury includes abdominal wall hematoma, umbilical hernia, umbilical wound infections, etc.
- People having low BMI or history of prior abdominal surgeries is more prone to such injuries. These injuries are life-threatening.
- Sometimes, few surgeons work with electrodes that leak current into the surrounding tissues and give electrical burn that leads to peritonitis.
- Due to increased exposure to cold, dry gases during insufflation, there is a risk of hypothermia and peritoneal trauma. Surgical humidification therapy is being used to reduce insufflations with the use of heated and humidified Carbon Dioxide (CO2).
- Many patients with pulmonary disorders cannot tolerate gas in the abdominal cavity (pneumoperitoneum), due to which surgeons have to change the mode of surgery means initially, they were starting from a laparoscopy and later on shift to open surgery.
- Coagulation disorder and dense adhesions of previous abdominal surgery may add risk to laparoscopic surgery.
Diagnostic Laparoscopy:
In many situations nowadays, Laparoscopy has become part of the Diagnostic workup for a definitive diagnosis of the problem. Some of the examples are:
- Pain abdomen in which all other modalities of investigations have failed to do a definitive diagnosis.
- Trauma patients in which the source of bleeding could not be identified.
- Problems related to intestines sometimes needs a diagnostic laparoscopy to find out the exact cause.
- In many Intra-abdominal malignancies, it is used for proper staging of the disease.
Dr. Pranay Gourav | Consultant – General Surgery | Narayana Multispeciality Hospital, Barasat