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Laparoscopic Surgery

Laparoscopic surgery, also known as keyhole surgery or minimally invasive surgery has revolutionised the treatment of many diseases. Surgery is less painful, has less bleeding and recovers faster with laparoscopy than open surgery techniques.

It is commonly used in abdominal and pelvic surgery, including gallstones, appendicitis, hernias, endometriosis, ovarian cysts, ectopic pregnancy, fibroids and other female conditions.

Although laparoscopic surgery is the main technique used in many patients, there are some misconceptions and unanswered questions about its safety, recovery, complications and suitability.

This article provides answers to some of the most common patient-related questions in simple terms. It also introduces new technologies such as robotic surgery, artificial intelligence (AI) technologies, 3D imaging, use of fluorescent light in surgery and augmented reality that further improve the safety and precision of laparoscopic surgery. Last but not least it references existing gaps in

Surgery can often cause anxiety. Patients worry about pain, the large scars, the long hospital stay and slow recovery. Luckily, in the last few decades, there have been significant advancements in medical technology.

Many can perform many operations with very small incisions, and not one large cut, anymore. This is called “laparoscopic” surgery. In laparoscopic surgery, the surgeon puts a thin tube known as a laparoscope through the abdomen, which has a high-resolution camera and light at the end. The camera is placed in a monitor, allowing the surgeon to see the inside of the body without making a lot of incisions. Special surgical instruments used for the procedure go through other small incisions.

Laparoscopy has become a common practice in general surgery, gynaecology, urology, bariatric surgery and colorectal surgery. Due to its many benefits, it is now the norm for many surgeries.

What is Laparoscopic surgery?

Laparoscopic surgery is a minimally invasive surgical procedure that is carried out through small incisions, typically between 0.5 and 1 cm.

The laparoscope (small camera) is placed into one opening; other instruments go into the other openings, and an operation is performed.

During the procedure, the surgeon views a high-definition video screen—rather than directly looking at the body.

Why is Laparoscopic surgery called keyhole surgery?

It is termed keyhole surgery because only very small cuts are made rather than making one large cut as with conventional open surgery. The small incisions are like a keyhole.

During laparoscopic surgery,

  • The surgeon makes 2-4 small incisions in the abdomen.
  • One incision is made to insert a thin tube equipped with a camera and light (laparoscope).
  • The other small incisions are used to insert long, specialised surgical instruments.
  • A monitor receives magnified images from the camera, so the surgeon can complete the procedure without having to make a large opening in the abdomen.
  • These are very small incisions, and as such, the surgery is often referred to as keyhole surgery or minimally invasive surgery.

What are the advantages of Laparoscopic surgery?

Keyhole surgery typically offers:

  • Smaller scars.
  • The surgery is less painful.
  • Reduced blood loss.
  • Reduced likelihood of infection of the wound.
  • Shorter hospital stays.
  • Speeds up healing and return to normal.
  • Better cosmetic results.

Which conditions can be treated with Laparoscopic surgery?

Laparoscopic surgery is frequently performed on,

  • Gallbladder stones.
  • Appendicitis.
  • Hernia repair.
  • Ovarian cyst removal.
  • Endometriosis.
  • Ectopic pregnancy.
  • Fibroid removal (Myomectomy).
  • Hysterectomy.
  • Tubal ligation.
  • Infertility evaluation.
  • Kidney surgery.
  • Bariatric (weight-loss) surgery.
  • Colon surgery.
  • Certain cancer surgeries.

How should I prepare before Laparoscopic surgery?

  • Follow fasting guidelines- Do not eat or drink 6-8 hours before surgery (or as directed by your physician).
  • Let your doctor know if you are taking any medicines- Particularly medicines used to thin blood, medicines for diabetes, vitamins and medicines from plants.
  • Avoid smoking and alcohol- It is best to quit smoking for several weeks before surgery and to not drink alcohol for 24 hours before surgery.
  • Have a bath- Shower with soap the night before or on the morning of surgery.
  • No make-up or jewellery- Take off nail polish, contact lenses and body jewellery.
  • Dress in comfortable clothes- Bring loose-fitting clothes to the hospital.
  • Bring Identification, medical records, reports of tests and a medication list.
  • Have someone else go with you, such as a family member or friend who can help you get home after surgery.
  • If you are not feeling well, tell your doctor- Let your doctor know of any new sickness, cold, cough or fever before surgery.
  • Stay calm and follow your doctor instructions- Ask questions if you have any concerns.

What is the procedure for performing Laparoscopic surgery?

Laparoscopic surgery is also known as keyhole surgery or minimally invasive surgery, and involves a few small cuts as opposed to one big incision.

An instrument consisting of a thin tube equipped with a camera (a laparoscope) is inserted into the abdominal cavity through an incision to help the surgeon with a high-definition monitor view the inside of the body, and with the use of specialized instruments to carry out the procedure.

Step-by-Step Procedure

Anaesthesia

The patient is under general anaesthesia, meaning he or she is asleep and free of pain during the surgery.

Making small incisions

The surgeon will make 2-4 small incisions, typically 0.5- 1 cm long, in the abdomen.

Inflating the abdomen

A small amount of carbon dioxide (CO₂) gas is slowly added to the abdomen.

This provides more room between the organs and the abdomen for the surgeon to work, making surgery easier and safer.

Inserting a laparoscope

One of the small incisions is used for a laparoscope, a thin tube containing a camera and light, to be inserted.

It transmits live, magnified images to the monitor, enabling the surgeon to see the organs inside the patient’s body.

Inserting Surgical Instruments

Through the other small incisions, specialised long, thin instruments are inserted.

The surgeon carefully performs the required procedure while watching the monitor.

Completing the Surgery

After the procedure is finished, the instruments are removed.

The carbon dioxide gas is let out from the abdomen.

Small incisions made are stitched, glued or taped over with dressings.

Recovery

The patient is then taken to the recovery room, where the patient’s status is monitored.

Depending on the type of surgery and the health of the patient, many of the surgeries can be done laparoscopically, and the patients can go home on the same day or within 24-48 hours.

What are the complications of Laparoscopic surgery?

As with any surgery, there are risks associated with laparoscopic surgery, but they are not serious and do not happen very often

Possible complications include:

  • Bleeding.
  • Infection.
  • Damaged of surrounding areas.
  • Clotting of blood.
  • Complications due to anaesthesia.

What should I eat after surgery?

After surgery, the patient needs to take:

Day 1 (24hrs)

  • Drink plenty of water.
  • Lemon water, coconut water, fruit juices.
  • Khichadi, yoghurt, dal, soup, banana as per doctor’s advice.

Day 2-7

Protein: Fish, paneer, chicken, Greek yoghurt

  • Protein: Eggs, dal, paneer, tofu, chicken, fish, Greek yoghurt.
  • Whole grains: Wheat roti, oats, brown rice.
  • Fruits: Oranges, apples, papaya, berries.
  • Vegetables: Carrots, beans, pumpkin, broccoli.
  • Healthy fats: Avocado, olive oil, nuts.

Foods to avoid:

  • Fried, spicy and oily foods.
  • Carbonated drinks.
  • Excess caffeine.
  • Heavy meals that may cause bloating.

What are the modern innovations used in Laparoscopic surgery?

The development of technology is making the laparoscopic surgery safer, more accurate and patient-centred.

Robot-assisted laparoscopic surgery

Whether this translates to greater precision, improved dexterity and more control, robotic systems have proven to excel in complex procedures like prostate surgery, hysterectomy and colorectal surgery. The surgeon is always in control of the robotic instruments.

Three-Dimensional 3D imaging

3D laparoscopic cameras offer depth perception, allowing surgeons to carry out more intricate procedures with greater precision than the traditional 2D cameras.

Artificial Intelligence

AI is being used in the medical field to enhance the ability to recognise anatomical structures, aid decision-making, and minimize the risk of unintended harm during surgery.

Fluorescence-Guided Surgery

Surgeons can more clearly see the blood vessels, lymph nodes and bile ducts during surgery when they use these special fluorescent dyes, which helps them perform the surgery more safely to minimise complications.

Enhanced Recovery After Surgery (ERAS) Programs

The evidence-based strategies included in ERAS protocols include early nutrition, early mobilisation, and optimised pain control, which help to promote rapid recovery, reduce hospital length of stay and enhance patient satisfaction.

Laparoscopic surgery has completely transformed the surgical care, as it offers an alternative with less invasiveness and safety to many traditional surgeries. It is easier to work with it is less painful and generally a smaller incision and it means a shorter stay in the hospital and a quicker recovery for millions of patients all over the world.

Though not a viable option for all diseases, it is the recommended treatment for a wide range of abdominal and pelvic surgeries. Future improvements in robotics, AI, advanced imaging and better recovery programs will further transform laparoscopic surgery to become even safer, more accurate, and more commonplace.

The steps that they take after the surgery will have the greatest impact on how successful they are, so by knowing the procedure, heeding their surgeon advice, and being actively involved in their recovery, they can maximise their chances of success.

More Information

  1. Overby, D. W., Apelgren, K. N., Richardson, W., & Fanelli, R. D. (2010). SAGES guidelines for the clinical application of laparoscopic biliary tract surgery. Surgical Endoscopy, 24(10), 2368–2386. https://doi.org/10.1007/s00464-010-1268-7
  2. Buia A, Stockhausen F, Hanisch E. Laparoscopic surgery: A qualified systematic review. World J Methodol. 2015;5(4):238-254. doi:10.5662/wjm.v5.i4.238 https://www.wjgnet.com/2222-0682/full/v5/i4/238.htm
  3. American College of Surgeons. Laparoscopic Surgery Information for Patients. Available from: https://www.facs.org/for-patients/
  4. National Institute for Health and Care Excellence. Interventional Procedures Guidance. Available from: https://www.nice.org.uk/guidance
  5. National Library of Medicine. PubMed Database – Laparoscopic Surgery. Available from: https://pubmed.ncbi.nlm.nih.gov/?term=laparoscopic+surgery
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