Laparoscopy – General Surgery

Introduction – Laparoscopy

Laparoscopy is a minimally invasive procedure. The surgical procedure uses a thin, lighted tube (called as laparoscope) put through an incision in the stomach. It is used as a diagnostic tool and surgical procedure that is performed to examine the abdominal and pelvic organs, or the thorax, head, or neck. Laparoscopy helps to find problems like- cysts, adhesions, fibroids, and infection. Tissue samples can also be collected for biopsy using laparoscopy and malignancies treated when it is combined with other therapies. Laparoscopy can also be used for some cardiac and vascular procedures. In many cases laparoscopy can be done instead of laparotomy surgery that uses a larger incision in the stomach. Laparoscopy can be less stressful and may have fewer problems and lower costs than laparotomy for minor surgeries. It can often be done without needing to stay overnight in the hospital.

Objective of laparoscopy-

Laparoscopy is done to scan the abdominal and pelvic organs to detect certain conditions. Surgeries may be performed further based on the condition. Laparoscopy is commonly used in gynaecological cases to examine the outside of the uterus, the fallopian tubes, and the ovaries; particularly in pelvic pain cases.

Laparoscopy is done to-

  1. Verify and surgically remove, if required, the abnormal growths like- tumours in the abdomen or pelvic area.
  2. Test for and treat conditions such as ectopic pregnancy, endometriosis, or pelvic inflammatory disease (PID).
  3. Find conditions that can reduce the probability of a woman to get pregnant. These conditions include cysts, adhesions, fibroids, and infection. Laparoscopy may be done after initial infertility tests do not show the cause for the infertility.

Procedure-

  1. Generally, laparoscopy is done under general anaesthesia, although some laparoscopic procedures can be performed using local anaesthetic agents.
  2. Once after anaesthesia is induced, a urinary catheter is placed into the patient’s bladder for collection of urine.
  3. A small incision is made in the lower part of the abdomen, just below the navel, to begin the procedure and a cannula is inserted into the incision that allows laparoscope to enter inside.
  4. Few other small slits may be made in the abdomen to allow the insertion of additional laparoscopic instrumentation.
  5. A laparoscopic insufflation device is used to pump up the abdomen with carbon dioxide gas to create a space in which the laparoscopic surgeon can manoeuvre the instruments.
  6. After the laparoscopic diagnosis and treatment are completed, the laparoscope, cannula, and other instrumentation are removed, and the cut is sutured and bandaged.
  7. There are inbuilt cameras in the laparoscopes for transmitting images during the procedure.
  8. The images from the laparoscope are transmitted to a monitor that the surgeon uses to visualize the internal anatomy and conduct any surgical procedure.
  9. Robotic systems are available to assist with laparoscopy. A robotic arm, attached to the operating table may be used to hold and position the laparoscope. This serves to reduce accidental camera movement that is common when a surgery assistant holds the laparoscope. The surgeon controls the robotic arm movement by foot pedal with voice-activated command, or with a handheld control panel.
  10. Microlaparoscopy has become more common over the past few years. The procedure involves the use of smaller laparoscopes (that is, 2 mm compared to 5–10 mm for hospital laparoscopy), with the patient undergoing local anaesthesia with conscious sedation. Video and photographic equipment, previously explained, may be used.

The skills of surgeons will be enhanced as well with further development of training simulators and computer technology.
Laparoscopy has been explored in combination with other therapies for the treatment of certain types of malignancies, including pelvic and aortic lymph node dissection, ovarian cancer, and early cervical cancer. Laparoscopic radiofrequency ablation is a technique whereby laproscopy assists in the delivery of radiofrequency probes that distribute pulses to a tumor site. The pulses generate heat in malignant tumor cells and destroy them.

The introduction of items such as temperature-controlled instruments, surgical instruments with greater rotation and articulation, improved imaging systems, and multiple robotic devices will expand the utility of laparoscopic techniques in the future. The skills of surgeons will be enhanced as well with further development of training simulators and computer technology.

- Link of interest: General Surgery News on Facebook

This article is not medical advice nor a substitute to professional health advice. Always consult a doctor.

 

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