Laparoscopic surgery, also called laparoscopy or diagnostic laparoscopy, is a minimally invasive procedure that allows doctors and consultants to examine organs inside the abdomen. As a low-risk procedure, the only “surgery” involved with this procedure are small incisions that are made so any laparoscopy instruments can be used to look at the abdominal organs, such as a laparoscope, which is a long, thin tube with a high-intensity light and a high-resolution camera at the front. With this camera, images are sent to a video monitor so a doctor can see inside the body in real-time without the need of open surgery. Likewise, with different attachments to the laparoscope, a doctor can also obtain biopsy samples for further testing.
Laparoscopic surgery avoids large incisions on the skin and abdominal wall, which, apart from allowing it to be an outpatient procedure, prevent the intestines from being exposed to the open air during surgery. This has also allowed laparoscopy to replace open surgery as the preferred treatment for bariatric surgery, gastric bypass, bowel resection and gallbladder removal. Laparoscopy is also used to diagnose the source of pelvic or abdominal pain when routine, noninvasive methods like ultrasounds, CT scans and MRI scans do not provide enough information for an accurate diagnosis.
The Laparoscopy Process
More often than not, a doctor may recommend a laparoscopy to examine the following organs:
- Small and large intestine
- Pelvic and reproductive organs
After an examination, a doctor may be able to detect:
- An abdominal mass or tumor
- Fluid in the abdominal cavity
- Liver disease
- The effectiveness of a particular treatment
- The progression of a particular disease
- Inflammation of Organs
As a minimally invasive procedure, laparoscopy carries very small risks, with the most common risks being bleeding, infection and damage to organs in the abdomen. These are all rare in occurrence, though, and through proper sterile processing methods, infections, the most preventable of the risks, can be drastically reduced.
Although the risks are small, doctors may believe that they are too high in certain circumstances to warrant the benefits of a minimally invasive procedure. For example, if the patient has had prior abdominal surgery, which increases the probability of an adhesion forming between structures in the abdomen. In these instances, laparoscopic surgery will not only take longer, but will also carry increased risks of damage to the organs.
Preparing for a Laparoscopy
Because laparoscopy is usually an outpatient procedure, a patient will be able to go home after observation for any adverse reactions to the anesthesia or the procedure. For this type of procedure, general or local anesthesia may be used, which means that a patient may either sleep through the procedure (general) with an intravenous (IV) line inserted into a vein, or stay awake while a local anesthetic numbs the area (local). In either case, a patient will need to have someone with them to take them home afterwards because the effects of both may take a couple of hours to wear off. Apart for considerations due to anesthesia, a patient will also have to avoid eating and drinking for at least eight hours before a laparoscopy so the organs being examined can be free and clear of any potential blockage.
All laparoscopic instruments have to be narrow enough so they can fit through laparoscopic ports—sizes typically range from 3 mm, 5 mm, 10 mm and 15 mm—which means they have to be made of durable materials like high quality stainless steel that can remain intact throughout the laparoscopy process. Alongside a laparoscope, which can be described as a thin telescope fitted with a light source and a video camera on the end, a variety of tools with different tips and handles are used to precisely manipulate tissue (e.g. rotate and grasp) and inflate the abdominal region with inert gases like carbon dioxide to increase the distance between the organs and the abdominal wall.
Though common surgical instruments like hooks, needles and scissors are used during a laparoscopy, the most common laparoscopy-specific instruments you will encounter are:
- Needle Drivers
A laparoscope is a fiber-optic instrument attached with a light source and video camera that is inserted through the abdominal wall to view organs in the abdomen. Scopes with different diameters and tips are commonly used for different procedures, such as a larger scope that allows more light and leads to better image quality, and angled tips that allow for looking around corners or at the undersurface of the abdominal wall. After the video feed is sent to the monitor, a doctor can view it and possibly send it for additional processing, such as filtering, noise reduction, color adjustment and image enhancement.
Needle drivers, also called needle holders, are typically comprised of a long, narrow surgical steel shaft that is attached to a handle at one end, and a set of hinged jaws at the other end. The shaft is usually coated with an outer layer of non-conductive plastic or silicone, and most jaws are made from tungsten carbide with additional coatings applied to improve grip. In a laparoscopy, needle drivers are used to hold and manipulate needles during an operation, which enables free-hand suturing of wounds or surgical incisions. To achieve this, needle holders are comprised of three parts—the jaws, joints and handles—and, depending on the shape of the jaws, are classified as either straight or curved:
- Curved left
- Curved right
A trocar is a pen-shaped device with a sharp, triangular piercing stylus at one end that is used to create an opening in the abdominal wall, which is used as an access port during surgery. Most trocars are housed inside of a sleeve that is inserted and placed in the body after the piercing stylus has made the opening, which is then removed through an opening in the upper end of the device so the laparoscope and other instruments can be placed through.
In laparoscopic surgery, trocars have many uses, and are referred to as both an initial entry device and an operational device, as is the case when a hollow cannula is used inside the body to drain fluid. Trocars are also used to create pneumoperitoneum by inflating the abdomen with carbon dioxide, which functions to increase internal space between organs for better surgical instrument manipulation. This procedure, called insufflation, uses a gas-tight valve located at the top of the trocar to allow instruments to be inserted and removed during a procedure without letting any carbon dioxide escape.
Laparoscopic bowel graspers are grasping instruments designed to safely maneuver abdominal tissue during laparoscopic surgery, and are used during observation, excision and biopsy procedures. For example, they are used to hold bowel tissue clear of the operating field to facilitate access to the surgical site. If a grasped tissue must be maintained for a prolonged period of time, a locking mechanism is usually used to help reduce hand fatigue, which can be locked in a range of different positions, depending on the amount of pressure required. The instrument’s exterior is also coated with an electrically insulating layer of plastic or silicone to alleviate the risk of electrical burns during the application of electrosurgical energy.
Laparoscopic surgery is a widely accepted minimally invasive surgical technique used to examine the organs inside the abdomen. Because the incisions with this procedure are much smaller than those used for open surgery, recovery is faster and post-operative pain is lessened, making it a common outpatient procedure. Various forms of disposable laparoscopic instruments also exist because of the difficulty involved cleaning and sterilizing the many small parts that comprise these devices. Though more expensive than reusable instruments, disposable instruments are sometimes chosen to alleviate the sterile processing burden.