Over the past 15 years technology has radically changed the way many surgeries are performed. Many elective and emergency surgeries can now be performed laparoscopically.
Laparoscopic or “minimally invasive” surgery is where the surgeon makes a very small incision, often in the patient’s belly button, and uses this incision to insert a camera, called a laparoscope, into the abdominal cavity. The surgeon then looks at a television screen to perform the operation. Carbon dioxide, a nontoxic and odorless gas, is then used to create an air pocket within the abdomen for the surgeon to operate.
Depending on the operation, one or more additional incisions, less than a half-inch in size, are made to insert surgical instruments into the abdomen to perform the procedure. The incisions are then usually closed with stitches that dissolve so that patients don’t have to go through the discomfort of having stitches or staples removed.
THE ADVANTAGES
There are many advantages of laparoscopic surgery compared with traditional surgery, which is performed through large incisions. Patients have much less discomfort and require less pain medicine. They are able to get up and walk around sooner and get back to their regular activities earlier. With long incisions, patients are usually restricted in their activities when they go home to prevent developing a hernia at the incision site. Hernias rarely occur at laparoscopic incision sites, so patients can exercise and lift a lot earlier. They are also less likely to develop wound infections because the incisions are so small. Because patients are able to get out of bed sooner they are less likely to develop blot clots or pneumonia than with traditional surgery. Patients undergoing bowel surgery are able to drink and eat earlier than in the past. After the incisions have healed the scars are almost invisible so patients don’t have to feel self-conscious at the beach or pool.
Many procedures are now done on an outpatient basis or with only an overnight stay. For example, gallbladder removal used to be performed through a six-to-eight inch incision. Afterwards patients would often have a tube through their nose into their stomach until the next morning and would be in the hospital four or five days. In contrast, hundreds of patients in
THE DISADVANTAGES
There are not many disadvantages. Laparoscopic surgery requires that patients undergo a general anesthetic or be “put to sleep,” which means patients are hooked to a breathing machine during surgery. This may cause a sore throat after the operation.
Sometimes patients have nausea from the anesthesia medicines. Most procedures done laparoscopically require general anesthesia for the open type of operation as well. However patients with certain problems, such as small hernias, may choose to have open surgery to avoid general anesthesia. Overall, patients have much less pain. Occasionally, patients may get air pockets under the diaphragm – the muscle between the chest and abdominal cavity. These pockets of air may cause neck and shoulder pain, which can be uncomfortable. Some patients complain of feeling bloated after this type of surgery. Usually, the pain associated with air pockets and sensation of bloating improves in the two to three days after surgery.
TYPES OF PROCEDURES
Many different operations are now done laparoscopically. The most common surgeries are removal of the gallbladder and appendix and hernia repair. Surgeons are also now able to use minimally invasive technology for removal of the spleen, colon, kidney, uterus, ovaries and prostate gland. Severe reflux and obesity are also treated laparoscopically. Most women having their “tubes tied” undergo laparoscopy.
Although most of these operations can be safely performed through small incisions, patients and their doctors need to be prepared to convert to an open operation if needed due to problems encountered during the operation. This may occur if the patient has unusual anatomy, bleeding, infection or if for any reason the surgeon thinks it is the safest choice.
CAN ANYONE HAVE LAPAROSCOPIC SURGERY?
Most patients can safely undergo laparoscopic procedures. In patients with severe heart or lung disease some procedures may be more safely performed without general anesthesia. Consequently, these patients may have certain operations done with heavy sedation, numbing medicine and an open incision instead. Obesity is not a contraindication for laparoscopic surgery. In fact, this type of procedure is often easier on these patients than open surgery. Patients who have had multiple prior operations may not be candidates for minimally invasive surgery due to scar tissue, which can build up after surgery and make it difficult to safely do laparoscopic procedures. Your surgeon is the best person to determine if a particular operation should be done with traditional or laparoscopic surgery.
Carolyn S. Day, M.D. is a practicing general surgeon in
