Laparoscopy Health Article

Definition

Laparoscopy is a minimally invasive surgical proce dure performed to examine the abdominal and pelvic organs.

Purpose

Laparoscopy is performed to directly examine the abdominal and pelvic organs to diagnose certain conditions and—depending upon the condition—to perform surgery. Laparoscopy is commonly used in gynecology to examine the outside of the uterus, the Fallopian tubes, and the ovaries—particularly in pelvic pain cases where the underlying cause of pain cannot be determined using diagnostic imaging (e.g., ultrasound; computed tomography). Gynecologic conditions diagnosed using laparoscopy include endometriosis, ectopic pregnancy, ovarian cysts or tumors, pelvic inflammatory disease, pelvic abscess, infertility, uterine fibroids, and cancer. Laparoscopy is used in general surgery to examine abdominal organs such as the gallbladder, bile ducts, liver, appendix, and intestines (external surface). Laparoscopy can identify appendicitis, cholecystitis, cirrhosis, hernias, ascites, and abdominal cancers.

During the laparoscopic procedure, certain conditions can be treated surgically using special laparoscopic instruments and devices designed to be used with laparoscopes. For example, appendectomy, cholecystectomy, biopsy of the ovary or liver, hernia repair, and removal of endometriotic tissue or cysts can all be performed laparoscopically. Medical devices that can be used in conjunction with laparoscopy include surgical lasers and electrosurgical units. Other procedures that can be performed laparoscopically include hysterectomy, oophorectomy, tubal ligation, and lymphadenectomy. Laparoscopic surgery is now preferred over open surgery for several types of procedures due to its minimally invasive nature and associated lower complication rate.

A relatively new development is microlaparoscopy performed in the physician's office using smaller laparoscopes. Common clinical applications in gynecology include pain mapping (e.g., endometriosis), and sterilization and fertility procedures. Common applications in general surgery include evaluation of chronic and acute abdominal pain (e.g., appendix), basic trauma evaluation, biopsies, and evaluation of abdominal masses.

Laparoscopy has been most commonly used by gynecologists, urologists, and general surgeons for abdominal and pelvic applications. In addition to expanding applications in these areas, laparoscopy is now being used by orthopedic surgeons for spinal applications and by cardiac surgeons for minimally invasive heart surgery.

Precautions

Patients should be carefully screened for allergies to anesthetic agents used for laparoscopy. Obese patients, very thin patients, and patients with abnormal anatomy have a higher risk of complications, and laparoscopy should be performed with caution in these patients. Preoperative imaging examinations may be helpful to visualize any anatomical abnormalities. Some daily medications, such as blood thinners or arthritis medications, may need to be stopped for a certain time period prior to the procedure. Any medications taken on a regular basis, including over-the-counter medicines, should be discussed with the physician and anesthesiologist. Patients who have had prior abdominal surgical procedures may have resulting scar tissue that would interfere with laparoscopy; thus, these patients are usually not considered good candidates for laparoscopic procedures.

Description

Laparoscopy is typically performed in the hospital under general anesthesia, although some laparoscopic procedures can be performed using local anesthesia. Once the patient is under anesthesia, a urinary catheter is inserted to collect urine during the procedure. To begin the procedure, a small incision is made just below the navel and a cannula or trocar is inserted into the incision to accommodate the insertion of the laparoscope. Other incisions (one or two) may be made in other areas of the abdomen to allow for insertion of other laparoscopic instrumentation. A laparoscopic insufflation device is used to inflate the abdomen with carbon dioxide gas to create a space in which the laparoscopic surgeon can maneuver the instruments.

Laparoscopes, which have integral cameras for transmitting images during the procedure, are available in various sizes depending upon the type of procedure being performed. The images from the laparoscope are transmitted to a viewing monitor, which the surgeon uses to visualize the internal anatomy and guide any surgical procedure. Video and photographic equipment are used to document the procedure.

After laparoscopic diagnosis and treatment are completed, the laparoscope, cannula, and other instrumentation are removed, and the incision is sutured and bandaged.

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 in order to reduce unintentional camera movement that is common when a surgical assistant holds the laparoscope. The surgeon controls the robotic arm movement by foot pedal, voice-activated command, or handheld control panel.

Microlaparoscopy has become more common over the past few years. This procedure involves the use of smaller laparoscopes (e.g., 2 mm compared to 5 to 10 mm for hospital laparoscopy) with the patient undergoing local anesthesia with conscious sedation in a physician's office. Video and photographic equipment used are similar to that used for general laparoscopy.