Laparoscopy Health Article

Definition

Laparoscopy is a minimally invasive procedure used as a diagnostic tool and surgical procedure that is performed to examine the abdominal and pelvic organs, or the thorax, head, or neck. 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.

Purpose

Laparoscopy is performed to examine the abdominal and pelvic organs to diagnose certain conditions and—depending on the condition—can be used 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 cannot be determined using diagnostic imaging (ultrasound and computed tomography). Examples of gynecologic conditions diagnosed using laparoscopy include endometriosis, ectopic pregnancy, ovarian cysts, pelvic inflammatory disease [PID], infertility, and cancer. Laparoscopy is used in general surgery to examine the abdominal organs, including the gallbladder, bile ducts, the liver, the appendix, and the intestines.

During the laparoscopic surgical procedure, certain conditions can be treated using instruments and devices specifically designed for laparoscopy. Medical devices that can be used in conjunction with laparoscopy include surgical lasers and electrosurgical units. Laparoscopic surgery is now preferred over open surgery for several types of procedures because of its minimally invasive nature and its association with fewer complications.

Microlaparoscopy can be performed in the physician's office using smaller laparoscopes. Common clinical applications in gynecology include pain mapping (for endometriosis), sterilization, and fertility procedures. Common applications in general surgery include evaluation of chronic and acute abdominal pain (as in appendicitis), basic trauma evaluation, biopsies, and evaluation of abdominal masses.

Laparoscopy is commonly used by gynecologists, urologists, and general surgeons for abdominal and pelvic applications. Laparoscopy is also being used by orthopedic surgeons for spinal applications and by cardiac surgeons for minimally invasive heart surgery. As of 2003, procedures under investigation for possible laparoscopy included thyroidectomy and parathyroidectomy.

Demographics

At first, laparoscopy was only been performed on young, healthy adults, but the use of this technique has greatly expanded. Populations on whom laparoscopies are now performed include infants, children, the elderly, the obese, and those with chronic disease states, such as cancer. The applications of this type of surgery have grown considerably over the years to include a variety of patient populations, and will continue to do so with the refinement of laparascopic techniques.

Description

Laparoscopy is typically performed in the hospital under general anesthesia, although some laparoscopic procedures can be performed using local anesthetic agents. Once under anesthesia, a urinary catheter is inserted into the patient's bladder for urine collection. 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 may be made in the abdomen to allow the insertion of additional 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. After the laparoscopic diagnosis and treatment are completed, the laparoscope, cannula, and other instrumentation are removed, and the incision is sutured and bandaged.

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

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

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 anesthesia with conscious sedation (during which the patient remains awake but very relaxed) in a physician's office. Video and photographic equipment, previously explained, may be used.

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 destroys 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.