Laparoscopic Surgery

Laparoscopic surgery is a minimally invasive, video-guided technique that has revolutionized the field of surgery.  Instead of making a large incision through the skin and underlying muscles (laparotomy), a laparoscopic surgeon makes just a few tiny incisions, one for a long, narrow telescope with a camera attached, and two or three others for the instruments needed.  In pelvic laparoscopic surgery, the entry port for the camera is generally through the navel.  The entry ports for the instruments are generally just half-inch or smaller incisions in the groin area.

The procedure begins with the introduction of a gas, usually carbon dioxide, into the pelvic cavity to provide adequate working space.  Then the camera is inserted so that the surgeon can clearly see a magnified view of the pelvic organs.  Specially designed instruments enable the surgeon to perform all the delicate maneuvers needed to remove diseased tissue, introduce needed materials (such as mesh in cases of pelvic floor repair) and suture.

Because there is less trauma to the body, recovery is much faster than with traditional, open abdominal surgery, and there is less pain.  Patients can often get up and move around within a few hours of surgery.  Hospital stay is reduced to a day, if needed at all.  Many procedures can be done on an outpatient basis. 

Another advantage is reduced risk of infection, because tissues are not exposed as they are in open surgery.

Because it requires sophisticated equipment, laparoscopic surgery is expensive, and not all hospitals are able to offer it.  It also requires specialized training, even for surgeons who are experts at open surgery.  They must learn to transfer their skills at working in a three-dimensional situation to working from a two-dimensional video screen.  However, as more and more young surgeons who have grown up in the computer age enter the field, the supply of qualified laparoscopic surgeons will multiply.

Questions to ask your doctor
 

 If you need surgery for a pelvic disorder, it is appropriate to ask your doctor everything you need to know.  Most doctors welcome the chance to explain things to you, because an informed patient is a better patient.  Most doctors also welcome a second opinion to confirm their own conclusions.  Never be afraid to ask questions.

• What is causing my problem?
   
• Do we need to confirm this diagnosis with other tests? What are their side effects, risks and costs?
• What treatment do you recommend?
• Can my condition be treated with a minimally invasive surgical technique?
   
• What is the risk if we "wait and see?"
• Can you do this procedure, or do I need a specialist?
• How many patients have you treated for a condition just like mine?
• What are the success rates of this procedure?
• What are the possible complications, and how often do they occur?
• What will be involved in my recovery?
   
• What is the impact of this surgery on my ability to have children?
• Will this treatment affect my sexual function?
   
• What is the risk of recurrence of my condition?
   
• Should I get a second opinion?

References
 

1. American Society for Reproductive Medicine. Laparoscopy and hysteroscopy: A guide for patients. Patient Information Series 2006. www.asrm.org/Patients/patientbooklets/ laparoscopy.pdf
2. eMedicineHealth. Laparoscopy. www.emedicinehealth.com/laparoscopy/article_em.htm
3. Medina M. About laparoscopy and endoscopy: Laparoscopic surgery. Society of Laparoendoscopic Surgeons. 2004. http://www.sls.org/ | http://www.laparoscopy.org/

Reviewed:  March 2008.