Laparoscopy

Definition

Laparoscopy is a term given to a group of operations that are performed with the aid of a camera placed in the abdomen. Originally, laparoscopy was used for gynecological procedures such as tubal ligation.

This technique was then adapted for removal of the gallbladder (laparoscopic cholecystectomy) and the appendix (laparoscopic appendectomy). Additionally, exploratory laparoscopy has often been used for diagnostic purposes to view the abdomen after abdominal trauma and in cases of abdominal illness.

Now the laparoscope also allows physicians to perform minimally invasive surgery with just a small incision in the abdomen. This technology, known as laparoscopic assisted surgery, enables the minimally invasive removal of the colon or the kidney (for living donors in kidney transplants), and weight reducing procedures such as gastric bypass and vertical banding gastroplasty (VBG).

Finally, large operations such as liver and pancreatic resections may begin with laparoscopy to rule out the presence of additional tumors (metastatic disease) that would make it difficult to cure the disease through surgery. For complex laparoscopic operations, patients should consult with their primary health care provider to find a center of excellence in the specific operation.

How the test is performed

The procedure is usually done in the hospital, under general anesthesia, and after informed consent has been obtained. A catheter (a small flexible tube) is inserted through the urethra into the bladder. An additional tube may be passed through the nostril and into the stomach to remove intestinal contents (N-G tube). The skin of the abdomen is cleansed, and sterile drapes are applied.

A small incision is made above or below the navel to allow the insertion of a trocar (essentially a tube extending from inside the abdomen to the outside), which allows passage of a video camera. Prior to insertion of the trocar, a needle is inserted into the incision and carbon dioxide gas is injected to elevate the abdominal wall, and thereby create a larger space to work in. This allows for easier viewing and manipulation of the organs.

After an adequate amount of gas is instilled, the laparoscope is inserted, and the organs of the pelvis and abdomen are examined. Additional small incisions are made for instruments that allow the surgeon to move the abdominal organs, cut tissue, suture, and staple structures to safely and effectively perform the necessary procedure.

Following the examination, the laparoscope is then removed, the incisions are closed with sutures, and bandages are applied. Depending upon the operation performed, a drain may be left through one of the incisions to allow for removal of accumulated fluid.

How to prepare for the test