Type of Surgery
Information
Last updated: 11/24/2009
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.
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This video shows how the large intestine or colon is removed through laparoscopic surgery. The perspective is that of the surgeon performing the colectomy or colon resection. A note to viewers, this video shows surgery on an actual patient. The anatomical landmarks are not labeled, but described by the surgeon narrator.
This surgeon is performing a laparoscopic procedure on a patient. (Photo Researchers, Inc. Reproduced by permission.)
The surgeon has a choice of incision options for laparoscopy, depending on the needs of the procedure (A). In this abdominal procedure, carbon dioxide is pumped into the cavity to create a condition called pneumoperitoneum, which allows the surgeon easier access to internal structures. The laparoscope is connected to a video monitor, and special forceps are used to carry out any necessary procedure (C and D) (Illustration by GGS Inc.)
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Other Information
Laparoscopic surgery, also called minimally invasive surgery (MIS), bandaid surgery, keyhole surgery, or pinhole surgery is a modern surgical technique in which operations in the abdomen are performed through small incisions (usually 0.5-1.5cm) as compared to larger incisions needed in traditional surgical procedures. Laparoscopic surgery includes operations within the abdominal or pelvic cavities, whereas keyhole surgery performed on the thoracic or chest cavity is called thoracoscopic surgery. Laparoscopic and thoracoscopic surgery belong to the broader field of endoscopy.
Other Information
Biliary colic is the presenting symptom in 80% of patients with gallstone disease who seek medical care; however, only 10-20% of all individuals with gallstones experience severe gallstone pain.
From: eMedicine
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