Laparoscopic surgery, which has created a revolution in the field of surgery, is a type of minimally invasive surgery that allows the surgeon to perform operations without making large incisions in the abdomen. A lighted tube with a camera at its tip, called a laparoscope, is inserted into the abdomen through a small incision, often through the navel. The images transmitted from the camera are transferred to a TV monitor in the operating room and allow the surgeon to see inside the abdomen and perform the operation without making large incisions.
The procedure first begins with the application of a gas into the abdominal cavity to create sufficient working space inside the abdomen. Before the operation begins, the patient is always completely put to sleep under general anesthesia. A thin instrument called a Veress needle is inserted into the abdominal cavity through the navel, and the abdomen is inflated with carbon dioxide gas. Afterwards, a thin and long surgical instrument containing a camera inside, called a laparoscope, is inserted through a camera port placed via a small incision in the navel so that the surgeon can clearly see the enlarged view of the pelvic organs. If there is a problem that needs to be corrected after visualization of the abdomen, auxiliary surgical instruments are used. Depending on the need, 1 to 3 auxiliary ports that allow the passage of surgical instruments are usually placed by making smaller incisions in the groin area. These specially designed surgical instruments allow the surgeon to perform all the precise maneuvers required to remove diseased tissue and, when necessary, to place stitches.
After the operation is completed, the surgical instruments are removed and the gas inside the abdomen is released. The small incisions are closed. After the patient wakes up, they are sent to their room. For a few hours, the patient may feel sleepy and may experience some nausea due to anesthesia.
If the surgical procedure performed is a day-case laparoscopic surgery, the patient is kept in the hospital until they can stand up without assistance and urinate. Afterwards, they are usually discharged home on the same day with the help of a companion. If more complex surgical procedures such as laparoscopic hysterectomy have been performed, the patient may need to stay in the hospital for one night.
What should the patient expect during recovery?
For the first few days after the operation, the patient may feel a little tired and uncomfortable. There may be some pain around the small incisions on the abdomen and navel. The tube placed in the throat during surgery to help the patient breathe may cause a sore throat. Throat lozenges and gargling with salt water relieve the complaints. The patient may feel pain in the shoulder or back after surgery. This pain is caused by a small amount of gas remaining in the abdomen during the procedure. It goes away on its own within a few hours or days.
What are the benefits of laparoscopy?
Laparoscopic surgery has many benefits. Since it causes less trauma to the body, recovery is much faster compared to traditional open surgery and there is less pain after the operation. Patients can usually get up and move a few hours after surgery. Patients can return to their daily activities much more quickly, and the incision sites heal leaving less scar tissue. Many patients can go home the same day or the next morning.
Another advantage of laparoscopic surgery is that the risk of infection is reduced because the tissues do not come into contact with the external environment as they do in open surgeries.
Which surgeries can be performed with laparoscopy?
Tubal sterilization (tying of the tubes) is an example of surgeries that can be performed using laparoscopy. Laparoscopic surgery can also be applied for many gynecological conditions such as hysterectomy (removal of the uterus), endometriosis, fibroids, ovarian cysts, ectopic pregnancy, and uterine prolapse, which previously required large incisions.
Which problems can be diagnosed and treated with laparoscopy?
Laparoscopy can be used to investigate the cause of chronic pelvic pain, infertility, or a pelvic mass. If a problem is found, it can often be corrected during the same surgical procedure. Laparoscopy can also be used in the diagnosis and treatment of many medical conditions:
Endometriosis – If you have symptoms and signs of endometriosis and your complaints continue despite medical treatment, laparoscopy may be necessary. The laparoscope is used to visualize the inside of the abdomen. If endometriotic lesions are found, they can often be removed during the same surgical procedure.
Fibroids – Fibroids are lesions originating from the muscle layer of the uterus and can grow into or outside the uterine wall. Most fibroids are benign, but a very small portion may be malignant (cancerous). Fibroids can often cause pain or heavy bleeding. Laparoscopic surgery can often be used to remove fibroids.
Ovarian cysts – Some women may have cysts on their ovaries. Cysts can often disappear without treatment. If they do not disappear, they can be removed by laparoscopy.
Ectopic pregnancy – Today, laparoscopy is accepted as the gold standard treatment for the diagnosis and treatment of ectopic pregnancy.
Pelvic floor disorders – Laparoscopic surgery can be used in the treatment of pelvic floor disorders such as urinary incontinence and uterine prolapse.
Cancer – Treatments for some gynecological cancers such as endometrial (uterine) cancer can be performed with laparoscopic surgery.
Since laparoscopic surgery requires advanced equipment, it is more expensive compared to conventional surgery and not all hospitals can offer this possibility. In addition, surgeons need to receive special training in addition to their conventional surgical education in order to perform laparoscopic surgery. They need to learn how to transfer their three-dimensional working skills in conventional open surgery to working on a two-dimensional video screen. The learning curve is longer and it is a demanding process that requires special training, interest, willingness, and patience for surgeons.