Although the incisions made to introduce the surgical instruments are very small (approximately 1 cm each), laparoscopy requires general anesthesia.
The results are more than satisfactory, since, compared to traditional surgery, post-operative recovery is very fast and the risks of complications are very low.
of a patient, without resorting to the large incisions required by traditional open surgery.
In fact, laparoscopy involves making a small number of small incisions, necessary to introduce a particular instrument, the laparoscope, and any other surgical tools.
WHAT IS THE LAPAROSCOPE?
The laparoscope is the main and most representative instrument of laparoscopy.
Figure: a laparoscope. From the site: chinamedevice.com
Similar to a drinking straw, at the end to be inserted inside the organism it has a network of optical fibers, which act as both a light source and a camera. Everything that is illuminated and captured by the laparoscope is projected in real time. on a monitor, so that the surgeon can orient himself inside the abdomen (or pelvis) and can perform the surgery correctly.
ADVANTAGES OF LAPAROSCOPY
Compared to "open" surgery, the reduced invasiveness of laparoscopy provides several advantages:
- A shorter hospitalization (usually one night only) and faster recovery
- Less pain and less blood loss after the operation
- Less noticeable scars
WHAT KIND OF ANESTHESIA DO YOU EXPECT?
Although it is a minimally invasive method, laparoscopy requires general anesthesia. Therefore, the patient will be sedated and rendered completely unconscious for the duration of the operation.
and / or ultrasound. However, it may happen that these harmless procedures for the patient provide unclear or comprehensive results. In such situations, therefore, it is possible that the doctor is forced to resort to surgery.Diagnostic laparoscopy is used only in extreme cases, since, despite being minimally invasive, it is still a surgical procedure; it requires in fact an "anesthesia, the incision of the skin, a particular preparation, a post-operative phase, etc."
Thanks to diagnostic laparoscopy it is possible to identify the following morbid conditions:
- Pelvic inflammatory disease. It is an acute or chronic inflammatory process that affects the woman's reproductive organs and adjacent structures. It may be due to various infectious agents present in the female genital area, including Chlamydia trachomatis, Mycoplasma hominis And Neisseria gonorrhoeae.
- Endometriosis. It is a disease characterized by the presence of endometrial tissue outside its natural location, ie the uterus.
- Ectopic pregnancy. It is the medical term for pregnancy that occurs outside the uterus (ectopic ectopic pregnancy) or in an inadequate location of the uterus (ectopic intrauterine pregnancy).
- Ovarian cyst. It is a small sac filled with fluid that forms inside or on the surface of the ovaries.
- Uterine fibroma. It is a benign tumor that forms inside or on the surface of the uterus
- Female infertility.
- Cryptorchidism. It is the medical term for the failure of one or both testicles to descend from the abdominal cavity to the scrotum.
- Appendicitis. It is the inflammation of a small section of the large intestine, called the appendix.
- Abdominal and / or pelvic pain for no apparent reason.
- Malignant tumors of the abdominal / pelvic organs. The possible organs affected are: liver, pancreas, kidneys, ovaries, bile duct and gallbladder.
Diagnostic laparoscopy and tumors
In the case of cancer, diagnostic laparoscopy offers the possibility of taking a small sample of cells from the diseased organ to be analyzed later in the laboratory (biopsy).
If the surgeon finds a problem that can (or must) be solved immediately, the diagnostic laparoscopy can become, during the same session, also therapeutic.
THERAPEUTIC LAPAROSCOPY
Using laparoscopy, the surgeon can perform various surgeries, such as:
- Remove the inflamed appendix.
- Remove the gallbladder (cholecystectomy) if it has gallstones.
- Remove a section of intestine that is heavily inflamed and does not improve with any type of less invasive treatment. This happens, for example, in the case of Crohn's disease or diverticulitis.
- Perform a hernial surgery. A classic example is inguinal hernia surgery.
- Stop the bleeding caused by a gastric ulcer.
- Remove portions of fatty tissue, to reduce an individual's body weight.
- Remove an organ, or parts of it, that has a malignant tumor
- Remove the embryo from a pregnant woman suffering from ectopic pregnancy.
- Remove one or more uterine fibroids.
- Removes the uterus (hysterectomy), in cases of pelvic inflammatory disease, endometriosis, etc.
Clinical cognitive checks are used by the doctor to establish whether the patient can safely undergo laparoscopy. Specifically, these exams consist of:
- A thorough physical examination
- An evaluation of the medical history (illnesses suffered in the past, any allergies to anesthetic drugs, medicines taken at the time of the checks, etc.)
- A "complete blood test
- An electrocardiogram
In fact, they are the classic checks that are carried out before any surgery in which an anesthesia is also provided (it does not matter, whether local or general).
INFORMATION ON INTERVENTION METHODS
Once the clinical cognitive checks have been completed, the patient is informed about what the intervention involves, what is the duration of the entire procedure, what anesthesia is expected and how long the healing phase usually lasts (NB: except for anesthesia, which is always of a general type, the other parameters also vary according to the causes for which laparoscopy is required).
It is at this moment that the patient is invited by the medical staff or by the surgeon himself to remove any doubts or fears regarding the operation.
PRE- AND POST-OPERATIVE RECOMMENDATIONS
In order for the entire operation to proceed smoothly, the patient is obliged to:
- Before laparoscopy, stop any drug intake based on antiplatelet agents (aspirin), anticoagulants (warfarin) and anti-inflammatory drugs (NSAIDs); these drugs, in fact, reduce the coagulation capacity of the blood predisposing to severe blood loss.
- On the day of laparoscopy, go to complete fasting for at least the previous evening, as general anesthesia is required.
- After the surgery, be accompanied home by a family member or friend, because the patient will not be self-sufficient. In addition, driving a few hours after anesthesia is considered very dangerous.
Figure. representation of a therapeutic laparoscopy operation in this image taken from the site: gmchospital.com
At this point, if laparoscopy is therapeutic, the surgeon makes a second incision (similar in size to the first) and then introduces the surgical instruments necessary to treat the disease or health problem in progress.
The site of the second incision depends on the type of operation and the location of the organ to be treated.
If needed, the surgeon could make a third incision.
CONCLUSIVE PHASES OF THE OPERATION
In the final stages of laparoscopy, the surgeon removes the carbon dioxide blown into the abdominal cavity and pelvis, closes the incisions with sutures and applies a bandage to the wounds to protect them from any infections.
DURATION OF LAPAROSCOPY
The duration of laparoscopy depends on the purpose of the procedure; the diagnostic one lasts between 30 and 60 minutes, while the therapeutic laparoscopy is much longer the more complicated the operation is.
What does general anesthesia consist of?
General anesthesia involves the use of anesthetics and pain relievers, which make the patient unconscious and insensitive to pain.
The administration of these drugs, carried out intravenously and / or by inhalation, takes place before and for the entire duration of the surgery.
At the end of the operation, the anesthetist (or a doctor specialized in anesthesia practices) interrupts the drug treatment, to allow the patient to regain consciousness.
A VARIATION TO THE CLASSIC LAPAROSCOPY: ROBOTIC LAPAROSCOPY
Recently, experts working in the medical technology sector have designed and made available to surgeons a robotic instrument, with which it is possible to perform even more precise and even less invasive laparoscopy operations.
Figure. equipment for robotic laparoscopy interventions. From the site: orlandohealthdocs.com
This instrument, which responds to the commands of a special console, consists of an exploratory camera and a series of mechanical arms, which effectively replace the surgeon's hands.
These symptoms should not worry, because they disappear, without any treatment, within a few days: the carbon dioxide is, in fact, absorbed by the body and expelled with breathing.
HEALING TIMES
Healing times depend on:
- The purpose of laparoscopy
And
- The state of health of the patient
If the laparoscopy was only diagnostic, the return to normal activities can take place even after a week (N.B: in these cases, much obviously depends on what the laparoscopic examination found).
If, on the other hand, the laparoscopy was therapeutic, recovery times vary according to the type and severity of the operation: for example, in the case of simple appendicitis, healing occurs in about 2 weeks, while, in the case of ovarian cancer , it can also occur after 12 weeks. Therefore, the more serious the pathology for which laparoscopy is required, the longer the post-operative phase will be.
IN THE PRESENCE OF WHICH DISORDERS SHOULD YOU CONTACT THE DOCTOR?
The patient should contact their doctor if they feel:
- Fever above 38 ° C
- Chills
- Abdominal pain which, rather than subsiding, gets worse
- Redness, pain, swelling and discharge of pus at the wounds
- Pain and swelling in one of the two legs
- Burning and painful sensation while urinating
SERIOUS COMPLICATIONS
The most serious complications that laparoscopy can lead to are:
- Damage to an abdominal / pelvic organ (intestine, bladder, etc.) resulting in loss of its functionality.
- Damage to one of the major arterial vessels (eg the descending aorta).
- Severe allergic reaction to the anesthetic used.
- Formation of blood clots within the veins (deep vein thrombosis) and their transfer to the blood vessels leading to the heart (pulmonary embolism).
- Adverse reaction to the presence of carbon dioxide inside the abdomen.
- Formation of severe intra-abdominal adhesions (or adhesions). Intra-abdominal adhesions are bands of fibrous tissue that are created as a result of the healing process, and which affect the normal anatomy of the internal organs. In fact, they are internal scars located in the points where the surgeon intervened.
When such problems arise, it is very common for a surgical repair to follow laparoscopy.
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