What Is Laparoscopic Surgery?

Laparoscopic surgery, also known as minimally invasive surgery, is a specialized technique in which surgical procedures are performed with the assistance of a video camera and several thin instruments. Many operations that were traditionally performed through a single large incision can now be accomplished through small keyhole incisions. This technique is now commonly used for gallbladder removal and for gynecologic surgery.

The surgery begins by inflating the abdomen with carbon dioxide gas to lift the abdominal wall away from the internal organs. This provides a viewing and working space for the surgeon. Several small (0.5-1.0 cm) incisions are made and hollow plastic cylinders called trochars are inserted through the abdominal wall. A laparoscope is then inserted into one of the trochars or ports. The laparoscope is a fiber-optic telescope that attaches to a video camera and allows detailed images of the abdominal organs to be transmitted to video monitors in the operating room. Long thin instruments are then inserted into the remaining ports. This technique allows the surgeon to perform the same operations as traditional “open” surgery, but through much smaller incisions.

For some operations, the surgeon may choose to use a special type of port that allows a hand to be inserted into the patient in order to gain a tactile sense during the procedure. This method is called “hand assisted” laparoscopy. Although the incision required for the hand port is larger than other laparoscopic incisions, it is still smaller then the incision used for open surgery.

What Are The Benefits Of Laparoscopic Surgery?
In general the benefits of laparoscopic procedures are:

• Less post-operative pain since the incisions are smaller
• Decreased use of post-operative pain medication
• Shorter hospital stays
• Quicker recovery times
• Earlier return to full activities
• Smaller scars

What Operations Can Be Performed Using The Laparoscopic Technique?
To date nearly all abdominal colorectal procedures have been performed using the laparoscopic technique. These include operations for diverticular disease, ulcerative colitis, Crohn’s disease, severe constipation, rectal prolapse, and cancer.

How Safe Is Laparoscopic Surgery?
Although any operation is associated with certain risks including complications related to anesthesia, bleeding, or infection, laparoscopic surgery is as safe as traditional open surgery. When laparoscopic colon surgery first began being performed for cancer, there were reports of increased cancer recurrence at the sites where the trochars had been placed. These reports prompted a landmark study which has since shown that recurrence rates were similar after laparoscopic colectomy and open colectomy. Thus, the laparoscopic technique is an acceptable alternative to open surgery for colon cancer.

Finally, it is important to point out that laparoscopic surgery cannot always be performed on everyone. Some patients with prior operations may have so much scar tissue within the abdomen that a safe laparoscopic operation cannot be done. If excessive scar tissue or other factors that prevent good visualization are encountered, the surgeon may need to make a larger incision in order to complete the operation safely.