Surgery isn't exactly something to look forward to, but you're likely to dread it less if the incision is smaller and the recovery time is quicker. Laparoscopy (laparoscopic surgery), also known as minimally invasive or "keyhole" surgery, is now the standard of care whenever possible these days. That's because it's just so much easier on the body than traditional open abdominal surgery.
It might surprise you to learn that this technique has been around for a very long time. Pioneering physicians Dimitri Ott, Georg Kelling and Hans Christian Jacobeus are some of the docs credited with exploring the potential for minimally invasive surgery way back in the early 1900s. As is often the case with major scientific developments, laparoscopy progressed slowly, with just some doctors daring to dabble in the practice, although usually for diagnostic, rather than surgical, purposes. Finally, the late 1980s, some physicians began performing successful laparoscopic cholecystectomy (gallbladder removal) procedures, inspiring scores of other surgeons to reevaluate the potential for this game-changing technique.
Nowadays, laparoscopy is the surgery style of choice for dozens of diagnostic and surgical procedures. Diagnostically speaking, laparoscopy is used to confirm a particular diagnosis or to figure out what's going wrong when X-ray, ultrasound and other non-invasive imaging efforts just aren't cutting it. Many painful gynecological conditions are diagnosed and/or treated using the method, including ectopic pregnancy, pelvic inflammatory disease, endometriosis and ovarian cysts.
On the surgical side, laparoscopy can be employed to remove problematic organs, like the appendix or gallbladder, and repair hernias and ulcers. Many patients turn to laparoscopy for hysterectomies and even weight-loss surgeries, and minimally invasive techniques are also helpful for suspected cancer biopsies.
How Laparoscopic Surgery Is Done
When it comes to surgery, size actually does matter. Laparoscopy usually involves small incisions ranging from 0.2-0.4 inches (0.5-1 centimeter), up to no more than about a half an inch (1.27 centimeters) in length. This is tiny compared with standard open surgery incisions of several inches, or even more! A tube-shaped instrument called a trochar is inserted into each incision, and it's through these devices (sometimes more than one is used) that other instruments can be inserted.
One of these is the aptly named laparoscope, which is a long, skinny device fitted with a tiny camera that broadcasts images on a screen, so that the surgeon can adequately see and navigate the area. The area is inflated using carbon dioxide gas to allow for better visibility when the surgery starts. Sometimes, additional incisions are necessary to be able to insert instruments like scissors or biopsy forceps, but those cuts are also very small in size.
So how do surgeons get an organ, like an appendix or gallbladder, out through those tiny incisions? We asked Dr. Gerald M. Fried, surgeon-in-chief at McGill University Health Center in Quebec to explain. "The appendix is usually small enough to bring either into a 10-12 mm [0.4-0.5 inch] diameter trocar which we usually place at the belly button," Fried says in an email interview. "Otherwise, we put the appendix in a plastic bag, remove the trocar and bring the appendix out through the incision. This sometimes requires mild stretching of the incision."
And the gallbladder? "[It] is bigger but is filled with liquid (bile). It is pear-shaped. We first pull out the narrower part of the 'pear,' then as we pull further the pressure pushes the liquid from the part of the gallbladder that is in the abdomen out into the portion that is outside the abdomen, allowing the remaining gallbladder to collapse and be removed. If the gallbladder contains stones larger than 12 mm, we use the bag and stretching technique described above, " he adds.
Risk vs. Reward of Laparoscopy
The success rates and reduced pain associated with minimally invasive surgery have turned laparoscopy into the preferred surgical method whenever possible. It produces less bleeding, less pain and scarring, as well as shorter hospital stays than regular surgery, according to studies. It's also associated with a lower infection risk, which is key because surgical site infection is linked to higher risk of death, as well as lengthier hospital stays and associated costs.
Amanda Marshall, a customer service representative in Brookhaven, Georgia would definitely choose laparoscopy over the more typical surgery, having experienced both. "Laparoscopic was significantly easier. The only discomfort I felt were gas pains in my shoulders and back immediately following but it couldn't even be considered 'pain,'" she recalls, noting that she had surgery on Thursday, spent the night at the hospital, and was back to work on Monday. "I never had any discomfort that couldn't be managed with Advil or Tylenol."
Laparoscopy isn't totally without risk, though. Often, the surgeries take longer to perform than traditional surgeries, which means that patients are under anesthesia longer, and therefore at greater risk of complications. Other possible problems can include infection, internal bleeding, hernia and/or bleeding at incision sites, and even damage to internal organs or blood vessels.
Not everyone is a prime candidate for laparoscopy, however. Fried notes that the technique is not advised for unstable trauma patients because bleeding can cover the lens and make visualization impossible. He also says that people with extensive prior abdominal surgeries are typically not candidates.
"In these cases scarring (adhesions) from the previous surgery may make it difficult or impossible to appropriately view the abdominal contents to do the surgery safely," he explains. Large tumors that require bigger incisions for removal will also exclude laparoscopy as an option.