2012-09-25 16:45:00
Laparoscopy is a less traumatic surgical procedure than a conventional procedure. He can be diagnostic or operative. It is often used to diagnose or treat gynecological or digestive diseases.
Definition: what is laparoscopy or laparoscopy?
Laparoscopy, also called laparotomy or laparoscopy, is “a surgical technique allowing access the inside of the abdomen through small incisions in the abdominal wall », defines Health Insurance (source 1).
“This technique, invented in France by Prof. R. Palmer then developed by MA Bruhat and his team, was a real technological revolution », explains the National College of French Gynecologists and Obstetricians (CNGOF) (source 2). Laparoscopy has many advantages, including a reduction in the duration of hospitalization, convalescence, postoperative pain and the risk of infection. On the aesthetic level, it limits abdominal scars.
Laparoscopy is an act performed to diagnose or treat certain diseases, in particular gynecological or digestive. Other small openings are also made to allow instruments to pass and perform surgical procedures, in several areas and for different pathologies.
Laparoscopy and laparotomy
Unlike laparoscopy, laparotomy involves opening the abdomen either through a vertical incision (often from below the navel to the pubis) or through a horizontal incision above the pubis.
Indications for laparoscopy: why perform this operation?
This surgical endoscopy technique makes it possible to poser un diagnostic what to take samples and/or to operate on numerous organs such as the gallbladder, appendix, colon, small intestine, ovaries, uterus, kidney, bladder, prostate, lungs and even the heart…
Gynecological indications
In gynecological surgery, most surgeries can be performed by laparoscopy, writes the CNGOF. The main indications are:
- Ectopic pregnancy (GUE);
- Endometriosis: a laparoscopy may be necessary to confirm the diagnosis evoked by the imaging examinations;
- Infertility : “When a couple is unable to conceive within a certain time, it may be necessary to perform a laparoscopy to explore the pelvis”indicates the CNGOF;
- Pelvic infection : “When salpingitis (tube infection) or pyosalpinx (tube abscess) is suspected, it is advisable to do a laparoscopy to confirm the diagnosis, and take samples to treat the infection as well as possible”, recommends the CNGOF;
- Fibroma : “myomectomy (removal of fibroids) can be performed by laparoscopy in patients with a desire for pregnancy and one or more fibroids located in the thickness of the uterine muscle” ;
- Kystectomie (removal of an ovarian cyst);
- Ovariectomie (removal of the ovary) or adnexectomy (removal of the ovary and fallopian tube);
- Hysterectomy (removal of the uterus);
- Promontofixation (treatment by laparoscopy of organ descent);
- Pelvic and lumboaortic dissections.
Other indications
Laparoscopy is also used in the following specialties, adds the Health Insurance:
- Digestive Surgery (in case of acute appendicitis, cholelithiasis, acute cholecystitis, inguinal hernia, etc.);
- Obesity surgery ;
- urologists (treatment of an undescended testicle or urinary tract abnormality);
- Cancerology (treatment and monitoring of certain cancers).
Are there risks and contraindications to this surgery?
As with any intervention, risk of infection or bleeding (very rare perforation accidents) exist. Laparoscopy can be contraindicated in cardiovascular disease. It can also lead to a conventional procedure for technical or anatomical reasons.
How is a laparoscopy performed?
This technique requires a great experience and an deep general anesthesia, because it is longer than a classic intervention. It can last from 20 minutes to several hours.
You are taken to an operating theater equipped with anesthetic monitoring devices, and anesthesia is performed. The practicing surgeon small holes (2 to 4) in the abdomen using rigid metal gutters (trocars). This is to introduce optical and surgical instruments. “Through this small orifice, he introduces a fine hollow needle into the abdominal cavity. Carbon dioxide passes through the needle, and the wall of the abdomen rises”describes the health insurance.
The abdomen is therefore inflated with carbon dioxide : three to four liters of gas are insufflated through one of the trocars to inflate the belly and create a ” workspace “.
A mini camera a few millimeters in diameter is inserted into the abdomen through the same incision. The orifice through which the tube passes, surmounted by a mini-camera, is, if possible, made in the umbilicus. I’camera magnifying effect allows observation and precision of the surgical gesture. The surgeon then works with his eyes riveted on a screen which retransmits the image. He can resort to therobotic assistancewho him makes it possible to improve his operating gesture (sitting at a control console, he remotely directs the movements of the robot which simultaneously reproduces the same operating gestures).
At the end of the intervention, the blown air is withdrawnthe carbon dioxide is evacuated, et the small skin openings closed.
To note : most often, a urinary catheter is placed at the beginning of the intervention and then removed the same day or the next day.
Does a laparoscopy hurt?
The operation itself is not not painful because it is performed under general anesthesia. But postoperative pain can sometimes occur, even if they less compared to a traditional intervention.
What are the postoperative consequences of laparoscopy?
The duration of hospitalization depends on the nature of the laparoscopy and the procedure performed. Leaving the hospital is usually quite fast, the same evening or the next day.
Postoperative pain (gas, swollen stomach, etc.)
Some postoperative pain may appear, mainly related to the presence of residual gas which irritates the peritoneum. In particular, we see painful phenomena, mainly at the abdominal level but which can extend to the shoulders”, indicates the CNGOF. Among them, bloating, gas, disturbed transit. These problems can last for a few hours or even days. The gas usually resolves within one to three days after the operation. Of the strong painkillers are prescribed for pain.
The scars
The small openings that were used to operate on you heal in about a week. Due to the mini-incisions, the scars are more aesthetic. There is no large visible scar.
Possible postoperative complications
After returning home, if abdominal pain resistant to simple analgesics, bleeding, fever, malaise, cessation of transit, red spots around the scars or any other abnormality appear, it is essential to consult or inform the surgeon.
Returning home and recovery after laparoscopy
After a laparoscopy, you need rest. A work stoppage is prescribed, which can vary from one to three weeks. The day after the operation, you can take a shower. On the other hand, it is recommended to wait a week before taking a bath.
When to make love again after laparoscopy?
You must not have sexual relations or make substantial physical efforts (carrying heavy loads, playing sports, etc.) during two weeks after the operation.
When do we get the results?
Before your departure, the surgeon gives you the first laparoscopy results and the operating report, indicates the Health Insurance. You fix together a follow-up appointment (monitoring of proper healing, communication of any results of analyzes or a biopsy).
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