What is laparoscopic surgery?
Laparoscopic surgery is a way to perform operations using only very small incisions (cuts) into the skin. This type of surgery uses a thin rod-shaped instrument with a tiny camera on the tip, called a laparoscope. The laparoscope is put into the body and moved from the outside by the surgeon. The camera sends pictures to a screen. During the operation, the surgeon can see the organs inside the body on the screen.
Because this surgical technique does not require a big incision like traditional open surgery does, laparoscopy is often referred to as minimally invasive surgery.
Laparoscopy is used for many different types of surgery on the abdomen and pelvis. Depending on the type and reasons for the surgery, the laparoscopy may take several hours.
There are different reasons to perform laparoscopy
There are different types of laparoscopy:
- Laparoscopy to find out the cause of a problem or to provide more information after other tests are done is called a diagnostic laparoscopy.
- Laparoscopy to treat a problem is called an operative laparoscopy. Sometimes if a problem is found at a diagnostic laparoscopy, then it can be fixed at the same time. This means only one operation is needed, not two.
In general surgery, laparoscopy is done for the following reasons:
- appendectomy
- cholecystectomy (gallbladder removal)
- hernia repair
- spleen removal
- intestinal surgery
- fundoplication
- pyloromyotomy
In gynaecology, laparoscopy is done for the following reasons:
- treating ovarian cysts
- removing some ovarian masses
- diagnosing and treating ovarian torsion (twisting)
- evaluating chronic pelvic pain
- diagnosing and treating endometriosis
- evaluating infertility
- treating some ectopic pregnancies
Laparoscopy is not for everyone or for every situation
There are many other reasons laparoscopy might be performed. However, laparoscopy is not always right for everyone. It cannot always be done for every type of condition requiring surgery.
Your child's surgical team will discuss with you whether laparoscopy is right for your child's condition.
All surgeries have some risk
All surgeries have risks from infection, bleeding, the anesthetic and other problems. All steps are taken to reduce these risks.
Sometimes, though very rarely, organs and structures in the body can be injured during a laparoscopic surgery. If this rare situation occurs, the surgeon can usually repair the damage right away. Sometimes, if there is an injury, the little incisions have to be converted to a bigger incision so the surgeon can get a better look at the injury and fix it.
During a laparoscopic surgery
Like traditional open surgery, laparoscopy is done in the hospital. Your child will be prepared for surgery and will have to stop eating and drinking several hours before the procedure begins.
During the procedure, your child will be under general anesthetic. This helps make sure that your child will sleep through the procedure and will feel no pain.Your child's abdomen (belly) is filled with carbon dioxide gas (CO2). This lifts the abdominal wall like a dome. It gives the surgeon a better view of the organs inside the body. It also gives the surgeon more space to work inside the body.
Laparoscopic incision points
The surgeon makes a 1 cm incision (about half an inch) near the belly button for the laparoscope. Then the surgeon makes small 5 mm incisions (about a quarter inch each) in the corners of the abdomen. These incisions are for any other instruments that might be needed.
The number and exact location of the incisions depends on which type of surgery is being performed. If different incisions are being used, the surgical team will tell you ahead of time.
After the operation is finished, all the instruments are removed. The CO2 gas is removed from inside the body. Any remaining CO2 is absorbed and naturally processed by the blood. The surgeon closes the incisions with dissolving stitches and/or Steri-strips or a type of surgical skin adhesive. Steri-strips are little sticky tapes used to help hold together and protect the healing skin. If surgical skin adhesive was used this will dissolve on its own five to 10 days following the procedure.
After the laparoscopic surgery
Children usually recover faster from laparoscopic surgery than from traditional open surgery. Many patients go home the same day as the surgery, depending on the reason for the procedure. Because of the smaller incisions, scars are very small compared to traditional surgery.
Many children return to school after a few days.
Depending on the surgery, your child may take a little longer to return to all of their usual physical activities, such as contact sports. Ask the surgical team what activities your child can and cannot do in the days and weeks after the surgery including bathing and swimming instructions.
Following surgery, avoid ointments or creams as this may disrupt the healing process of the wound and cause the steri-strips or skin adhesive to fall off early. Speak with the surgical team about timing of applying any ointments/creams to the area.
All cuts will leave a small scar, that will fade over time. It is important to protect this scar from the sun, to prevent it from darkening. Sunscreen should be used for at least one year over the healed scar. Speak to your child’s surgeon about when it is appropriate to begin putting sunscreen on the scar.
Managing pain after the operation
Children usually have less pain after laparoscopic surgery than after traditional open surgery. If there is pain after the surgery, your child's surgical team may prescribe a pain medication or suggest that your child take a non-prescription pain medication such as acetaminophen or ibuprofen.
Your child's shoulders might be sore as the remaining CO2 gas from the operation is re-absorbed into the body. The gas can irritate the diaphragm, which is a muscle in the abdomen. Because the diaphragm muscle shares nerves with the shoulders, some children have sore shoulders after the surgery. This should go away within one to two days of surgery. Heat packs can often help with this pain.
Complications after laparoscopic surgery
All surgeries have a risk of complications. Monitor your child for the following symptoms:
- infection – fever (greater than 38C), redness to the incision, abnormal discharge, pain to the incision that is not getting better
- surgical wounds opening up
- trouble urinating
- trouble breathing
- vomiting
- pain that does not improve or gets worse
Following up after the operation
Your child’s health-care team will discuss with you what specific surgical follow-up is required.
When to seek medical attention after a laparoscopic surgery
Contact your child’s health-care provider or go to the emergency department if your child has any of the following signs or symptoms:
- signs of infection, such as fever (greater than 38C), redness, discharge, pain around the surgical sites that is worsening, foul odour
- the wound is opening up
- bleeding from the surgical cuts
- pain that is worsening in the area that was operated on
- abdominal distension
- vomiting