Thanks to the possibilities offered by modern medicine, many operations are performed much faster, safer and more comfortably today. Laparoscopy, which is one of the techniques that allows this; It can be preferred in many abdominal operations with the advantages of smaller incisions, less risk of complications and faster recovery time. Laparoscopy, which can be used for diagnostic purposes as well as treatment, is popularly known as closed surgery. In these operations, where the inside of the abdomen can be viewed with the help of an illuminated camera, the surgical procedure is one of the minimally invasive (minimal damage to tissues) surgery types. Today, diagnosis and surgical treatment applications can be performed for many diseases related to gynecology, gastroenterology, oncology and many other medical branches.
What is laparoscopy?
Laparoscopy is a surgical technique that allows surgeons to reach the abdominal cavity and pelvis without making large incisions on the skin. Laparoscopy, also known as minimally invasive surgery or the keyhole technique, is performed with the help of devices called laparoscopes. Laparoscope is an illuminated thin tube with a high-resolution camera at its tip and allows the abdomen or inside of the pelvis to be easily seen. The images obtained from the camera are reflected on a monitor and the surgeon can follow and perform the operations on this monitor. In addition to the laparoscope, which allows the view of the inside of the body, the desired procedures can be performed in the abdomen with the help of a few tube-like devices. Under normal conditions, a large incision is required to see the inside of the abdomen clearly with the open surgery method, whereas laparoscopy technique requires only a few incisions of 1-1.5 cm in size. It also brings great advantages in terms of complication risk, recovery time, postoperative scar formation. This method, which was previously preferred only for gallbladder surgeries and gynecological surgeries, is now preferred for diagnosis and treatment for the liver, intestines and many other organs.
Why is laparoscopy done?
Laparoscopy technique can be used in the diagnosis and treatment of many diseases that develop in the abdomen or pelvis. Especially gynecology, urology and gastroenterology units are among the medical units that use laparoscopy technique frequently. Some of the situations where laparoscopic operations are commonly preferred are as follows:
• Removing a diseased or damaged organ
• Gallbladder operations
• Removal of cysts and fibroids
• Removal of appendicitis (appendectomy)
• Removal of part of the intestine due to diseases such as diverticulitis, ulcerative colitis
• Treatment of stomach ulcers
• Partial or complete removal of organs such as the prostate, kidney, and bladder
• Termination of ectopic pregnancy
• Treatment of hernias
• Pelvic inflammatory disease (PID) and endometriosis treatment
• Removal of the uterus (hysterectomy)
• Taking tissue samples (biopsy)
Apart from the treatment, laparoscopy technique can be used in the diagnosis phase. Imaging methods such as ultrasound, magnetic resonance (MRI), computed tomography (CT) are sufficient for most of the investigations on diseases in the pelvis and abdominal cavity. However, in some cases, the only way to confirm the diagnosis is by laparoscopy. Diagnostic laparoscopy may be required in cases such as pelvic inflammatory disease, endometriosis, ectopic pregnancy, ovarian cysts, undescended testicles, fibroids and unexplained female infertility and abdominal pain. In addition, laparoscopy technique can be used in the diagnosis of cancers of the pancreas, liver, ovaries, bile duct and gall bladder.
How is laparoscopy performed?
Laparoscopy is a type of operation performed under general anesthesia. Patients are evaluated before the operation in terms of compliance with anesthesia. 12 hours before the operation time, the patient should stop eating and drinking water. In addition, individuals who use blood thinners are also asked to stop using these drugs a few days before the operation. When starting the operation, one or more holes are made in the abdominal wall by the surgeon. A laparoscope, a tube used to inflate the abdomen with carbon dioxide and small surgical instruments are inserted through these holes. In laparoscopic operations, the inside of the abdomen is inflated using carbon dioxide gas to achieve a better view and range of motion. Then, the necessary examinations and treatments are carried out with the help of tools placed using incisions. When the operation is completed, the carbon dioxide gas in the abdomen is evacuated, the tools are removed, the incisions are stitched and the dressing is made. In laparoscopic surgery applied for diagnostic purposes, the procedure time is usually in the range of 30-60 minutes. In laparoscopy for treatment purposes, the duration of the operation varies according to the applications to be performed. Patients are usually discharged on the same day or the next day. Since laparoscopic surgery is a minimally invasive (less harmful) operation, the risk of complications is much lower than open operations. However, since it is a surgical procedure, complications such as infection, bleeding and bruising around the incisions, nausea and vomiting due to anesthesia can be seen, albeit rarely. Because of such possibilities, patients are usually kept under 24-hour observation. In some patients, antibiotic treatment may be preferred in response to the risk of infection.
How is the recovery process after laparoscopy?
Recovery time is much shorter in laparoscopic surgery compared to classical surgical technique. Due to the application of general anesthesia, symptoms such as nausea, vomiting and feeling weak may be seen in patients in the first hours. For this reason, patients are usually kept under the supervision of a nurse for a few hours. Before leaving the hospital, the patient is given the necessary information by the physician about the medications to use, the actions to avoid and other issues to be considered. Nowadays, self-melting sutures are generally used in the stitches of the incisions made during laparoscopy. For stitches that are not made in this way, an appointment is made to remove the stitches after a certain period of time. Sore throat can be seen in the first few days after the operation. This is because the breathing tube used during general anesthesia irritates the throat. In addition, there may be pain and discomfort in the areas where the incisions are located. Due to these possibilities, pain medication is usually prescribed by the physician. Patients who experience problems such as fever, severe abdominal pain and vomiting, abnormal vaginal discharge, itching, swelling and discharge around the wounds after laparoscopic surgery should seek help from health institutions as soon as possible. During the operation, some of the gas used to inflate the abdomen may remain in the abdomen. Therefore, gas pains and abdominal cramps can be seen. In addition, pain can be seen in the shoulders due to gas. These ailments heal spontaneously within a few days when the gas is absorbed and expelled by the body. In line with the recommendations given by the physician, it may be necessary not to touch the suture areas with water for a certain period of time and to avoid some physical activities. The times to return to daily life and work life vary depending on the purpose of the laparoscopy procedure. In diagnostic laparoscopy, patients can return to their normal lives within 5-7 days. This process can take up to 3 weeks in small laparoscopy operations such as appendicitis or simple ovarian cyst removal. In larger-scale operations for cancer treatment, it may be necessary to wait up to 12 weeks to return to normal life. The surgical team performing the operation should be consulted about the time to return to normal physical activities and to start jobs that require physical work.