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Laparoscopy: Frequently Asked Questions

Wednesday, April 18, 2012 - 17:43

Contributing Author: Guy Slowik FRCS

Here are some frequently asked questions related to laparoscopy:

Q: I'm confused about the medical terms forminimally invasive surgery and the traditional open operations. Which is which?

A: Laparoscopy means surgery on the abdominal area using a laparoscope. This is minimally invasive, or Band-Aid, surgery, which uses small incisions. Laparotomy is the term for the traditional open surgery on the abdomen, which involves a larger incision. There are many different terms used for specific types of minimally invasive surgery and the instruments used.

Q: Why do people recover faster from minimally invasive surgery?

A: Mainly because of the small incisions. The large incision used in many traditional operations causes more damage to layers of skin, muscle, and other body tissue. It takes a long time for the body to repair that damage - usually about six weeks. During that period, patients often have to restrict their normal activities so that the incision heals properly. The incision also causes a good deal of discomfort that makes patients want to take it easy for several weeks.

Q: Since the incisions are so small, why can't minimally invasive surgery be done with a local anesthetic?

A: Some kinds of arthoscopic surgery, such as that done on the knee, may not need general anesthesia. It still is necessary for most operations, including those on the abdomen and pelvic areas. That's because the general anesthesia does more than block the sensation of pain; it also relaxes muscles and makes it easier for the surgeon to work inside the body and complete the operation.

Q: The doctor wants to do a diagnostic laparoscopy to find out why I'm having pelvic pain. She says the surgery will take less than an hour, and I can go home right away and back to work the next day. If it is really that simple, why do I have to bring someone to the surgery center to drive me home?

A: Because of the effects of general anesthesia. You may feel groggy for a few hours after you awake and you may not be in complete control of the reflexes needed to drive a vehicle. It is safer to have someone else who is fully alert do the driving.

Q: Why does the doctor want to videotape my surgery? Is that standard for laparoscopic operations?

A: A videotape gives the most detailed possible record of the operation. Surgeons normally dictate an account of the operation and a paper record goes into the patient's file, but the amount of detail varies from surgeon to surgeon. Almost every operating room with modern laparoscopic equipment can videotape each procedure, creating a visual document of the operation. A record of the operation clearly shows what the surgeon found during the first operation, what difficulties were encountered, and what procedures were done. The record is very important for other doctors who may be involved in your care at some point, especially if complications occur after the first surgery or the disease comes back later on.

Q: My sister had her gallbladder removed with Band-Aid surgery. Now I need a similar operation and my doctor wants to use the old "open" surgery that will leave a bigger scar. Should I insist that the doctor use the newer surgery?

A: There may be good reasons why your doctor wants to use the traditional laparotomy operation. People who underwent previous abdominal surgery, for instance, sometimes have internal scar tissue that makes laparoscopy difficult. Your gallbladder disease may be more serious than your sister's. There may be other problems that favor the traditional operation. If you feel uncomfortable with the doctor's plans, consider getting a second opinion.

Q: The doctor says there's a chance that she will have to "convert" to a laparotomy - "open" surgery with the larger incision - after starting it with belly button surgery. Why could that be necessary?

A: Even the most experienced doctors sometimes find that they cannot complete an operation as planned with the laparoscope. There are several reasons why the doctor might have to change, or convert, to an open operation. The patient's disease, for instance, may turn out to be different or more extensive than originally thought. Organs may not be in their normal position in the body. Patients who had previous surgery in the same area may have developed scar tissue that makes it difficult for the doctor to work with a laparoscope. Bleeding, leakage of body fluids, or other problems that require open surgery may occur during the laparoscopy.

Q: What is laparoscopically-assisted surgery? My gynecologist wants to use that method for my hysterectomy.

A: It is a modern way of performing a hysterectomy that avoids a large abdominal incision. In this procedure, instead of the normal large incision, very small incisions are made for a laparoscopic procedure, and the doctor uses the laparoscope to see and cut the tough bands of tissue that hold the uterus in place. That's the "laparoscopically-assisted" part. Then the uterus is removed through the vagina.

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