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Laparoscopy

Laparoscopy

Definition

Laparoscopy is a minimally invasive procedure used as a diagnostic tool and surgical procedure that is performed to examine the abdominal and pelvic organs, or the thorax, head, or neck. Tissue samples can also be collected for biopsy using laparoscopy and malignancies treated when it is combined with other therapies. Laparoscopy can also be used for some cardiac and vascular procedures.


Purpose

Laparoscopy is performed to examine the abdominal and pelvic organs to diagnose certain conditions anddepending on the conditioncan be used to perform surgery. Laparoscopy is commonly used in gynecology to examine the outside of the uterus, the fallopian tubes, and the ovariesparticularly in pelvic pain cases
where the underlying cause cannot be determined using diagnostic imaging (ultrasound and computed tomography). Examples of gynecologic conditions diagnosed using laparoscopy include endometriosis, ectopic pregnancy, ovarian cysts, pelvic inflammatory disease [PID], infertility, and cancer. Laparoscopy is used in general surgery to examine the abdominal organs, including the gallbladder, bile ducts, the liver, the appendix, and the intestines.

During the laparoscopic surgical procedure, certain conditions can be treated using instruments and devices specifically designed for laparoscopy. Medical devices that can be used in conjunction with laparoscopy include surgical lasers and electrosurgical units. Laparoscopic surgery is now preferred over open surgery for several types of procedures because of its minimally invasive nature and its association with fewer complications.

Microlaparoscopy can be performed in the physician's office using smaller laparoscopes. Common clinical applications in gynecology include pain mapping (for endometriosis), sterilization, and fertility procedures. Common applications in general surgery include evaluation of chronic and acute abdominal pain (as in appendicitis), basic trauma evaluation, biopsies, and evaluation of abdominal masses.

Laparoscopy is commonly used by gynecologists, urologists, and general surgeons for abdominal and pelvic applications. Laparoscopy is also being used by orthopedic surgeons for spinal applications and by cardiac surgeons for minimally invasive heart surgery . As of 2003, procedures under investigation for possible laparoscopy included thyroidectomy and parathyroidectomy .


Demographics

At first, laparoscopy was only been performed on young, healthy adults, but the use of this technique has greatly expanded. Populations on whom laparoscopies are now performed include infants, children, the elderly, the obese, and those with chronic disease states, such as cancer. The applications of this type of surgery have grown considerably over the years to include a variety of patient populations, and will continue to do so with the refinement of laparascopic techniques.


Description

Laparoscopy is typically performed in the hospital under general anesthesia, although some laparoscopic procedures can be performed using local anesthetic agents. Once under anesthesia, a urinary catheter is inserted into the patient's bladder for urine collection. To begin the procedure, a small incision is made just below the navel and a cannula or trocar is inserted into the incision to accommodate the insertion of the laparoscope. Other incisions may be made in the abdomen to allow the insertion of additional laparoscopic instrumentation. A laparoscopic insufflation device is used to inflate the abdomen with carbon dioxide gas to create a space in which the laparoscopic surgeon can maneuver the instruments. After the laparoscopic diagnosis and treatment are completed, the laparoscope, cannula, and other instrumentation are removed, and the incision is sutured and bandaged.

Laparoscopes have integral cameras for transmitting images during the procedure, and are available in various sizes depending upon the type of procedure performed. The images from the laparoscope are transmitted to a viewing monitor that the surgeon uses to visualize the internal anatomy and guide any surgical procedure. Video and photographic equipment are also used to document the surgery, and may be used postoperatively to explain the results of the procedure to the patient.

Robotic systems are available to assist with laparoscopy. A robotic arm, attached to the operating table may be used to hold and position the laparoscope. This serves to reduce unintentional camera movement that is common when a surgical assistant holds the laparoscope. The surgeon controls the robotic arm movement by foot pedal with voice-activated command, or with a handheld control panel.

Microlaparoscopy has become more common over the past few years. The procedure involves the use of smaller laparoscopes (that is, 2 mm compared to 510 mm for hospital laparoscopy), with the patient undergoing local anesthesia with conscious sedation (during which the patient remains awake but very relaxed) in a physician's office. Video and photographic equipment, previously explained, may be used.

Laparoscopy has been explored in combination with other therapies for the treatment of certain types of malignancies, including pelvic and aortic lymph node dissection, ovarian cancer, and early cervical cancer. Laparoscopic radiofrequency ablation is a technique whereby laproscopy assists in the delivery of radiofrequency probes that distribute pulses to a tumor site. The pulses generate heat in malignant tumor cells and destroys them.

The introduction of items such as temperature-controlled instruments, surgical instruments with greater rotation and articulation, improved imaging systems, and multiple robotic devices will expand the utility of laparoscopic techniques in the future. The skills of surgeons will be enhanced as well with further development of training simulators and computer technology.


Diagnosis/Preparation

Before undergoing laparoscopic surgery, the patient should be prepared by the doctor for the procedure both psychologically and physically. It is very important that the patient receive realistic counseling before surgery and prior to giving informed consent . This includes discussion about further open abdominal surgery (laparotomy) that may be required during laparoscopic surgery, information about potential complications during surgery, and the possible need for blood transfusions. In the case of diagnostic laparoscopy for chronic pelvic pain, the procedure may simply indicate that all organs are normal and the patient should be prepared for this possibility. The surgery may be explained using pictures, models, videotapes, and movies. It is especially important for the patient to be able to ask questions and express concerns. It may be helpful, for the patient to have a family member or friend present during discussions with the doctor. Such conversations could understandably cause anxiety, and information relayed may not be adequately recalled under such circumstances.

There is usually a presurgical exam two weeks before the surgery to gather a medical history and obtain blood and urine samples for laboratory testing. It is important that the patient inform the doctor completely about any prior surgeries, medical conditions, or medications taken on a regular basis, including such nonsteroidal anti-inflammatory drugs (NSAIDs) as aspirin . Patients taking blood thinners like Coumadin or Heparin (generic name: warfarin) should not adjust their medication themselves, but should speak with their prescribing doctors regarding
their upcoming surgery. (Patients should never adjust dosage without their doctors' approval. This is especially important for elderly patients, asthmatics, those with hypertension, or those who are on ACE inhibitors.) If a tubal dye study is planned during the procedure, the patient may also be required to provide information on menstrual history. For some procedures, an autologous (self) blood donation may be suggested prior to the surgery to replace blood that may be lost during the procedure. Chest x rays may also be required. For some obese patients, weight loss may be necessary prior to surgery.

Immediately before to surgery, there are several preoperative steps that the patient may be advised to take. The patient should shower at least 24 hours prior to the surgery, and gently but thoroughly cleanse the umbilicus (belly button) with antibacterial soap and water using a cotton-tipped swab. Because laparoscopy requires general anesthesia in most cases, the patient may be asked to eat lightly 24 hours prior to surgery and fast at least 12 hours prior to surgery. Bowel cleansing with a laxative may also required, allowing the it to be more easily visualized and to prevent complications in the unlikely event of bowel injury. Those who are have diabetes or have hypoglycemia may wish to schedule their procedures early in the morning to avoid low blood sugar reactions. The patient should follow the directions of the hospital staff, arriving early on the day of surgery to sign paperwork and to be screened by the anesthesiology staff. Questions will be asked regarding current medications and dosages, allergies to medication, previous experiences with anesthesia (that is, allergic reactions, and previous experiences regarding time-to-consciousness), and a variety of other questions. It is often helpful for the patient to make a list of this information beforehand so that the information can be easily retrieved when requested by the hospital staff.

Aftercare

Following laparoscopy, patients are required to remain in a recovery area until the immediate effects of anesthesia subside and until normal voiding is accomplished (especially if a urinary catheter was used during the surgery). Vital signs are monitored to ensure that there are no reactions to anesthesia or internal injuries present. There may be some nausea and/or vomiting, which may be reduced by the use of the propofol anesthetic for healthy patients undergoing elective procedures such as tubal ligation , diagnostic laparoscopy, or hernia repair. Laparoscopy is usually an outpatient procedure and patients are discharged from the recovery area within a few hours after the procedure. For elderly patients and those with other medical conditions, recovery may be slower. Patients with more serious medical conditions, or patients undergoing emergency laparoscopy, an overnight hospital stay or a stay of several days may be required.

Discharged patients will receive instructions regarding activity level, medications, postoperative dietary modifications, and possible side effects of the procedure. It may be helpful to have a friend or family member present when these instructions are given, as the aftereffects of anesthesia may cause some temporary confusion. Postoperative instructions may include information on when one might resume normal activities such as bathing, housework, and driving. Depending on the nature of the laparoscopic procedure and the patient's medical condition, daily activity may be restricted for a few days and strenuous during administration of anesthesia may cause some soreness. Additionally, shoulder pain may persist as long as 36 hours after surgery. Pain-relieving medications and antibiotics may be prescribed for several days postoperatively.

Patients will be instructed to watch for signs of a urinary tract infection (UTI) or unusual pain; either may indicate organ injury. It is important to understand the difference between normal discomfort and pain, because pain may indicate a problem. Patients may also experience an elevated temperature, and occasionally "postlaparoscopy syndrome"; this condition is similar in appearance to peritonitis (marked by abdominal pain, constipation, vomiting, and fever) that disappears shortly after surgery without antibiotics. However, any postoperative symptoms that cause concern for the patient should be discussed with the doctor, so that any fears can be alleviated and recovery can be accomplished. Due to the after-effects of anesthesia, patients should not drive themselves home.

It is advisable for someone to stay with the patient for a few hours following the procedure, in case complications arise. Injury to an organ might not be readily apparent for several days after the procedure. The physical signs that should be watched for and reported immediately include:

  • fever and chills
  • abdominal distension
  • vomiting
  • difficulty urinating
  • sharp and unusual pain in the abdomen or bowel
  • redness at the incision site, which indicate infection
  • discharge from any places where tubes were inserted or incisions were made

Additional complications may include a urinary tract infection (resulting from catheterization) and minor infection of the incision site. An injury to the ureter may be indicated by abdominal distention or a pain in the flank. Additional testing may be required if a complication is suspected.


Risks

Complications may be associated with the laparoscopy procedure in general, or may be specific to the type of operation that is performed. Patients should consult with their doctors regarding the types of risks that are specific for their procedures. The most serious complication that can occur during laparoscopy is laceration of a major abdominal blood vessel resulting from improper positioning, inadequate insufflation (inflation) of the abdomen, abnormal pelvic anatomy, and too much force exerted during scope insertion. Thin patients with well-developed abdominal muscles are at higher risk, since the aorta may only be an inch or so below the skin. Obese patients are also at higher risk because more forceful and deeper needle and scope penetration is required. During laparoscopy, there is also a risk of bleeding from blood vessels, and adhesions may require repair by open surgery if bleeding cannot be stopped using laparoscopic instrumentation. In laparoscopic procedures that use electrosurgical devices, burns to the incision site are possible due to passage of electrical current through the laparoscope caused by a fault or malfunction in the equipment.

Complications related to insufflation of the abdominal cavity include gas inadvertently entering a blood vessel and causing an embolism, pneumothorax, or subcutaneous emphysema. One common but not serious side effect of insufflation is pain in the shoulder and upper chest area for a day or two following the procedure.

Any abdominal surgery, including laparoscopy, carries the risk of unintentional organ injury (punctures and perforations). For example, the bowel, bladder, ureters, or fallopian tubes may be injured during the laparoscopic procedure. Many times these injuries are unavoidable due to the patient's anatomy or medical condition. Patients at higher risk for bowel injury include those with chronic bowel disease, PID, a history of pervious abdominal surgery, or severe endometriosis. Some types of laparoscopic procedures have a higher risk of organ injury. For instance, during laparoscopic removal of endometriosis adhesions or ovaries, the ureters may be injured due to their proximity to each other.

Several clinical studies have shown that the complication rate during laparoscopy is associated with inadequate surgeon experience. Surgeons who are more experienced in laparoscopic procedures have fewer complications than those performing their first 100 cases.


Normal results

In diagnostic laparoscopy, the surgeon will be able to see signs of a disease or condition (for example, endometriosis adhesions; ovarian cysts; diseased gallbladder)immediately, and can either treat the condition surgically or proceed with appropriate medical management. In diagnostic laparoscopy, biopsies may be taken of tissue in questionable areas, and laboratory results will govern medical treatment. In therapeutic laparoscopy, the surgeon performs a procedure that rectifies a known medical problem, such as hernia repair or appendix removal. Because laparoscopy is minimally invasive compared to open surgery, patients may experience less trauma and postoperative discomfort, have fewer procedural complications, have a shorter hospital stay, and return more quickly to daily activities. The results will vary, however, depending on the patients's condition and type of treatment.


Morbidity and mortality rates

Laparoscopic surgery, like most surgeries, is not without risk. Risks should be thoroughly explained to the patient. Complications from laparoscopic surgeries arise in 15% of the cases, with a mortality of about 0.05%. Complications may arise from the laparoscopic entry during procedure, and the risks vary depending on the elements specific to a particular procedure. For example, the risk of injury to the common bile duct in laparoscopic biliary surgery is 0.30.6% of cases. The factors that contribute to morbidity are currently under study and debate. Injury may occur to blood vessels and internal organs. Some studies examining malpractice data indicate that trocar injury to the bowel or blood vessels may account up to one-fourth of laparoscopic medical claims. It has been suggested that these injuries can be reduced by alterations in the placement and use of the Verses needle, or by using an open technique of trocar insertion in which a blunt cannula (non-bladed) is inserted into the abdominal cavity through an incision. The insertion of secondary trocars may be of particular interest as a risk factor. There is still some debate, however, as to which method of trocar insertion is most appropriate in a particular situation, as no technique is without risk. The most commonly cited injury in laparoscopic malpractice claims has been injury to the bile duct (66%). Proper identification of this structure by an experienced surgeon, or by a cholangiogram, may reduce this type of injury. Other areas of the body may be injured during access including the stomach, bladder, and liver. Hemorrhages may also occur during the operation.

Laparoscopic entry injuries have been the subject of recent study. Data collected from insurance companies and medical device regulation indicate that bowel and vascular injuries may account for 76% of the injuries that occur when a primary port is created. Delayed recognition of bowel injuries was noted to be an important factor in mortality. The risk of possible injury or death in laparoscopy depends on such factors as the anatomy of the patient, the force of entry, and the type operative procedure being performed.


Alternatives

The alternatives to laparoscopy vary, depending on the medical condition being treated. Laparotomy (open abdominal surgery with larger incision) may be pursued when further visualization is needed to treat the condition, such as in the case of pain of severe endometriosis with deeper lesions. For those female patients with pelvic masses, transvaginal sonography may be a helpful technique in obtaining information about whether such masses are malignant, assisting in the choice between laparoscopy or laparotomy.


Resources

books

Merrell, Ronald C., ed. Laparoscopic Surgery. New York: Springer-Verlag New York, Inc., 1999.

Pasic, Resad P., Ronald L. Levine. A Practical Manual of Laparoscopy: A Clinical Cookbook. New York: The Parthenon Publishing Group, 2002.

Schier, Felix. Laparoscopy in Children. Berlin: Springer, 2003.

Soderstrom, Richard M., ed. Operative Laparoscopy, 2nd ed. Philadelphia: Lippincott-Raven, 1998.

Webb, Maurice, ed. J. Mayo Clinic Manual of Pelvic Surgery, 2nd ed. Philadelphia, 2000.

Zucker, Karl A., ed. Surgical Laparoscopy, 2nd ed. Philadelphia, 2001.

periodicals

Abu-Rustum, Nadeem R. "Laparoscopy 2003: Oncologic Perspective." Clinical Obstetrics and Gynecology 46, no.1 (March 2003): 61-69.

Bieber, Eric. "Laparoscopy: Past, Present, and Future." Clinical Obstetrics and Gynecology 46, no.1 (March 2003): 314.

Boike, Guy M., and Brian Dobbins. "New Equipment for Operative Laparoscopy." Contemporary OB/GYN, no. 2 (April 1998). <http://consumer.pdr.net/consumer/psrecord.htm>.

Chandler, J.G., S.L. Corson, L.W. Way. "Three Spectra of Laparoscopic Entry Access Injuries." Journal of American College of Surgeons 192, no.4 (April 2001):478490.

organizations

American College of Obstetricians and Gynecologists. 409 12th Street SW, P.O. Box 96920, Washington, DC 20090-6920. <http://www.acog.org>.

Society of American Gastrointestinal Endoscopic Surgeons (SAGES). 2716 Ocean Park Boulevard, Suite 3000, Santa Monica, CA 90405. (310) 314-2404. <http://www.endoscopy-sages.com>.

Society of Laparoendoscopic Surgeons. 7330 SW 62nd Place, Suite 410, Miami, FL 33143-4825. (305) 665-9959. <http://www.sls.org>.

other

Agency for Healthcare Research and Quality. <http://www.webmm.ahrq.gov/cases.aspx?ic=3>.

"Diagnostic Laparoscopy." Society of Gastrointestinal Endoscopic Surgeons. <http://www.sages.org/pi_diaglap.html>.

"Laparoscopy." WebMD.com. October 24, 2002). <http://my.webmd.com/content/healthwise/21/5199.htm?lastselectedguid={5FE84E90-BC77-4056-A91C-9531713CA348>.


Jennifer E. Sisk, M.A.
Jill Granger, M.S.

QUESTIONS TO ASK THE DOCTOR


  • Will this surgery be covered by my insurance? Will any postsurgical care that I require also be covered?
  • What do I need to do to prepare for the surgery? Are there any restrictions on diet, fluid intake, or other measures?
  • Are there any medications that should be stopped prior to the surgery?
  • Does my medical history pose any potential problems that need to be considered before undergoing this procedure?
  • What is your (the doctor's) training in performing this surgery? Will you perform the actual surgery or will a trainee?
  • What aftereffects can I expect?
  • Are there any post-surgical symptoms that might indicate a complication that I should report, and to whom should these questions be directed? What post-surgical symptoms should be considered "normal" and how might discomfort be relieved?
  • What is the expected recovery period from this procedure?
  • What special care or self-care is required following this surgery?

WHO PERFORMS THE PROCEDURE AND WHERE IS IT PERFORMED?


Laparoscopy may be performed by a gynecologist, general surgeon, gastroenterologist, or other physiciandepending upon the patient's condition. An anesthesiologist is required during the procedure to administer general and/or local anesthesia and to perform patient monitoring. Nurses and surgical technicians/assistants are needed during the procedure to assist with scope positioning, video system adjustments and image recording, and laparoscopic instrumentation.

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Sisk, Jennifer E.; Granger, Jill. "Laparoscopy." Gale Encyclopedia of Surgery: A Guide for Patients and Caregivers. 2004. Encyclopedia.com. 24 Jul. 2016 <http://www.encyclopedia.com>.

Sisk, Jennifer E.; Granger, Jill. "Laparoscopy." Gale Encyclopedia of Surgery: A Guide for Patients and Caregivers. 2004. Encyclopedia.com. (July 24, 2016). http://www.encyclopedia.com/doc/1G2-3406200257.html

Sisk, Jennifer E.; Granger, Jill. "Laparoscopy." Gale Encyclopedia of Surgery: A Guide for Patients and Caregivers. 2004. Retrieved July 24, 2016 from Encyclopedia.com: http://www.encyclopedia.com/doc/1G2-3406200257.html

Laparoscopy

Laparoscopy

Definition

Laparoscopy is a type of surgical procedure in which a small incision is made, usually in the navel, through which a viewing tube (laparoscope) is inserted. The viewing tube has a small camera on the eyepiece. This allows the doctor to examine the abdominal and pelvic organs on a video monitor connected to the tube. Other small incisions can be made to insert instruments to perform procedures. Laparoscopy can be done to diagnose conditions or to perform certain types of operations. It is less invasive than regular open abdominal surgery (laparotomy).

Purpose

Since the late 1980s, laparoscopy has been a popular diagnostic and treatment tool. The technique dates back to 1901, when it was reportedly first used in a gynecologic procedure performed in Russia. In fact, gynecologists were the first to use laparoscopy to diagnose and treat conditions relating to the female reproductive organs: uterus, fallopian tubes, and ovaries.

Laparoscopy was first used with cancer patients in 1973. In these first cases, the procedure was used to observe and biopsy the liver. Laparoscopy plays a role in the diagnosis, staging, and treatment for a variety of cancers.

As of 2001, the use of laparoscopy to completely remove cancerous growths and surrounding tissues (in place of open surgery) is controversial. The procedure is being studied to determine if it is as effective as open surgery in complex operations. Laparoscopy is also being investigated as a screening tool for ovarian cancer .

Laparoscopy is widely used in procedures for non-cancerous conditions that in the past required open surgery, such as removal of the appendix (appendectomy) and gallbladder removal (cholecystectomy).

Diagnostic procedure

As a diagnostic procedure, laparoscopy is useful in taking biopsies of abdominal or pelvic growths, as well as lymph nodes. It allows the doctor to examine the abdominal area, including the female organs, appendix, gallbladder, stomach, and the liver.

Laparoscopy is used to determine the cause of pelvic pain or gynecological symptoms that cannot be confirmed by a physical exam or ultrasound. For example, ovarian cysts, endometriosis, ectopic pregnancy, or blocked fallopian tubes can be diagnosed using this procedure. It is an important tool when trying to determine the cause of infertility.

Operative procedure

While laparoscopic surgery to completely remove cancerous tumors, surrounding tissues, and lymph nodes is used on a limited basis, this type of operation is widely used in noncancerous conditions that once required open surgery. These conditions include:

  • Tubal ligation. In this procedure, the fallopian tubes are sealed or cut to prevent subsequent pregnancies.
  • Ectopic pregnancy. If a fertilized egg becomes embedded outside the uterus, usually in the fallopian tube, an operation must be performed to remove the developing embryo. This often can be done with laparoscopy.
  • Endometriosis. This is a condition in which tissue from inside the uterus is found outside the uterus in other parts of (or on organs within) the pelvic cavity. This can cause cysts to form. Endometriosis is diagnosed with laparoscopy, and in some cases the cysts and other tissue can be removed during laparoscopy.
  • Hysterectomy. This procedure to remove the uterus can, in some cases, be performed using laparoscopy. The uterus is cut away with the aid of the laparoscopic instruments and then the uterus is removed through the vagina.
  • Ovarian masses. Tumors or cysts in the ovaries can be removed using laparoscopy.
  • Appendectomy. This surgery to remove an inflamed appendix required open surgery in the past. It is now routinely performed with laparoscopy.
  • Cholecystectomy. Like appendectomy, this procedure to remove the gallbladder used to require open surgery. Now it can be performed with laparoscopy, in some cases.

In contrast to open abdominal surgery, laparoscopy usually involves less pain, less risk, less scarring, and faster recovery. Because laparoscopy is so much less invasive than traditional abdominal surgery, patients can leave the hospital sooner.

Cancer staging

Laparoscopy can be used in determining the spread of certain cancers. Sometimes it is combined with ultrasound. Although laparoscopy is a useful staging tool, its use depends on a variety of factors, which are considered for each patient. Types of cancers where laparoscopy may be used to determine the spread of the disease include:

  • Liver cancer. Laparoscopy is an important tool for determining if cancer is present in the liver. When a patient has non-liver cancer, the liver is often checked to see if the cancer has spread there. Laparoscopy can identify up to 90% of malignant lesions that have spread to that organ from a cancer located elsewhere in the body. While computed tomography (CT) can find cancerous lesions that are 0.4 in (10 mm) in size, laparoscopy is capable of locating lesions that are as small as 0.04 in (1 millimeter).
  • Pancreatic cancer. Laparoscopy has been used to evaluate pancreatic cancer for years. In fact, the first reported use of laparoscopy in the United States was in a case involving pancreatic cancer.
  • Esophageal and stomach cancers. Laparoscopy has been found to be more effective than magnetic resonance imaging (MRI) or computed tomography (CT) in diagnosing the spread of cancer from these organs.
  • Hodgkin's disease . Some patients with Hodgkin's disease have surgical procedures to evaluate lymph nodes for cancer. Laparoscopy is sometimes selected over laparotomy for this procedure. In addition, the spleen may be removed in patients with Hodgkin's disease. Laparoscopy is the standard surgical technique for this procedure, which is called a splenectomy.
  • Prostate cancer . Patients with prostate cancer may have the nearby lymph nodes examined. Laparoscopy is an important tool in this procedure.

Cancer treatment

Laparoscopy is sometimes used as part of a palliative cancer treatment. This type of treatment is not a cure, but can often lessen the symptoms. An example is the feeding tube, which cancer patients may have if they are unable to take in food by mouth. The feeding tube provides nutrition directly into the stomach. Inserting the tube with a laparoscopy saves the patient the ordeal of open surgery.

Precautions

As with any surgery, patients should notify their physician of any medications they are taking (prescription, over-the-counter, or herbal) and of any allergies. Precautions vary due to the several different purposes for laparoscopy. Patients should expect to rest for several days after the procedure, and should set up a comfortable environment in their home (with items such as pain medication, heating pads, feminine products, comfortable clothing, and food readily accessible) prior to surgery.

Description

Laparoscopy is a surgical procedure that is done in the hospital under anesthesia. For diagnosis and biopsy, local anesthesia is sometimes used. In operative procedures, such as abdominal surgery, general anesthesia is required. Before starting the procedure, a catheter is inserted through the urethra to empty the bladder, and the skin of the abdomen is cleaned.

After the patient is anesthetized, a hollow needle is inserted into the abdomen in or near the navel, and carbon dioxide gas is pumped through the needle to expand the abdomen. This allows the surgeon a better view of the internal organs. The laparoscope is then inserted through this incision to look at the internal organs. The image from the camera attached to the end of the laparoscope is seen on a video monitor.

Sometimes, additional small incisions are made to insert other instruments that are used to lift the tubes and ovaries for examination or to perform surgical procedures.

Preparation

Patients should not eat or drink after midnight on the night before the procedure.

Aftercare

After the operation, nurses will check the vital signs of patients who had general anesthesia. If there are no complications, the patient may leave the hospital within four to eight hours. (Traditional abdominal surgery requires a hospital stay of several days).

There may be some slight pain or throbbing at the incision sites in the first day or so after the procedure. The gas that is used to expand the abdomen may cause discomfort under the ribs or in the shoulder for a few days. Depending on the reason for the laparoscopy in gynecological procedures, some women may experience some vaginal bleeding. Many patients can return to work within a week of surgery and most are back to work within two weeks.

Risks

Laparoscopy is a relatively safe procedure, especially if the physician is experienced in the technique. The risk of complication is approximately 1%.

The procedure carries a slight risk of puncturing a blood vessel or organ, which could cause blood to seep into the abdominal cavity. Puncturing the intestines could allow intestinal contents to seep into the cavity. These are serious complications and major surgery may be required to correct the problem. For operative procedures, there is the possibility that it may become apparent that open surgery is required. Serious complications occur at a rate of only 0.2%.

Rare complications include:

  • Hemorrhage
  • Inflammation of the abdominal cavity lining
  • Abscess
  • Problems related to general anesthesia

Laparoscopy is generally not used in patients with certain heart or lung conditions, or in those who have some intestinal disorders, such as bowel obstruction.

Normal results

In diagnostic procedures, normal results would indicate no abnormalities or disease of the organs or lymph nodes that were examined.

Abnormal results

A diagnostic laparoscopy may reveal cancerous or benign masses or lesions. Abnormal findings include tumors or cysts, infections (such as pelvic inflammatory disease), cirrhosis, endometriosis, fibroid tumors, or an accumulation of fluid in the cavity. If a doctor is checking for the spread of cancer, the presence of malignant lesions in areas other than the original site of malignancy is an abnormal finding.

See Also Endoscopic retrograde cholangiopancreatography; Gynecologic cancers; Liver biopsy; Lymph node biopsy; Nutritional support; Tumor grading; Tumor staging; Ultrasonography

Resources

BOOKS

Carlson, Karen J., Stephanie A. Eisenstat, and Terra Ziporyn. The Harvard Guide to Women's Health. Cambridge, MA: Harvard University Press, 1996.

Cunningham, F. Gary, Paul C. MacDonald, et al. Williams Obstet rics, 20th ed. Stamford, CT: Appleton & Lange, 1997.

Kurtz, Robert C., and Robert J. Ginsberg. "Cancer Diagnosis: Endoscopy." In Cancer: Principles & Practice of Oncolo gy., edited by Vincent T. DeVita Jr. Philadelphia: Lippin cott, Williams & Wilkins, 2001, 725-27.

Lefor, Alan T. "Specialized Techniques in Cancer Manage ment." In Cancer: Principles & Practice of Oncology, 6th ed., edited by Vincent T. DeVita Jr., et al. Philadelphia: Lippincott, Williams & Wilkins, 2001, 739-57.

Ryan, Kenneth J., Ross S. Berkowitz, and Robert L. Barbieri. Kistner's Gynecology, 6th ed. St. Louis: Mosby, 1997.

OTHER

Iannitti, David A. "The Role of Laparoscopy in the Manage ment of Pancreatic Cancer." Home Journal Library Index. 23 March 2001. 27 June 2001 <http://bioscience.org/1998/v3/e/iannitti/e181-185.htm>.

Carol A. Turkington

Rhonda Cloos, R.N.

QUESTIONS TO ASK THE DOCTOR

  • What is your complication rate?
  • What is the purpose of this procedure?
  • How often do you do laparoscopies?
  • What type of anesthesia will be used?
  • Will a biopsy be taken during the laparoscopy if anything abnormal is seen?
  • If more surgery is needed, can it be done with a laparoscope?
  • What area will be examined with the laparoscope?
  • What are the risks?
  • How long is the recovery time?

KEY TERMS

Biopsy

Microscopic evaluation of a tissue sample. The tissue is closely examined for the presence of abnormal cells.

Cancer staging

Determining the course and spread of cancer.

Cyst

An abnormal lump or swelling that is filled with fluid or other material.

Palliative treatment

A type of treatment that does not provide a cure, but eases the symptoms.

Tumor

A growth of tissue, benign or malignant, often referred to as a mass.

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Turkington, Carol A.; Cloos, Rhonda. "Laparoscopy." Gale Encyclopedia of Cancer. 2002. Encyclopedia.com. 24 Jul. 2016 <http://www.encyclopedia.com>.

Turkington, Carol A.; Cloos, Rhonda. "Laparoscopy." Gale Encyclopedia of Cancer. 2002. Encyclopedia.com. (July 24, 2016). http://www.encyclopedia.com/doc/1G2-3405200250.html

Turkington, Carol A.; Cloos, Rhonda. "Laparoscopy." Gale Encyclopedia of Cancer. 2002. Retrieved July 24, 2016 from Encyclopedia.com: http://www.encyclopedia.com/doc/1G2-3405200250.html

Laparoscopy

Laparoscopy

Definition

Laparoscopy is a type of surgical procedure in which a small incision is made, usually in the navel, through which a viewing tube (laparoscope) is inserted. The viewing tube has a small camera on the eyepiece. This allows the doctor to examine the abdominal and pelvic organs on a video monitor connected to the tube. Other small incisions can be made to insert instruments to perform procedures. Laparoscopy can be done to diagnose conditions or to perform certain types of operations. It is less invasive than regular open abdominal surgery (laparotomy).

Purpose

Since the late 1980s, laparoscopy has been a popular diagnostic and treatment tool. The technique dates back to 1901, when it was reportedly first used in a gynecologic procedure performed in Russia. In fact, gynecologists were the first to use laparoscopy to diagnose and treat conditions relating to the female reproductive organs: uterus, fallopian tubes, and ovaries.

Laparoscopy was first used with cancer patients in 1973. In these first cases, the procedure was used to observe and biopsy the liver. Laparoscopy plays a role in the diagnosis, staging, and treatment for a variety of cancers.

As of 2001, the use of laparoscopy to completely remove cancerous growths and surrounding tissues (in place of open surgery) is controversial. The procedure is being studied to determine if it is as effective as open surgery in complex operations. Laparoscopy is also being investigated as a screening tool for ovarian cancer.

Laparoscopy is widely used in procedures for noncancerous conditions that in the past required open surgery, such as removal of the appendix (appendectomy ) and gallbladder removal (cholecystectomy ).

Diagnostic procedure

As a diagnostic procedure, laparoscopy is useful in taking biopsies of abdominal or pelvic growths, as well as lymph nodes. It allows the doctor to examine the abdominal area, including the female organs, appendix, gallbladder, stomach, and the liver.

Laparoscopy is used to determine the cause of pelvic pain or gynecological symptoms that cannot be confirmed by a physical exam or ultrasound. For example, ovarian cysts, endometriosis, ectopic pregnancy, or blocked fallopian tubes can be diagnosed using this procedure. It is an important tool when trying to determine the cause of infertility.

Operative procedure

While laparoscopic surgery to completely remove cancerous tumors, surrounding tissues, and lymph nodes is used on a limited basis, this type of operation is widely used in noncancerous conditions that once required open surgery. These conditions include:

  • Tubal ligation. In this procedure, the fallopian tubes are sealed or cut to prevent subsequent pregnancies.
  • Ectopic pregnancy. If a fertilized egg becomes embedded outside the uterus, usually in the fallopian tube, an operation must be performed to remove the developing embryo. This often can be done with laparoscopy.
  • Endometriosis. This is a condition in which tissue from inside the uterus is found outside the uterus in other parts of (or on organs within) the pelvic cavity. This can cause cysts to form. Endometriosis is diagnosed with laparoscopy, and in some cases the cysts and other tissue can be removed during laparoscopy.
  • Hysterectomy. This procedure to remove the uterus can, in some cases, be performed using laparoscopy. The uterus is cut away with the aid of the laparoscopic instruments and then the uterus is removed through the vagina.
  • Ovarian masses. Tumors or cysts in the ovaries can be removed using laparoscopy.
  • Appendectomy. This surgery to remove an inflamed appendix required open surgery in the past. It is now routinely performed with laparoscopy.
  • Cholecystectomy. Like appendectomy, this procedure to remove the gall bladder used to require open surgery. Now it can be performed with laparoscopy, in some cases.

In contrast to open abdominal surgery, laparoscopy usually involves less pain, less risk, less scarring, and faster recovery. Because laparoscopy is so much less invasive than traditional abdominal surgery, patients can leave the hospital sooner.

Cancer staging

Laparoscopy can be used in determining the spread of certain cancers. Sometimes it is combined with ultrasound. Although laparoscopy is a useful staging tool, its use depends on a variety of factors, which are considered for each patient. Types of cancers where laparoscopy may be used to determine the spread of the disease include:

  • Liver cancer. Laparoscopy is an important tool for determining if cancer is present in the liver. When a patient has non-liver cancer, the liver is often checked to see if the cancer has spread there. Laparoscopy can identify up to 90% of malignant lesions that have spread to that organ from a cancer located elsewhere in the body. While computerized tomography (CT) can find cancerous lesions that are 0.4 in (10 mil) in size, laparoscopy is capable of locating lesions that are as small as 0.04 in (1 millimeter).
  • Pancreatic cancer. Laparoscopy has been used to evaluate pancreatic cancer for years. In fact, the first reported use of laparoscopy in the United States was in a case involving pancreatic cancer.
  • Esophageal and stomach cancers. Laparoscopy has been found to be more effective than magnetic resonance imaging (MRI) or computerized tomography (CT) in diagnosing the spread of cancer from these organs.
  • Hodgkin's disease. Some patients with Hodgkin's disease have surgical procedures to evaluate lymph nodes for cancer. Laparoscopy is sometimes selected over laparotomy for this procedure. In addition, the spleen may be removed in patients with Hodgkin's disease. Laparoscopy is the standard surgical technique for this procedure, which is called a splenectomy.
  • Prostate cancer. Patients with prostate cancer may have the nearby lymph nodes examined. Laparoscopy is an important tool in this procedure.

Cancer treatment

Laparoscopy is sometimes used as part of a palliative cancer treatment. This type of treatment is not a cure, but can often lessen the symptoms. An example is the feeding tube, which cancer patients may have if they are unable to take in food by mouth. The feeding tube provides nutrition directly into the stomach. Inserting the tube with a laparoscopy saves the patient the ordeal of open surgery.

Precautions

As with any surgury, patients should notify their physician of any medications they are taking (prescription, over-the-counter, or herbal) and of any allergies. Precautions vary due to the several different purposes for laparoscopy. Patients should expect to rest for several days after the procedure, and should set up a comfortable environment in their home (with items such as pain medication, heating pads, feminine products, comfortable clothing, and food readily accessible) prior to surgery.

Description

Laparoscopy is a surgical procedure that is done in the hospital under anesthesia. For diagnosis and biopsy, local anesthesia is sometimes used. In operative procedures, such as abdominal surgery, general anesthesia is required. Before starting the procedure, a catheter is inserted through the urethra to empty the bladder, and the skin of the abdomen is cleaned.

After the patient is anesthetized, a hollow needle is inserted into the abdomen in or near the navel, and carbon dioxide gas is pumped through the needle to expand the abdomen. This allows the surgeon a better view of the internal organs. The laparoscope is then inserted through this incision to look at the internal organs. The image from the camera attached to the end of the laparoscope is seen on a video monitor.

Sometimes, additional small incisions are made to insert other instruments that are used to lift the tubes and ovaries for examination or to perform surgical procedures.

Preparation

Patients should not eat or drink after midnight on the night before the procedure.

Aftercare

After the operation, nurses will check the vital signs of patients who had general anesthesia. If there are no complications, the patient may leave the hospital within four to eight hours. (Traditional abdominal surgery requires a hospital stay of several days).

There may be some slight pain or throbbing at the incision sites in the first day or so after the procedure. The gas that is used to expand the abdomen may cause discomfort under the ribs or in the shoulder for a few days. Depending on the reason for the laparoscopy in gynecological procedures, some women may experience some vaginal bleeding. Many patients can return to work within a week of surgery and most are back to work within two weeks.

Risks

Laparoscopy is a relatively safe procedure, especially if the physician is experienced in the technique. The risk of complication is approximately 1%.

The procedure carries a slight risk of puncturing a blood vessel or organ, which could cause blood to seep into the abdominal cavity. Puncturing the intestines could allow intestinal contents to seep into the cavity. These are serious complications and major surgery may be required to correct the problem. For operative procedures, there is the possibility that it may become apparent that open surgery is required. Serious complications occur at a rate of only 0.2%.

Rare complications include:

  • hemorrhage
  • inflammation of the abdominal cavity lining
  • abscess
  • problems related to general anesthesia

Laparoscopy is generally not used in patients with certain heart or lung conditions, or in those who have some intestinal disorders, such as bowel obstruction.

Normal results

In diagnostic procedures, normal results would indicate no abnormalities or disease of the organs or lymph nodes that were examined.

Abnormal results

A diagnostic laparoscopy may reveal cancerous or benign masses or lesions. Abnormal findings include tumors or cysts, infections (such as pelvic inflammatory disease), cirrhosis, endometriosis, fibroid tumors, or an accumulation of fluid in the cavity. If a doctor is checking for the spread of cancer, the presence of malignant lesions in areas other than the original site of malignancy is an abnormal finding.

KEY TERMS

Biopsy Microscopic evaluation of a tissue sample. The tissue is closely examined for the presence of abnormal cells.

Cancer staging Determining the course and spread of cancer.

Cyst An abnormal lump or swelling that is filled with fluid or other material.

Palliative treatment A type treatment that does not provide a cure, but eases the symptoms.

Tumor A growth of tissue, benign or malignant, often referred to as a mass.

Resources

BOOKS

Kurtz, Robert C., and Robert J. Ginsberg. "Cancer Diagnosis: Endoscopy." In Cancer: Principles & Practice of Oncology, edited by Vincent T. DeVita, Jr. Philadelphia: Lippincott, Williams & Wilkins, 2001, pp. 725-27.

Lefor, Alan T. "Specialized Techniques in Cancer Management." In Cancer: Principles & Practice of Oncology, edited by Vincent T. DeVita Jr., et al., 6th ed. Philadelphia: Lippincott, Williams & Wilkins, 2001, pp. 739-57.

OTHER

Iannitti, David A. "The Role of Laparoscopy in the Management of Pancreatic Cancer." Home Journal Library Index. March 23, 2001. [cited June 27, 2001]. http://bioscience.org/1998/v3/e/iannitti/e181-185.htm.

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Laparoscopic Surgery

Laparoscopic surgery

Laparoscopic surgery has become a common method for treating a variety of abdominal medical problems. To insert the laparoscopic version of the endoscope (an endoscope is an optical instrument that allows doctors to see inside the human body; also referred to as a fiberscope), doctors make tiny incisions instead of the usual large cuts across the surgical area. After the incisions are made, carbon dioxide is blown into the abdomen through the navel to make a space for small video cameras and scalpels to do the actual surgery. This technique dramatically reduces the amount of trauma to the patient's body tissues and shortens surgery and recovery times.

Early Laparoscopic Techniques

The laparoscopic technique was introduced in the 1960s by Raoul Palmer of the Broca Hospital in Paris, France, to help diagnose gynecological (sexual organ) problems in women. At first, Palmer had to use a bicycle pump to get air into the abdomen. He also had to use a regular laboratory scope rather than a video camera to see into the body.

Tiny Blades Make the Difference

It was not until 1986 that laparoscopy was used for actual surgery rather than just diagnosis. By this time, tiny remote-control scalpels had been developed that allowed doctors to use Palmer's techniques for surgical procedures. These small scalpels could be attached to the tip of the endoscope to manipulate tissue and draw samples for diagnosis and treatment.

The main disadvantages of such procedures are the cost, which is greater than for conventional surgery, and the temptation to perform surgery when other, more conservative, therapies might do just as well. There are also the risks associated of any kind of surgery, such as excessive bleeding, or patient reaction to anesthesia.

The Flexible Endoscope

An endoscope is a narrow, flexible tube containing several bundles of glass fibers that are covered with a reflective coating. An intense light source is used to transmit light along one bundle of fibers to the target, or surgical, area. Different types of endoscopes are specially designed for use in specific parts of the body. The angioscope passes through the arteries that carry blood to the heart; the arthroscope is used to explore the interior area of joints; the bronchoscope is used with a special dye and florescent light to detect lung growths; and the laparoscope is used for the diagnosis and treatment of abdominal conditions.

Although laparoscopy was received with skepticism by surgeons at first, it is now widely used in gynecology. It is also being adapted for other types of surgery, particularly for the cardiovascular (heart and blood vessel) system, and more recently, to treat certain cancers. In the future, laparoscopic techniques may be used so that a surgeon can perform an operation by remote control on a patient in another city or even country.

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laparoscopy

laparoscopy (abdominoscopy, peritoneoscopy) (lap-er-os-kŏpi) n. examination of the abdominal structures by means of a laparoscope (a type of endoscope). This is passed through a small incision in the wall of the abdomen after injecting carbon dioxide into the abdomen (pneumoperitoneum). In addition to being a diagnostic aid, it is used when taking a biopsy, aspirating cysts, dividing adhesions, and collecting ova for in vitro fertilization. Surgery, including cholecystectomy, prostatectomy, and the occlusion of Fallopian tubes for sterilization, can also be performed through a laparoscope, using either a laser or diathermy to control bleeding. See also minimally invasive surgery.
laparoscopic adj.

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"laparoscopy." A Dictionary of Nursing. 2008. Encyclopedia.com. 24 Jul. 2016 <http://www.encyclopedia.com>.

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laparoscopy

lap·a·ros·co·py / ˌlapəˈräskəpē/ • n. (pl. -pies) a surgical procedure in which a fiber-optic instrument is inserted through the abdominal wall to view the organs in the abdomen or to permit a surgical procedure. DERIVATIVES: lap·a·ro·scope / ˈlap(ə)rəˌskōp/ n. lap·a·ro·scop·ic / ˌlap(ə)rəˈskäpik/ adj. lap·a·ro·scop·i·cal·ly adv.

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laparoscopic surgery

laparoscopic surgery: see endoscope.

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