Laparoscopy is direct visualization of the peritoneal cavity, and organ inside peritoneal cavity.
Laparoscopy (lap-a-ros-copee) is an examination of the interior of the abdomen by means of an instrument called a laparoscope (lap-a- ros-cope). A laparoscope is a small telescope-like instrument with a light on one end which is passed through a small incision below the navel. This allows the doctor to view and examine the organs in the abdominal cavity.
Micro Laparoscopy is new minimally invasive diagnostic surgical procedure uses telescopes and instruments that are much smaller than normal. If this procedure is appropriate for your condition, smaller incisions will be made and postoperative abdominal tenderness may be reduced.
A diagnostic laparoscopy is a procedure in which the laparoscopic surgeon uses a laparoscope, to look at the organs and tissues inside abdominal cavity to diagnose the type & extent of disease
It’s a surgical technique in which the abdominal cavity (belly) is inflated with carbon dioxide gas (CO 2 ) and distended. A small (3-11mm thick) telescope (resembling a long and thin tube) is then inserted through the belly button, inside the abdominal cavity. This telescope called laparoscope has a light source at its end and a camera that allows the surgical team to watch on TV monitors, what is inside the belly under magnification and in great detail.
The laparoscopic surgery is a method by which surgery is done by making small incisions on the abdominal wall and inserting the instruments through specially designed ports. The procedure will be visualized with the help of a camera, which will be attached to the laparoscope.
In conventional surgery a long incision is made to gain entry into the abdominal cavity and operate. This result in increased post- operative pain, longer stay in hospital, delayed recovery, long and ugly scars, respiratory problems, higher chance of wound infection, higher chance of incisional hernia, delayed feeding after surgery. The incidence of all these is dramatically reduced by laparoscopic surgery as the incisions on abdomen are very small (5-10 mm or even smaller).
Almost all surgeries being done in open surgery are nowadays being performed Laparoscopically. The most common however are cholecystectomy (removal of the gall bladder), appendicectomy (removal of the appendix), removal of uterus(hysterectomy) removal of ovarian cysts ,tubal ligation (sterilisation), diagnostic laparoscopy, hernia repair, nephrectomy (removal of kidney).
A healthy person without any other medical ailments and complications can come in on the day of surgery or the previous day. Following a laparoscopic procedure for the gall bladder or appendix they can be discharged on the next day but for more advanced procedures three to four days in hospital may be required.
If the surgery is uneventful, feeding can be started on the same day once the patient has recovered completely from the effects of anaesthesia, provided no procedure has been performed on the intestines.
No. The advantage of this method as has been previously mentioned is that the incisions are very small, thereby reducing pain and danger of hernia. You can become ambulant as early as pain and anaesthetic factors permit.
The equipment, maintenance and procedure are more expensive but as the hospital stay and the intake of drugs is reduced it is actually the same if not less than open surgery. The cost effetivity studies and developed countries have clearly demonstreted that Laparoscopic surgury is more cost effective than the open procedures.
There are some risks when you have general anaesthesia.
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There is chance of infection or bleeding but it is less than that in open surgery.
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The abdominal organs, glands, intestines, or blood vessels may be damaged if surgeon is not experienced.
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The lining of the abdominal wall may become inflamed known as peritonitis.
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A blood clot may enter the bloodstream, and clog an artery in the lung, pelvis, or legs. Clot may break off and clog an artery in the heart or brain, causing a heart attack or stroke. But these risks are very rare .These risks are the same as in open surgery
Several procedures can be done by laparoscopy in children.
Laparoscopy is most commonly done to find and treat the cause of abdominal pain in children when other investigations have not been helpful. Appendicitis can be diagnosed and appendicectomy done laparoscopically. Paediatric Hernia can be treated Laparoscopically.
Other common indications are for treatment of benign ovarian cysts and when lower intestinal bleeding is suspected to be from a Meckel’s diverticulum.
Hernia result from a hole or defect in the layers of abdominal wall, through which the peritoneum protrudes, forming the sac. This sac can contain intestine and sometime give rise to serious problems, like, strangulation & obstruction.
This is the commonest type of hernia resulting from a hole or defect in the muscles of inguinal region, through which the peritoneum protrudes, forming the sac. Inguinal hernia's sac some time communicate with the scrotum and gives a passage to the intestine or omentum.
The hernia can be repaired by either conventional or laparoscopic methods. Inguinal Hernia repair is one of the most common operations that general surgeons perform. Laparoscopic Hernia repair is being done very successfully & has shown definite benefits over the open technique.
We can Imagine a bathtub. When we put the rubber stopper at the outlet and fill it with water, the water pressure pushes the stopper in place and keeps it fixed there. The more the water, the firmer is the stopper. Now, if we were to put the stopper from the outside. Then the water pressure in the tub is going to push the stopper out as the pressure increases.
The same scenario can be imagined with placing a mesh on the hole where the hernia is. Is it going to be better fixed from outside or inside? Open surgery places it from outside and laparoscopic surgery places it from inside.
The hernia is protrusion of the body contents through the weakness in the muscle. It is logical that something coming from inside is best dealt from inside. Also this way one does not cut and weaken the already weak muscle at the hernia site.
In the transabdominal preperitoneal (TAPP) repair, the peritoneal cavity is entered, the peritoneum is dissected from the myopectineal orifice, mesh prosthesis is secured, and the peritoneal defect is closed. This technique has been criticized for exposing intra-abdominal organs to potential complications, including small bowel injury and obstruction.
The totally extraperitoneal (TEP) repair maintains peritoneal integrity, theoretically eliminating these risks while allowing direct visualization of the groin anatomy, which is critical for a successful repair. The TEP hernioplasty follows the basic principles of the open preperitoneal giant mesh repair, as first described by Stoppa in 1975 for the repair of bilateral hernias.
The general anaesthesia and the pneumoperitoneum required as part of the laparoscopic procedure do increase the risk in certain groups of patients. Most surgeons would not recommend laparoscopic hernia repair in those with pre-existing disease conditions. Patients with Cardiac diseases and COPD should not be considered a good candidate for laparoscopy. The laparoscopic hernia repair may also be more difficult in patients who have had previous lower abdominal surgery. The elderly may also be at increased risk for complications with general anaesthesia combined with pneumoperitoneum.
The mesh used is the same as the one used for open operations over last 30 years. Its safety and efficacy is beyond doubt as proved by the numerous trials all over the world.
The cost of laparoscopic equipment and instrument that is used to fix the mesh inside increases the cost of surgery. Unfortunately these are still imported and will remain expensive till they are locally produced. However, the increased cost should be compared with the gain associated by a quicker and more productive return to work by the majority of the patients. The hidden lowering of cost is due to less leave, early return to normal activity and work, and also from the greatly reduced disruption of the family routine.
Appendix is a small worm like pouch attached to the cecum, the beginning of the colon, on the lower right side of the abdomen. It was useful in herbivorous animal for digestion of cellulose but the appendix is not necessary for human life. Sometime it can become diseased and give rise surgical emergency.
Appendicitis was first recognised as a disease entity in the sixteenth century and was called perityphlitis. Appendicitis is inflammation of the appendix. If untreated, an inflamed appendix can burst, causing infection, abscess, severe peritonitis and even death. Appendicitis can affect people at any age. It is most common in people ages 10 to 30. The danger of Appendix perforation (Burst Appendix) is more common in young children & old people.
The cause of appendicitis is usually unknown. It may occur after a viral infection in the digestive tract or when the opening connecting the large intestine and appendix is blocked. The inflammation can cause infection, a blood clot, or rupture of the appendix. Because of the risk of rupture, appendicitis is considered an emergency. Anyone with symptoms needs to see a doctor immediately.
There are no medically proven ways to prevent appendicitis. However, appendicitis is found to be less common in people who eat foods containing fiber and roughage such as raw vegetables and fruits.
The symptoms of appendicitis can initially be difficult to differentiate from an intestinal flu, which is commonly called gastroenteritis. Early symptoms may include vague bloating, indigestion and mild pain, which generally are perceived as being in the area of the umbilicus (belly-button). The main symptoms are:
Several ways have been suggested to diminish the diagnostic error that occurs if diagnosis is based solely on the clinical picture of suspected appendicitis. In fact appendicitis is a disease, which can mimic most of the causes of abdominal pain as well as some of the chest diseases. Despite new x-ray techniques, CT scans and ultrasounds, the diagnosis of appendicitis can be quite challenging. So far the most accurate non-invasive method of diagnosis is ultrasonography but this is not totally reliable. The history and physical examination will generally lead to the correct diagnosis.
Best treatment of appendicitis is its surgical removal. Mild appendicitis may sometimes be cured with antibiotics. More serious cases are treated with surgery to remove the appendix, called an appendectomy. Doctors may use laparoscopic surgery for appendectomy. This technique involves making several tiny cuts in the abdomen and inserting a miniature camera and surgical instruments. The surgeon then removes the appendix with the instruments, so there is usually no need to make a large incision in the abdomen.
Laparoscopic appendectomy provide less postoperative morbidity. Most cases of acute appendicitis can be treated laparoscopically. Laparoscopic appendectomy is a useful method for reducing hospital stay, complications and early return to normal activity. The main advantages are:
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Less post-operative pain
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Faster recovery
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Short hospital stay
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Less post-operative complications like wound infection and adhesion
No. Most surgeons would not recommend laparoscopic appendicectomy in those with pre-existing disease conditions. Patients with cardiac diseases and COPD should not be considered a good candidate for laparoscopic appendectomy. Laparoscopic appendectomy may also be more difficult in patients who have had previous lower abdominal surgery. The elderly may also be at increased risk for complications with general anaesthesia combined with pneumoperitoneum. Laparoscopy does add to the surgical risk in patients with a lowered cardio-pulmonary reserve with regard to the consequences of the pneumoperitoneum and a longer operative time.
In experienced hand there is not any specific complication directly related to laparoscopic procedure but if the surgeon is not trained enough in laparoscopy than the chance of following complication is there:
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Missed diagnosis
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Bleeding
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Incomplete appendectomy
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Visceral Injury
Leakage of purulent exudates from appendix at the time of operation:
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Intra-abdominal abscess
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Hernia
But inexperienced hands these complications are extremely rare. and altogether laparoscopic procedure has less complication than conventional surgery
Faq's for Patients :
Frequently asked questions about laparoscopic cholecystectomy
The gall bladder is that part of the digestive system which stores and secretes the bile salts that are used in the process of breaking down food into its adsorptive components. A lack of these salts leads to malabsorption maladies. The gall bladder is located on the right side of the body and is connected to the biliary tract system by the cystic duct.
When we eat, bile is added to the food as it passes out into the duodenum. Bile is stored in the gallbladder, which serves as a reservoir of bile. When we eat, fatty foods, the gallbladder contracts and push extra bile out through the common bile duct and into the duodenum. Bile breaks the fatty material of food into tiny fragments that can be more easily absorbed by the intestine.
Gall stone is the stone which develops inside the cavity of gallbladder. There are basically three types of gallstones (I) Metabolic- Most gallstones that occur in western civilizations are composed primarily of cholesterol. Therefore, ingestion of too much cholesterol is considered a risk factor. For women, the risk of cholesterol gallstones increases with age, use of oral contraceptive, rapid weight loss, family history of diabetes mellitus, and inflammatory bowel disease (Chrohn's disease and Ulcerative Colitis). (II) Pigment stones- These are composed primarily of calcium bilirubinate. This is found in people who suffer from chronic hemolytic (the destruction of blood cells) states such as sickle cell disease. It is also commonly found in Asian and African populations. A family history of gallstones also increases the risk of stoneformation. (III) Infaction- Recurrent infections of the abdomen like typhoid fever have been linked with higher incidence of gallstone formation. Bacteria have been found entombed in the gallstones & are supposed to be responsible for gallbladder disfuntion leading to stone formation. In many cases, more than one of these factors play a role but some people form stones without any knows risk factors.
Cholecystitis is defined as inflammation of the gall bladder. Most commonly this problem; inflammation, arise in this system when the flow of bile is stopped or interrupted due to stone (90%) or if infection of biliary tract occurs.
The usual symptoms which causes problem in sudden acute inflammation is:
Some people develop polyps within the gallbladder. Polyps can cause inflammation similar to those caused by gallstones. Polyps are associated with a potential for cancer, but this is relatively rare. It is usually recommended that patients with gallbladder polyps have their gallbladder removed, even if they have only minor or no symptoms. Some time Gallbladder can be diseased without stone or polyp known as acalculous cholecystitis. In this condition gallbladder becomes inflamed if it simply fails to empty properly. The symptoms are the same as those experienced by patients with gallstones. In this condition some time it is essential to remove the Gallbladder.
Non symptomatic stone may be left untreated if the patient is not of high risk group like diabetes etc. The symptomatic stone should be removed altogether with gallbladder by surgery.
Treatment of acute Cholecystitis depends on the severity of the attack. In severe cases, therapy initially is supportive with IV fluid replacement and nasogastric suction (a tube placed through the nose into the stomach) for the first day or two. Surgery is then performed to remove the gallbladder. Cholesterol stones in patients who are not surgical candidates, or in those who show no sign of cystic duct obstruction, may be treated with medications aimed at releiving the symptomes. There are a significant number of patients who will require surgical removal of the gallbladder to permanently alleviate symptoms. In fact, patients who are against surgery are at increased risk for developing perforation of the gallbladder, which carries about 25% mortality rate.
One is conventional open surgery and other is laparoscopic.
Explaining laparoscopic surgery is best accomplished by comparing it to traditional surgery. With traditional or 'open' surgery, the surgeon must make a cut that exposes the area of the body to be operated on. Until a few years ago, opening up the body was the only way a surgeon could perform the procedure. Now, laparoscopy eliminates the need for a large cut. Instead, the surgeon uses a laparoscope, a thin telescope-like instrument that provides interior views of the body. These days laparoscopic cholecystectomy is the gold standard treatment for cholecystitis or gall stone. Laparoscopic method has now virtually replaced the open procedure for the treatment of gallbladder disease.
During a laparoscopic gall bladder operation, the surgeon grasps the gall bladder from one instrument and with other instrument he frees its duct and artery. These are then clipped or tied off and the gall bladder removed from the liver bed. After ensuring that there is no bleeding the gall bladder including the stones is removed through one of the cannulas. The skin is closed with absorbable sutures. Patient should be able to go home in 12-24 hours after surgery.
No, the telescope is used only to see and is not involved with the operation. Operation is done by long cylindrical instruments which is always under the vision of surgeon on monitor.
No, the small cuts mean that less of the body is exposed to infection. The less post-operative wound infection is one of the advantage of laparoscopic surgery.
The patient can start drinking liquids soon after coming out of the anaesthesia which is about 4 hours after the operation. They can start eating soon thereafter. The patient is allowed to get off the bed 4 hours after the surgery and walk to the toilet to pass urine. They are usually allowed to go home the next day, can climb stairs and the majority can get back to routine activity in 5 days and back to work in about 10 days.
The operation is ideally suited for the fat patient as the thickness of the tummy wall is immaterial when putting in the telescope and instruments. This is in contrast to an open operation where the fatter patient has a deeper and larger cut causing more bleeding, stitches, and pain. The children can also very well tolerate laparoscopic intervention. The instrument used to do laparoscopy in child patients are less in thickness than adult patients. usually 5 mm and some time 3 mm.
No. Most surgeons would not recommend laparoscopic cholecystectomy in those with pre-existing disease conditions. Patients with cardiac diseases and COPD should not be considered a good candidate for laparoscopy. Laparoscopic cholecystectomy may also be more difficult in patients who have had previous upper abdominal surgery. The elderly may also be at increased risk for complications with general anaesthesia combined with pneumoperitoneum. Laparoscopy does add to the surgical risk in patients with a lowered cardio-pulmonary reserve with regard to the consequences of the pneumoperitoneum.
Frequently asked questions about Laparoscopic fundoplication
This is a surgical procedure done for Gastro Esophageal Reflux Disease (GERD). In this operation the fundus of the stomach which is on the left of the esophagus and main portion of the stomach is wrapped around the back of the esophagus until it is once again in front of this structure. The portion of the fundus that is now on the right side of the esophagus is sutured to the portion on the left side to keep the wrap in place. The fundoplication resembles a buttoned shirt collar. The collar is the fundus wrap and the neck represents the esophagus imbricated into the wrap. This has the effect of creating a one way valve in the esophagus to allow food to pass into the stomach, but prevent stomach acid from flowing into the esophagus and thus prevent GERD.
Gastro esophageal Refux Disease (GERD) is defined as the failure of the antireflux barrier, allowing abnormal reflux of gastric contents into the esophagus. It is a mechanical disorder which is caused by a defective lower esophageal sphincter, a gastric emptying disorder or failed esophageal peristalsis.
Medical therapy is the first line of management. Esophagitis will heal in approximately 90% of cases with intensive medical therapy. However, symptoms recur in more than 80% of cases within one year of drug withdrawal. Since it is a chronic condition, medical therapy involving acid suppression and/or pro-motility agents may be required for the rest of a patient's life. Nissen fundoplication is a safe and effective treatment for GERD when medical management fails. The expense and psychological burden of a life time of medication dependence, undesirable life style changes, uncertainty as to the long term effects of some newer medications, and the potential for persistent mucosal changes despite symptomatic control, all make surgical treatment of GERD an attractive option.
Nissen fundoplication has emerged as the most widely accepted procedure for patients with normal esophageal motility. Two surgical techniques are employed to perform Nissen fundoplication: open surgery or laparoscopic surgery. In open surgery we make a 6- to 10-inch incision in the middle of the abdomen, from just below the ribs to the umbilicus. If the patient has a hiatal hernia, that is repaired first and then the surgeon performs the procedure. In the laparoscopic procedure, we makes five small incisions in the abdomen. A telescope is inserted through one incision. This allows the surgeon to see the interior of the abdominal cavity. The surgical instruments are inserted through the other incisions. The fundoplication is performed in the same fashion as in open surgery.
The operation is ideally suited for the fat patient as the thickness of the tummy wall is immaterial when putting in the telescope and instruments. This is in contrast to an open operation where the fatter patient has a deeper and larger cut causing more bleeding, stitches, and pain.
No. Most surgeons would not recommend laparoscopy in those with pre-existing disease conditions. Patients with cardiac diseases and COPD should not be considered a good candidate for laparoscopy. Laparoscopic fundoplication may also be more difficult in patients who have had previous upper abdominal surgery. The elderly may also be at increased risk for complications with general anaesthesia combined with pneumoperitoneum. Laparoscopy does add to the surgical risk in patients with a lowered cardio-pulmonary reserve with regard to the consequences of the pneumoperitoneum and a longer operative time.
Babies should be kept lying on their stomach with their head propped up about 30 degrees. Lying in this position causes the stomach to fall forward, closing the connection between the stomach and the esophagus. Some infants will not lie in this position without crying, and if the baby cries all the time, they fill up their stomach with air, grunt, and strain, which tends to make their reflux worse. If babies cries in this position then it is much better to lie them down or place them in a seat that reclines a bit than to have them slumped down. Many infants will have less vomiting when they are switched from one type of milk to another or milk. Baby should take small diets. Over-feeding tends to make reflux worse. If these measures are not useful then anti reflux medicine should be tried, prescribed by a paediatrician.
Fortunately, it is extremely rare for children suffering from gastroesophageal reflux to require surgery. Commonly they respond to dietary correction and physiological correction of habits. In children who do require surgery, the most commonly performed operation is called Nissen fundoplication.
Frequently asked questions about Laparoscopic Complications
Like any surgery laparoscopy has the potential risk of anaesthesia and operation. Although laparoscopy causes less tissue injury then its open counterpart but it is wrong to say that it is totally risk free operation. Complications of laparoscopy may be categorized according to the various phases of the operation. Problems related to induction of the pneumoperitoneum and insertion of the laparoscope includes cardiac arrhythmias, perforation of a hollow viscus, and puncture of a solid organ, bleeding, and subcutaneous emphysema. In most reported series, complications of laparoscopic surgeries are minor and occur with a frequency of 1-5%, and the mortality rate is approximately 0.05%.
The common complications are:
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Complications of anaesthesia like cardiac arrhythmia, and respiratory complications.
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Transient high fever.
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Abdominal wall ecchymosis.
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Pneumonia and bronchitis.
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Bleeding due to injury of unrecognised blood vessels.
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Injury to internal solid organs.
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Perforation of hollow viscus
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Injury of major blood vessels.
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Thromboembolism.
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Infection.
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Hernia.
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Adhesion formation.
All these complication are not specific to laparoscopy. These complications are more frequent in open surgery than laparoscopy.
Infection is the most common complication of any surgical procedure. In laparoscopic surgery rate of infection is very less than open surgery but many statistical studies shows that infection is still the most common complication after laparoscopic surgery. This complication is not related to the laparoscopic technique itself but depends on the sterilization and theatre environment of the hospital. The Injury to the bowel is the second most common cause of morbidity and mortality after laparoscopic surgery.
The Injury to bowel and blood vessels is specially related to the technique of laparoscopic surgery. There is a small risk of complications that include, injury to the abdominal organs, intestines, urinary bladder or blood vessels. If the surgeon is not experienced than he can perforate an innocent bowel with the long pointed instruments of laparoscopic surgery. If complication is severe an additional operation may be required with a larger incision to either stop bleeding or repair an injury that cannot be fixed by laparoscopy. In case of infection and other mild complication short course of appropriate antibiotic is sufficient to overcome the problem. In experienced hands, complications may occur but are not frequent. Patient safety should be surgeon's strongest concern.
If patient has fever, chills, vomiting, is unable to urinate, developes increasing redness at an incision site, or if pain is worsening, distension of abdomen or any discharge from the port site, patient should contact their surgeon promptly.
It is a rare complication of minimally invasive surgery due to irritation of peritoneum. Carbon dioxide is known to be a peritoneal irritant which produces congestion of the vessels in patients undergoing laparoscopy. An exaggerated response to the irritant may manifest symptoms of weeping peritoneum which is pyrexia, Increased heart rate and respiration cramp abdomen, vomiting and if not treated sometimes leads to severe peritonitis.
Incisional bowel herniation is a complication of operative laparoscopy. Herniations occur through ports 10 mm in size at both umbilical and extraumbilical sites if not closed properly after operation. Surgeons should recognize the importance of closing fascia at these larger port sites and should maintain a high degree of suspicion in any patient who has a slow recovery with intermittent nausea and vomiting after an operative procedure. The underlying fascia and peritoneum should be closed not only when using trocars of 10mm and larger as previously suggested but also when extensive manipulation is performed through a 5mm trocar port, causing extension of the incision.
Contraindications for laparoscopy are relative and include the uncooperative patient, uncorrectable coagulation defects, severe congestive heart failure, respiratory insufficiency, suspected acute, diffuse peritonitis, and the presence of distended bowel. If tense ascites is present, large volume paracentesis can be performed as the preliminary step in the laparoscopy. Previous laparotomy incisions may necessitate alteration of the usual trocar insertion site, or may represent a contraindication to the procedure. Most surgeons would not recommend laparoscopy in those with pre-existing disease conditions. Patients with cardiac diseases and COPD should not be considered a good candidate for laparoscopy. Laparoscopy may also be more difficult in patients who have had previous abdominal surgery. The elderly may also be at increased risk for complications with general anaesthesia combined with pneumoperitoneum. Laparoscopy does add to the surgical risk in patients with a lowered cardio-pulmonary reserve with regard to the consequences of the pneumoperitoneum and a longer operative time.
Patient should not eat or drink for six to eight hours before the procedure.
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Report of all the investigations should be presented to the doctor like blood, urine or X-ray testing as they may be required before your operative procedure.
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Patient should have shower the evening before or the day of your operation. Cleaning of umbilicus ("belly button") with antiseptic soap, water, and a Q-tip is important.
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Patient should report to the hospital at the correct time, which is usually 4-6 hours earlier than your scheduled surgery.
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If patient take any medication on a daily basis, discuss this with your surgeon as you may need to take some or all of the medication on the day of surgery with a sip of water. If you take aspirin, blood thinners or arthritis medication, discuss this with your surgeon.
The outcome of any laparoscopic procedure greatly depends on the experience of the surgeon. In a study from Los Angeles, the outcome of cases operated by generalists (285) were compared with those performed by specialised laparoscopic surgeons (n = 232). 10 abscesses occurred post operatively (2.4%) in the group of patients whose operation was done by general surgical services as compared to one case (0.025%) in the group of patients whose operation was performed by expert. Laparoscopy by expert (using skilled dissection, use of retrieval bag, proper ligation of stump and thorough peritoneal toilet) decreases complication rate. In experienced hands, complications may occur but are not frequent. Patient safety should be your surgeon's strongest concern.
It is the laparoscopic operation which should be performed without any delay in life threatening situations. The gynaecologists were the first to start laparoscopy in the diagnosis and treatment, but since 1990s a lot of general surgeons have started to use this technique in the abdominal urgency, especially: abdominal trauma, acute cholecystitis, acute appendicitis, perforated peptic ulcer or intestinal obstruction. Initially laparoscopy was tried for elective surgery only, but with the advent of new technology many of the emergency surgeries are possible by laparoscopic method. Emergency Laparoscopic treatment of acute abdomen was first proposed by Philippe Mouret in 1990. The diagnostic value of emergency laparoscopy has been proved since the 1950s-1960s, but the emergency therapeutic application of the laparoscopic technique for the surgical treatment is recent.
Acute abdominal emergencies are diagnosed incorrectly or too late in 5 to 20% of cases. The delay in appropriate treatment, improper surgical access route and repeat surgery causes higher morbidity and mortality. Hospital stay and time of recovery are longer, resulting in higher costs for the community. In spite of rising accuracy of non-invasive methods there remain limitations which sometimes cannot be overcome by these investigations. In these condition only useful option is laparoscopy. Recently applicability of diagnostic and therapeutic emergency laparoscopy are highly demanded.
Despite new x-ray techniques, CT scans and ultrasounds, the diagnosis of acute abdomen can be difficult at times. So far the most accurate non-invasive method of diagnosis is ultrasonography but this is not totally reliable. The history and physical examination will generally lead to the correct diagnosis. According to one prospective non-randomised study laparoscopy may prevent unnecessary appendicectomy in 24% of patients with acute abdomen. Laparoscopy reveals a clinical misdiagnosis rate of 8% in male, and 41% in female of reproductive age group. Laparoscopic emergency intervention gives a better evaluation of the peritoneal cavity than that obtained by the standard laparotomy incision. The procedure allows rapid and thorough inspection of the para-colic gutters and the pelvic cavity that is not possible with the open approach. The emergency laparoscopic approach for patients with acute abdomen improves the diagnostic accuracy and is therefore now a days it is recommended and accepted world wide.
The emergency laparoscopy is done in the same way as elective laparoscopy only difference is that emergency laparoscopy should be done by a specialist laparoscopic surgeon and he should be able to perform laparoscopic surgery, once pathology is diagnosed inside the abdomen. If the surgeon is not a specialist laparoscopic surgeon than he will diagnose the disease and if he does not know the laparoscopic method to correct that particular disease, he will either convert the case to open, or withdraw his telescope.
No, the telescope is used only to see and is not involved with the operation. Operation is done by long cylindrical instruments which is always under the vision of surgeon on monitor.
No, the small cuts mean that less of the body is exposed to infection. The less post-operative wound infection is one of the advantage of laparoscopic surgery.
The recovery period after emergency laparoscopy depends on the diagnosis of the patient at the time of operation and what the surgeon did to treat the disease. In most of the cases the patient can start drinking liquids soon after coming out of the anaesthesia which is about 4 hours after the operation. They can start eating soon thereafter. The patient is allowed to get off the bed 4 hours after the surgery and walk to the toilet to pass urine. They are usually allowed to go home the next day, can climb stairs and the majority can get back to routine activity in 5 days and back to work in about 10 days.
The operation is ideally suited for the fat patient as the thickness of the tummy wall is immaterial when putting in the telescope and instruments. This is in contrast to an open operation where the fatter patient has a deeper and larger cut causing more bleeding, stitches, and pain. The children can also very well tolerate laparoscopic intervention. The instrument used to do laparoscopy in child patients are less in thickness than adult patients. usually 5 mm and some time 3 mm.
Relative contraindications to emergency laparoscopy are:
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The general anaesthesia and the pneumoperitoneum required as part of the laparoscopic procedure may increase risk in certain patient groups. Most surgeons would not recommend emergency laparoscopy in such patients.
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Patients with cardiac diseases and COPD are not good candidate for emergency laparoscopy.
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Patients who have had previous extensive abdominal surgery, emergency laparoscopy may be difficult.
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Those with diminished cardio-pulmonary reserve are also at risk because of the adverse effects of the pneumoperitoneum on the CVS and a longer operative time.
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Those with bleeding disorders or defective haematological values or pre-existing debilitating disease are also not a good candidate for emergency laparoscopy.
