This explanation of “laparoscopy” describes no specific operation. Rather, it is intended as a supplement to the Procedure Education Literature that you have received in the event that part or all of your procedure/surgery is going to be performed with laparoscopic technique. Throughout this pamphlet, we will refer to your “primary pamphlet” as the one describing your particular operation or procedure.
The surgical procedure that popularized laparoscopy is the cholecystectomy (removal of the gallbladder). Over the past decade, laparoscopy has become increasingly popular for urological surgeries as well. In pediatric urology, laparoscopy is most commonly used for performing an orchiopexy (bringing an undescended testicle into the scrotum). In adult urology, the most common laparoscopic operations are partial or total nephrectomy (removal of part or the entire kidney). Adrenalectomy (surgery to remove a small hormone-producing organ on top of the kidney), as well as lymphadenectomy (biopsy and/or removal of lymph nodes from the abdomen or pelvis) are sometimes performed laparoscopically. Some surgeons may perform incontinence surgeries in this fashion. Each year, there are an increasing number of radical prostatectomies (surgery performed to remove a cancerous prostate) performed in Europe and the United States.
As opposed to a laparotomy (open surgery through an incision), laparoscopy involves performing surgery through a few small holes in the abdomen. Through these holes, a camera and other instruments are placed, and the surgeons visualize the procedure on a television screen. With advances in camera optics (quality of the picture), laparoscopic instruments, and laparoscopic technique, many operations can be performed entirely or partially in this fashion.
The technique of hand-assisted laparoscopy uses a combination of laparoscopy with a short incision that allows just one hand to be placed in the abdomen. The advantage of this technique is that it allows the surgeon to make a smaller incision, and often, in an area that is less painful in the post-operative period. In urology, this technique is most commonly employed for a nephrectomy (removal of a kidney).
As is often true with an open abdominal procedure, it may help the surgeon if your small intestine and colon are empty. You should avoid constipating foods (i.e. rice, bananas, red meat) for a few days prior to your procedure. Some surgeons may request that you clean out your intestines or colon the evening prior to your procedure. If asked to do so, you may receive instructions from your surgeon.
It is necessary, as with any procedure or operation requiring anesthesia, that you have not eaten for at least 8 hours prior to the scheduled time.
Depending on the particular procedure, we may ask you to clean out your small intestine and colon the night before. * If we ask you to do so, instructions will be included in the primary literature pamphlet.
An empty gastrointestinal tract may facilitate the surgery and may also make you more comfortable in the postoperative period. You should plan a light lunch and early, very light dinner the day prior. For the remainder of the evening, it is important to continue to drink plenty of clear fluids, but you CANNOT eat. You may drink up until midnight but not after and not in the morning of your scheduled surgery.
If you are on medications that must be taken, you will have discussed this with us and/or the anesthesiologist and instructions will have been given to you. The procedure will not be performed if you are currently taking, or have recently taken any medication that may interfere with your ability to clot your blood (“blood thinners, aspirin, anti-inflammatory medicines, etc….”). The most common of these medications are aspirin and all related pain relievers or anti-inflammatory compounds (whether prescription or over-the-counter). Please refer to the attached list and tell us if you took any of these within the past 10 days. If your new medication is not on the list, alert us immediately so that we may ensure optimal procedure safety. We will have reviewed all of your current medications with you during the pre-operative/pre-procedure consultation. You are obligated to inform us if anything has changed (medication or otherwise) since your previous visit.
Laparoscopic procedures are performed under general anesthesia (complete sleep). The procedure differs from open surgery in that there will be anywhere from two to five less than one inch incisions placed on your abdomen instead of one larger incision. With hand-assisted laparoscopy, there will be one longer incision and fewer smaller incisions. After the camera is placed in an initial incision (usually near the bellybutton or navel), the abdominal cavity is inflated with a gas (carbon dioxide) to lift the abdominal wall away from the intra-abdominal or pelvic organs. This elevation provides the necessary space to perform and properly visualize the operation. The pressure of the gas in the abdominal or pelvic cavity is monitored. Small instruments are then placed (under camera vision) through other small carefully positioned incisions into the abdominal or pelvic cavity. The camera projects the picture onto a television screen. The remainder of the procedure is fairly identical to the steps described in the primary pamphlet. After the surgery is complete, the instruments are removed and each of the holes are usually sutured close. Sterile bandages are put over the small incision sites.
After the procedure, you will be in the recovery room until you are ready to be discharged or moved to a regular room (if you are being admitted). This will have been discussed with you prior. There will be small dressing over each of the small incision sites. If a longer incision was made (hand-assisted laparoscopy), it will be covered with a larger bandage. Otherwise, the “post procedure” expectations are the same as those in the primary pamphlet.
The purpose of laparoscopy is to help minimize post-operative pain, hospital stay, and overall recovery. In most instances, this is accomplished. In many, but not all surgeries, actual operative time is also reduced. However, in some operations, operative time may be the same or even greater as compared with an open operation.
In any laparoscopic surgery, your surgeon will have told you that there is a chance of “conversion” to an open procedure. This means that a laparoscopic procedure has to be changed to an open operation. The indication to do so may be one of two scenarios. The first is that there are findings (scarring, unexpected anatomy) that prevent the surgeon from completing the procedure effectively or safely. The second is that there is a problem during laparoscopy that the surgeon feels might be more effectively handled through a larger incision.
Conversion is a decision made by the surgeon that is in the patient’s best interest, and it should not be considered to be a complication. It simply means that your surgery will be completed in the open fashion.
ALL surgical procedures (open or laparoscopic), regardless of complexity or time, can be associated with unforeseen problems. They may be immediate or even quite delayed in presentation. You should refer to the primary pamphlet describing your particular surgery for the complete list of complications. Some of those listed below are particular to laparoscopy, while others are already listed in your primary pamphlet. While we have discussed these and possibly others in your consultation, we would like you to have a list so that you may ask questions if you are still concerned.
*Laparoscopic technology and instrumentation have evolved tremendously over the past decade. As you read below, bear in mind that complications particular to laparoscopy (subcutaneous emphysema, tension pneumoperitoneum and pneumothorax, pneumomediastinum, pneumopericardium and gas embolism) while possible, are not common.
We provide this literature for patients and family members. It is intended to be an educational supplement that highlights some of the important points of what we have previously discussed in the office. Alternative treatments, the purpose of the procedure/surgery, and the points in this handout have been covered in our face-to-face consultation(s).
The information contained in this document is intended solely to inform and educate and should not be used as a substitute for medical evaluation, advice, diagnosis or treatment by a physician or other healthcare professional. While UUANJ endeavors to ensure the reliability of information, such information is subject to change as new health information becomes available. UUANJ cannot and does not guaranty the accuracy or completeness of the information contained in this document, and assumes no liability for its content or for any errors or omissions. Please call your doctor if you have any questions.