Is a laparoscopy a major operation

Laparoscopic reconnaissance

Dear Patient,

In order to assess your disease and, if necessary, treat it at the same time, you should have a laparoscopy laparoscopy.
In contrast to a large abdominal incision (laparotomy), in "keyhole surgery" the surgical instruments are introduced into the body cavity through small abdominal incisions.

The advantage of this method is that there is much less damage to the structures of the abdominal wall, fewer complications during and after the operation, and faster recovery after the operation.

Technical implementation of the intervention

In order to create space for the instruments to be introduced and the operation to be performed, the abdominal cavity is first filled with about 3-4 liters of CO2 gas, which is of course removed again after the operation. This lifts the abdominal wall (skin, fatty tissue, muscles) from the abdominal organs and creates a kind of "vault". The abdominal organs can thus be better assessed.

  • This is achieved by inserting a thin special needle 1 cm below the navel into the abdominal cavity, through which the gas is introduced or
  • through a slightly larger incision (approx. 2 cm) also below the navel after previous operations or if there is a suspicion of severe adhesions, the abdominal wall is opened layer by layer (so-called open laparoscopy) or
  • below the left costal arch, also if adhesions are suspected, in order to avoid injuries to the intestines, for example.

Then the approximately 10 mm wide optic (laparoscope or endoscope) is inserted through a guide sleeve (so-called trocar). A camera (video camera) is attached to these optics, with which the abdominal cavity can now be assessed on a large screen (monitor) and the entire operation can be recorded.
For your own information and for the information of your referring doctor, photo prints or digital photos are made that can be attached to the surgery report.

 

CO2 gas is passed through the umbilicus into the abdominal cavity and then a rigid tube is inserted. This is provided with an optical system and light can be directed into the abdomen. The abdomen can be viewed with 7x magnification.

 

The illustration shows a typical position of the optics in the navel and the surgical sleeves in the lower abdomen, as used in many gynecological operations. Recovered material can be recovered using plastic bags. Uterine nodes (myomas) or even entire uterus can be recovered by special electrical shredding devices through 1-2 cm openings.

The hemostasis is achieved by heating, but suturing is also possible without any problems.

With the exclusively diagnostic laparoscopy, no further punctures are usually required. However, if an operation is planned on the fallopian tubes, ovaries, uterus, lymph nodes, etc., i.e. operative laparoscopy (operative laparoscopy), additional accesses or guide sleeves are required for the operation to secure instruments (grasping forceps, scissors, needle holders and sutures, etc.) to be able to introduce into the abdominal cavity.

 

For this purpose, up to 3 further approx. 0.5 to 1 cm skin incisions are made in the pubic hair area (sometimes also in the area of ​​old abdominal incisions), through which correspondingly large guide sleeves are inserted under sight. As a rule, these punctures heal well and do not leave any cosmetically annoying scars.

Sometimes an additional instrument is required inside the uterus (e.g. when checking whether the fallopian tubes are open to fluid or gas, the so-called chromopertubation): a probe is attached to the cervix via the vagina in order to inject a dye or air.

To remove large fluid-filled tumors (cysts e.g. on the ovary), these are sucked off with a puncture needle in a small plastic bag (endobag) that is inserted into the abdominal cavity via the guide sleeves, so that the contents cannot empty into the abdominal cavity.
In the case of large, solid benign tumors (e.g. myomas = muscle nodes), either the lower middle abdominal incision is slightly enlarged to remove it from the abdominal cavity, or the tumor is broken up piece by piece using a motor-driven punch and removed via the guide sleeve.
Occasionally, during longer procedures, a urinary catheter has to be inserted temporarily during the operation in order to empty the constantly filling bladder, which could disturb the surgical area. Basically, before each procedure, the urinary bladder is emptied with a catheter in order to avoid injury when inserting the guide sleeves. Both of these can occasionally lead to irritation or even urinary tract infections after the operation.

After an operative laparoscopy (laparoscopy), a tube (so-called drainage) is seldom placed in the abdominal cavity in order to be able to drain the wound secretion and to be able to recognize complications (secondary bleeding or possible damage to organs [intestines / urinary bladder]) in good time.