As of Friday, June 27, 2014
DEAR DOCTOR K: I need to have surgery in my abdominal area. My surgeon said he can do it “laparoscopically.” What does that mean?
DEAR READER: It is good news. It means that the surgery you’ll have will involve cutting through less tissue, and it will be easier to recover.
Forty years ago, abdominal surgery would have required a relatively large incision. The surgeon had no way of looking at your insides and seeing what needed to be fixed or cut out. He or she had to open you up wide to get a good look, and to get his or her surgical instruments inside your body.
Laparoscopic surgery is done through much smaller incisions. It’s sometimes called “keyhole” surgery, or “minimally invasive” surgery. Because the incision is smaller, laparoscopic surgery tends to be less painful and leave smaller scars. Recovery is faster, and there is a reduced risk of serious bleeding.
Today’s laparoscopes are remarkable feats of mechanical engineering; they have revolutionized the diagnosis and treatment of many diseases. Laparoscopes are flexible tubes. At the tip of the tube are a light and a camera that sends a picture to a television screen. The doctor monitors his or her work on this screen.
Also at the tip of the tube are the tiny surgical instruments that perform the surgery — for example, graspers to hold tissue firmly and scissors to cut the tissue.
Laparoscopic abdominal surgery is done in an operating room under general anesthesia. The surgeon inserts the laparoscope through a very small incision, less than an inch long — like a keyhole. The incision is usually made in or just below the navel. A gas such as carbon dioxide or nitrous oxide is pumped into the abdomen. This helps lift your abdominal wall off of your pelvic and abdominal organs, and allows the camera to view the organs clearly.
At this point, the surgeon makes additional small incisions through which he or she can insert surgical instruments.
Your surgeon can use a wide variety of surgical instruments. These include instruments to cut or clip internal structures or burn away scar tissue. Other instruments may be used to remove small biopsy samples or even entire internal organs.
At the end of the surgery, the surgeon withdraws the instruments, removes the gas and stitches the incisions closed.
Patients recover much more easily from laparoscopic surgery than regular (open) abdominal surgery because the incisions are smaller. The risk of complications from anesthesia is smaller as well. That is because most laparoscopic surgeries are fairly simple and don’t require extended anesthesia.
Doctors and biological scientists have made most of the great advances in medicine over the past century. But don’t forget the engineers. They gave us the CT and MRI scans, and the laparoscope.
Dr. Komaroff is a physician and professor at Harvard Medical School. To send questions, go to AskDoctorK.com, or write: Ask Doctor K, 10 Shattuck St., Second Floor, Boston, MA 02115.