laparoscopy


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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.

laparoscopy

 [lap″ah-ros´kah-pe]
examination by means of the laparoscope; called also celioscopy. adj., adj laparoscop´ic.
Laparoscopy. From Frazier et al., 2000.

lap·a·ros·co·py

(lap'ă-ros'kŏ-pē),
Examination of the contents of the abdominopelvic cavity with a laparoscope passed through the abdominal wall.
See also: peritoneoscopy.
Synonym(s): abdominoscopy

Laparoscopy first became clinically practicable with the development of fiberoptics in the 1960s and of high-intensity, low-heat halogen bulbs in the 1970s. The technique has become standard, in selected cases, for many routine surgical procedures formerly requiring laparotomy, such as appendectomy, cholecystectomy, inguinal herniorrhaphy, oophorectomy, a second look after excision of an ovarian tumor, and diagnostic evaluation of endometriosis and female infertility. The peritoneal cavity is first inflated with CO2 gas, and the laparoscope passed through a small incision in the abdominal wall. One or two further incisions are usually required to provide surgical access to the area of interest. For some procedures a 6- to 8-cm incision may be made so that the surgeon can insert one hand. An elaborate armamentarium of surgical instruments has been developed to perform incision, drainage, excision, cautery, ligation, suturing, and other procedures with the laparoscope. The risk of intraoperative and postoperative complications, hospitalization time, and the cost of treatment are generally much less with laparoscopic surgery than with traditional open procedures.

laparoscopy

/lap·a·ros·co·py/ (lap″ah-ros´kah-pe) examination or treatment of the interior of the abdomen by means of a laparoscope.

laparoscopy

(lăp′ə-rŏs′kə-pē)
n. pl. laparosco·pies
1. An operation in which a laparoscope is used, as in surgical treatment of endometriosis.
2. Examination by use of a laparoscope.

lap′a·ro·scop′ic (-ər-ə-skŏp′ĭk) adj.
lap′a·ros′co·pist n.

laparoscopy

[lap′əros′kəpē]
a technique to examine the abdominal cavity with a laparoscope through one or more small incisions in the abdominal wall, usually at the umbilicus. The procedure is used for inspection of the gallbladder, ovaries, and fallopian tubes; diagnosis of endometriosis, intestinal conditions, and hernias; destruction of uterine leiomyomas; and myomectomy. Gynecological sterilization also can be accomplished by fulguration of the oviducts or by tubal ligation. Also called abdominoscopy. See also endoscopy, laparoscope.
enlarge picture
Laparoscopy

laparoscopy

Peritoneoscopy  Procedural medicine A procedure in which a laparoscope is used for various procedures–eg, lyse adhesions, tubal sterilization, remove foreign bodies, tissue and organs, stage cancer, fulgurate–'zap'–endometriosis implants, biopsy the liver, ovary, etc, diagnose abdominal pain, visualize the liver, evaluate pelvic masses–eg, lymphoma, and obtain biopsies. See Laparotomy.

lap·a·ros·co·py

(lap'ă-ros'kŏ-pē)
Examination of the contents of the peritoneum with a laparoscope. The abdomen is first inflated with carbon dioxide, and the laparoscope passed through a small incision in the abdominal wall. The device is frequently used to view the female reproductive organs, in particular where endometriosis or pelvic inflammatory disease is suspected. Fitted with grasping and cutting tools, the laparoscope can perform minor surgery and take tissue samples for biopsy.
See also: peritoneoscopy

laparoscopy

Direct visual examination of the interior of the abdomen, through a narrow optical device (endoscope) passed through a small incision in the abdominal wall. Endoscopes use fibre optic illumination and viewing channels. Laparoscopy allows a range of operations to be performed using instruments passed in through the endoscope.

laparoscopy

the technique of using an illuminated tubular instrument, the laparoscope, to examine structures within the abdomen.

laparoscopy (laˈ·p·räsˑ·k·pē),

n an examination of the internal aspects of the body with a thin optical or fiberoptic instrument known as a laprascope. Also called
peri-toneoscopy.
Enlarge picture
Laparascopy.

laparoscopy

examination of the peritoneal cavity by means of the laparoscope.
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