Background Information:

What are the other Names for the Procedure?

• Keyhole Surgery
• Minimally Invasive Surgery
• Minimally Invasive Technique

What is Laparoscopy surgical procedure?

• Laparoscopy involves a visual examination of the internal body structures with a camera. This commonly involves the abdominal and pelvic organs, but the technique is also being increasingly used in other areas, such as the chest, spine, etc.
• This procedure will not only help in a diagnosis, but also in the treatment of certain conditions. It has the advantage of being minimally-invasive, compared to traditional open surgeries

What part of the Body does the Procedure involve?

A Laparoscopy involves all contents within the body part that is being explored; but generally, it is the abdomen or pelvic region.

Why is the Laparoscopy surgical procedure Performed?

A Laparoscopy is performed for examining body organs - either to make a diagnosis, or treat conditions surgically. Some conditions that commonly use laparoscopic procedures include:

• General surgical procedures involving the gall bladder, intestines, liver, appendix, etc.
• Evaluating organ damage following trauma
• Gynecological conditions, such as uterine fibroids, endometriosis, sterilization procedures, pelvic mass, etc.
• This procedure may be performed for investigative reasons, such as female infertility
• Slippage of the uterus (prolapse)
• Chronic infection of the pelvis
• For diagnosis/treatment of complicated pregnancies
• Weight loss surgeries
• Minimally Invasive Techniques are also being applied to spine surgeries and some surgeries involving the heart.

What are some Alternative Choices for the Procedure?

Open surgery of the abdomen (laparotomy) is an alternative procedure that may be employed, instead of a Laparoscopy.

What are the Recent Advances in the Procedure?

Robotic Laparoscopic surgery that allows for a greater precision is under development.

What is the Cost of performing the Laparoscopy surgical procedure?

The cost of Laparoscopic surgical procedure depends on a variety of factors, such as the type of your health insurance, annual deductibles, co-pay requirements, out-of-network and in-network of your healthcare providers and healthcare facilities.

In many cases, an estimate may be provided before the procedure. The final amount depends upon the findings during the surgery/procedure and post-operative care that is necessary.

When do you need a Second Opinion, prior to the Procedure?

• It is normal for a patient to feel uncomfortable and confused with a sudden inflow of information regarding the laparoscopic surgical procedure and what needs to be done
• If the patient needs further reassurance or a second opinion, a physician will almost always assist in recommending another physician
• Also, if the procedure involves multiple surgeries or has many alternatives, the patient may take a second opinion to understand and choose the best one. They can also choose to approach another physician independently

What are some Helpful Resources?

http://www.surgery.com/procedure/laparoscopy (accessed on 08/02/2014)

http://www.fascrs.org/patients/treatments_and_screenings/laparoscopic_surgery/ (accessed on 08/02/2014)

Complete Guide to Symptoms, Illness & Surgery; Written by H Winter Griffith, M.D.; Revised and updated by Stephen Moore, M.D. and Kenneth Yoder, M.D.; The Berkley Publishing Group, 5^th Edition, New York, 2006

Prior to Laparoscopy surgical procedure:

How is the Laparoscopy surgical procedure Performed?

• A Laparoscopic procedure is usually performed under general anesthesia
• The surgeon makes a small incision on the abdomen (or on the concerned body area) and places a hollow tube, through which the laparoscope may be inserted
• The laparoscope has a camera that transmits images from within the body to an external monitor. This allows the surgeon to visualize the internal body structures
• Other small incisions are made on the abdomen, as needed, to introduce additional instruments. These incisions are called “ports”
• During the beginning of the procedure, carbon dioxide gas is used to inflate the abdomen. This gives the surgeon space to move the instruments and the camera
• After completion of the procedure, the laparoscope and other instruments are removed and incisions are sutured

Where is the Procedure Performed?

A Laparoscopy is generally performed in a hospital, usually as an outpatient procedure.

Who Performs the Procedure?

A Laparoscopic procedure may be performed by any of these medical personnel, with assistance from an anesthesiologist:

• General surgeon
• Obstetrician-gynecologist
• Gastroenterologist
• Thoracic surgeon

How long will the Procedure take?

The time taken for the procedure depends on the reason for performing a Laparoscopy. It may vary anywhere from 1-3 hours.

What do you need to tell your Physician before the Procedure?

It is very important to provide the following information to your healthcare provider. This enables your healthcare provider in assessing the risks for the Laparoscopic surgical procedure and helps avoid unnecessary complications.

• Provide a complete list of medications you are currently, taking to your physician. This information is useful for a variety of reasons. For example, it can help your healthcare provider prevent complications due to a drug interaction
• If you are allergic to any specific medication or food items
• If you are taking blood thinners, such as aspirin, warfarin, herbal supplements, or any other such medications
• If you or your family members, have a history of bleeding disorders, or if there is a tendency to bleed more than normal
• If you have diabetes, high blood pressure, chest pains, or have previously suffered from a heart attack
• If you have ever been diagnosed with blood clots in your leg (deep vein thrombosis) or lung (embolism of lung)
• If you have a history of frequent bone fractures (this may affect bone-healing, if bones are involved as part of your procedure)
• A list of all previous surgical procedures you have undergone, like for example: Removal of appendix, gallbladder, or any other part, of your body; surgical repair of any body part, such as hernia repair, perforation of bowel wall, etc.

What Preparations are needed, prior to the Procedure?

• The physician may evaluate the individual’s medical history to gain a comprehensive knowledge of the overall health status of the patient including information related to the medications that are being currently taken
• Some medications increase a person’s chances of bleeding and it may be recommended to discontinue them for a period of time, before the procedure is performed
• Blood tests may be performed to determine if there is a bleeding tendency or any other medical conditions that prevents the person from undergoing the procedure
• Normally local anesthesia is not used; however do inform the physician if you are allergic to any local anesthetics, lidocaine, etc.
• Avoid application of any cosmetics, deodorant, or topical medicines on the area, prior to the procedure
• It is advisable to quit smoking and the use of any nicotine based products, for a while, before the surgery
• Consumption of alcoholic drinks must also be avoided for a period of time, as instructed
• The patient must avoid eating or drinking at least 8 hours prior to the surgical procedure, depending on when the procedure is arranged
• For persons suffering from diabetes, it is important that the blood sugar stays within the normal range; if not their diabetologist may have to control blood sugar by recommending insulin and/or a combination of oral medicines

What is the Consent Process before the Procedure?

A physician will request your consent for the Laparoscopy procedure using an Informed Consent Form.

Consent for the Procedure: A “consent” is your approval to undergo a procedure. A consent form is signed after the risks and benefits of the procedure, and alternative treatment options, are discussed. This process is called informed consent.

You must sign the forms only after you are totally satisfied by the answers to your questions. In case of minors and individuals unable to personally give their consent, the individual’s legal guardian or next of kin, shall give their consent for the procedure.

What Tests are needed, before the Laparoscopy surgical procedure?

Before a Laparoscopy procedure, the patient has to undergo certain tests, such as:

• Routine blood and urine analysis
• Other investigative procedures pertaining to the condition being investigated/treated; per advise from the physician

What are some Questions for your Physician?

Some of the basic questions that you might ask your physician are as follows:

• What is a Laparoscopy?
• Why is this procedure necessary? How will it help?
• How soon should I get it done? Is it an emergency?
• Who are the medical personnel involved in this procedure?
• Where is the procedure performed? 
• What are the risks while performing the procedure?
• What are the complications that might take place, during recovery?
• How long will it take to recover? When can I resume normal work?
• How many such procedures have you (the physician) performed?
• Are there any follow-up tests, periodic visits to the healthcare facility required, after the procedure?
• What are the costs involved?

During the Laparoscopy surgical procedure:

What kind of Anesthesia is given, during the Procedure?

General anesthesia by injection and inhalation is administered, prior to the Laparoscopy procedure.

How much Blood will you lose, during the Procedure?

Normally, there is no much blood loss associated with laparoscopic procedures.

What are the possible Risks and Complications during the Laparoscopy surgical procedure?

There are general factors that increase the risk of getting complications during surgery and they include:

• Obesity: Generally greater the degree of obesity, greater is the surgical risk
• Smoking: Longer the smoking history (in pack years smoked), greater the surgical risk
• Advancing age
• Poorly controlled diabetes, as evidenced by a high hemoglobin A1c and a high fasting glucose
• Poorly functioning kidney, as evidenced by increased BUN (blood urea nitrogen) and blood creatinine
• Poorly functioning liver, as evidenced by increased blood liver function tests
• Hypertension (increased blood pressure), especially if it is poorly controlled
• Poor nutritional status (malnutrition with mineral and vitamin deficiencies)
• Poor lung function, as evidenced by abnormal lung function tests
• History of bleeding disorders
• Longstanding illness, such as autoimmune disorders, chronic infections
• Poor immune system due to a variety of causes

The possible risks or complications that may arise during the Laparoscopic surgery are:

• Injury to abdominal (or internal) organs
• Hypothermia
• Bleeding
• Infection in the surgical wound
• Anesthetic complications

What Post-Operative Care is needed at the Healthcare Facility after the Laparoscopy surgical procedure?

• Following a Laparoscopy, the individual shall remain in the PACU, until there is a full recovery from the anesthesia
• The vital signs are monitored and many patients are typically discharged from the recovery area, a few hours later
• Sometimes, depending on the reason for performing the Laparoscopic procedure, and the presence/absence of other medical conditions or complications, an overnight hospital stay, or even a brief hospital stay, may be recommended

After the Laparoscopy surgical procedure:

What are the possible Risks and Complications after the Laparoscopy surgical procedure?

The possible risks and complications that may arise after a Laparoscopy procedure are:

• Infection in the surgical wound
• Scar tissue formation, or the formation of adhesions between the  intestines
• In rare cases, a gastrointestinal or liver perforation may occur

What is the Prognosis after the Surgery?

• A complete recovery from a Laparoscopy procedure is normally achieved. The prognosis is usually excellent, without any serious complications being noted
• However, individuals should expect to experience some mild discomfort for the first 24-48 hours, following the procedure

When do you need to call your Physician?

Do contact your physician, if you notice any of the following symptoms:

• Loss of bladder/bowel function
• Abdominal pain or swelling
• Prolonged vaginal discharge; excessive vaginal bleeding
• Pain that worsens and swelling around the surgical wound
• Signs of an infection
• Fever, feeling sick
• Dizziness
• Muscle aches, headache

What Post-Operative Care is needed at Home after the Laparoscopy surgical procedure?

At home, the following post-operative care is recommended, after a Laparoscopy procedure:

• Slowly resume regular/daily activities as soon as possible, which aids in faster recovery
• Change bandages on the surgical wounds daily
• Resume showering and keep the wound clean and dry. Gently wash the surgical wound with mild soap
• Complete the present course of birth-control pills you are taking; refills should be taken, only as prescribed by a physician (if operation was for sterilization)
• It may be required to use sanitary napkins (for bleeding), for about a week or more
• Complete the course of prescribed medication, or follow the physician’s advise
• Resume driving 24 hours after the procedure, or as advised by your physician
• Avoid sex, till a complete healing has taken place (under advise by the physician)
• Avoid carbonated beverages for 48 hours after the procedure

How long does it normally take to fully recover, from the Procedure?

It takes approximately 1 week to fully recover from a Laparoscopy procedure.

Additional Information:

What happens to tissue (if any), taken out during the Procedure?

• Sometimes, the Laparoscopic procedure may involve the removal of tissue for investigative purposes
• Such specimens are examined by a pathologist under a microscope and later disposed, as per standard medical procedure

When should you expect results from the pathologist regarding tissue taken out, during the Procedure?

• The tissue removed is processed in the laboratory under a pathologist's supervision
• Slide(s) are prepared once the tissue is processed and is examined by a pathologist and a pathology report issued
• Depending on the complexity of the case, issue of the report may take anywhere between 72 hours to a week's time

Who will you receive a Bill from, after the Laparoscopy surgical procedure?

It is important to note that the number of bills that the patient may receive depends on the arrangement the healthcare facility has with the physician and other healthcare providers.

Sometimes, the patient may get a single bill that includes the healthcare facility and the consultant physician charges. Sometimes, the patient might get multiple bills depending on the healthcare provider involved. For instance, the patient may get a bill from:

• The outpatient facility or a hospital
• An anesthesiologist
• A general surgeon, an obstetrician-gynecologist surgeon, gastroenterologist, or a family doctor with experience in a Laparoscopy procedure
• A pathologist (if a specimen was sent for further analysis)

The patient is advised to inquire and confirm the type of billing, before a Laparoscopy is performed.

Thanks and Gratitude:

We sincerely acknowledge and thank Dr. Douglas J. Jones for reviewing the article. His valuable input and feedback has helped enrich the contents of this article.

Douglas J. Jones, MD FACS
Board Certified General Surgeon and Faculty Member
University of Illinois, College of Medicine at Urbana-Champaign
506 S. Mathews Ave., Urbana, IL 61801, USA