Overview

What is it used for?

Laparoscopy is used to diagnose or treat numerous conditions.

During the procedure, small surgical instruments and devices are inserted through small incisions. This helps your surgeon perform whatever surgical procedure needs to be carried out.

Diagnosing conditions

It's often possible to diagnose a condition using non-invasive methods, such as an ultrasound scan, a computerised tomography (CT) scan or magnetic resonance imaging (MRI) scan. Sometimes, however, the only way to confirm a diagnosis is to directly study the affected part of the body using a laparoscope.

Laparoscopies are now widely used to diagnose many different conditions and investigate certain symptoms. For example, they may be used for:

• pelvic inflammatory disease (PID)  -  a bacterial infection of the female upper genital tract, including the womb, fallopian tubes and ovaries
• endometriosis  – where small pieces of the womb lining (the endometrium) are found outside the womb
• ectopic pregnancy - a pregnancy that develops outside the womb
• female infertility
• ovarian cyst -  a fluid-filled sac that develops on a woman’s ovary
• fibroids – non-cancerous tumours that grow in or around the womb (uterus)
• female infertility
• undescended testicles – a common childhood condition where a boy is born without one or both testicles in their scrotum
• appendicitis – a painful swelling of the appendix (a small pouch connected to the large intestine)
• unexplained pelvic or abdominal pain

Laparoscopy can also be used to diagnose certain types of cancers. The laparoscope is used to obtain a sample of suspected cancerous tissue, so it can be sent to a laboratory for testing. This is known as a biopsy.

Cancers that can be diagnosed using laparoscopy include:

• liver cancer
• pancreatic cancer
• ovarian cancer
• cancer of the bile duct
• cancer of the gallbladder

Treating conditions

Laparoscopic surgery can be used to treat a number of different conditions, including:

• removal of an inflamed appendix - in cases of appendicitis where there's a high risk of the appendix bursting
• removing the gallbladder - often used to treat gallstones
• removing a section of the intestine - often used to treat digestive conditions, such as Crohn’s disease or diverticulitis, that don't respond to medication
• repairing hernias - such as those found in the groin
• repairing burst or bleeding stomach ulcers
• performing weight loss surgery
• removing some or all of an organ affected by cancer -such as the ovaries, prostate, liver, colon, kidney or bladder
• treating ectopic pregnancy (it is usually necessary to remove the embryo to prevent damage to the fallopian tubes)
• removing fibroids
• removing the womb (hysterectomy) - sometimes used to treat pelvic inflammatory disease (PID), endometriosis, heavy periods or painful periods

How is it performed?

Laparoscopy is performed under general anaesthetic, so you'll be unconscious during the procedure and have no memory of it. You can often go home on the same day.

Preparation

Depending on the type of laparoscopic procedure being performed, you'll usually be asked not to eat or drink anything for 6 to 12 hours beforehand.

If you are taking blood-thinning medication (anticoagulants), such as aspirin or warfarin, you may be asked to stop taking it a few days beforehand. This is to prevent excessive bleeding during the operation.

If you smoke, you may be advised to stop during the lead-up to the operation. This is because smoking can delay healing after surgery and increase the risk of complications such as infection.

Most people can leave hospital either on the day of the procedure or the following day. Before the procedure, you'll need to arrange for someone to drive you home because you'll be advised not to drive for at least 24 hours afterwards.

The procedure

During laparoscopy, the surgeon makes a small cut (incision) of around 1 to 1.5cm (0.4 to 0.6 inches), usually near your belly button.

A tube is inserted through the incision, and carbon dioxide gas is pumped through the tube to inflate your tummy (abdomen). Inflating your abdomen allows the surgeon to see your organs more clearly and gives them more room to work. A laparoscope is then inserted through this tube. The laparoscope relays images to a television monitor in the operating theatre, giving the surgeon a clear view of the whole area.

If the laparoscopy is used to carry out a surgical treatment, such as removing your appendix, further incisions will be made in your abdomen. Small, surgical instruments can be inserted through these incisions, and the surgeon can guide them to the right place using the view from the laparoscope. Once in place, the instruments can be used to carry out the required treatment.

After the procedure, the carbon dioxide is let out of your abdomen, the incisions are closed using stitches or clips and a dressing is applied.

When laparoscopy is used to diagnose a condition, the procedure usually takes 30-60 minutes. It will take longer if the surgeon is treating a condition, depending on the type of surgery being carried out.

Recovery

After laparoscopy, you may feel groggy and disorientated as you recover from the effects of the anaesthetic. Some people feel sick or vomit. These are common side effects of the anaesthetic and should pass quickly.

You'll be monitored by a nurse for a few hours until you're fully awake and able to eat, drink and pass urine.

Before you leave hospital, you'll be told how to keep your wounds clean and when to return for a follow-up appointment or have your stitches removed (although dissolvable stitches are often used).

For a few days after the procedure, you're likely to feel some pain and discomfort where the incisions were made, and you may also have a sore throat if a breathing tube was used. You'll be given painkilling medication to help ease the pain.

Some of the gas used to inflate your abdomen can remain inside your abdomen after the procedure, which can cause:

• bloating
• cramps
• shoulder pain, as the gas can irritate your diaphragm (the muscle you use to breathe), which in turn can irritate nerve endings in your shoulder

These symptoms are nothing to worry about and should pass after a day or so, once your body has absorbed the remaining gas.

In the days or weeks after the procedure, you'll probably feel more tired than usual, as your body is using a lot of energy to heal itself. Taking regular naps may help.

Recovery times

The time it takes to recover from laparoscopy is different for everybody. It depends on factors such as the reason the procedure was carried out (whether it was used to diagnose or treat a condition), your general health and if any complications develop.

If you've had laparoscopy to diagnose a condition, you'll probably be able to resume your normal activities within 5 days.

The recovery period after laparoscopy to treat a condition depends on the type of treatment. After minor surgery, such as appendix removal, you may be able to resume normal activities within 3 weeks. Following major surgery, such as removal of your ovaries or kidney because of cancer, the recovery time may be as long as 12 weeks.

Your surgical team can give you more information about when you'll be able to resume normal activities.

When to seek medical advice

It's usually recommended that someone stays with you for the first 24 hours after surgery. This is in case you experience any symptoms that suggest a problem, such as:

• a high temperature of 38C or above
• chills
• severe or continuous vomiting
• increasing abdominal pain
• redness, pain, swelling, bleeding or discharge around your wounds
• abnormal vaginal discharge or vaginal bleeding
• pain and swelling in one of your legs
• a burning or stinging sensation when urinating

If you experience any of these symptoms during your recovery, you should contact either the hospital where the procedure was carried out, your GP or 111

Robotic-assisted laparoscopy

A relatively recent development in laparoscopy is the use of robots to assist with procedures. This is known as "robotic-assisted laparoscopy".

During robotic-assisted laparoscopy, your surgeon uses a console located in the operating theatre to carry out the procedure by controlling robotic arms. The robotic arms hold a special camera and surgical equipment.

The robotic system provides magnified 3D vision and an increased range of movement for instruments working inside the body.

Robotic-assisted laparoscopy allows surgeons to carry out complex procedures with increased precision and smaller incisions. The amount of robotic-assisted laparoscopy used in the UK has increased rapidly in recent years. In particular, robotic-assisted surgery for prostate cancer.

There's evidence to suggest robotic-assisted laparoscopy may have a lower risk of complications than regular laparoscopy or open surgery, as well as a shorter recovery time.