Laparoscopy is a minimally invasive surgical technique that allows a surgeon to examine and operate on organs inside the abdomen or pelvis through small incisions with the assistance of a camera. The incisions are generally smaller than those used for traditional open surgery. However, laparoscopy is still a surgical procedure that requires anaesthesia, preparation and a period of recovery.
Laparoscopic surgery may be used to remove the gallbladder, repair certain hernias, remove the appendix and perform other abdominal operations. The technique is also used in gynaecology, urology and other surgical specialties.
The appropriate surgical approach depends on the diagnosis, the patient’s health and the expected benefits. The surgeon determines whether laparoscopic or open surgery is more suitable.
Dr. Jānis Opincāns
What is laparoscopy?
During laparoscopy, the surgeon inserts a laparoscope through a small incision in the abdomen. A laparoscope is a narrow instrument equipped with a camera and light source. The camera transmits a magnified view of the internal organs to a monitor.
If an operation is performed, the surgeon normally makes several additional small incisions through which surgical instruments are inserted. The number and size of the incisions depend on the type and complexity of the procedure.
Laparoscopy may be:
- diagnostic, to investigate the cause of symptoms or abnormal findings;
- therapeutic, to treat an identified condition during surgery.
In some cases, diagnostic laparoscopy may proceed to surgical treatment if this possibility has been discussed with the patient beforehand and the necessary treatment can be performed safely.
Which operations can be performed laparoscopically?
Laparoscopy is used to treat a range of conditions affecting the abdomen and pelvis. Common applications in general surgery include:
- removal of the gallbladder for gallstones or inflammation;
- repair of inguinal, umbilical and certain other hernias;
- removal of the appendix;
- selected operations on the small or large bowel;
- diagnostic examination of the abdominal cavity;
- obtaining a tissue sample or biopsy.
Laparoscopy is also used to treat endometriosis, ovarian cysts, ectopic pregnancy and certain conditions affecting the uterus.
Laparoscopic surgery is not suitable for every condition or patient. Previous operations, adhesions, inflammation, the size of a lesion, the patient’s general health and other factors may influence the choice of surgical approach.
Benefits of laparoscopic surgery
Compared with open surgery, a laparoscopic approach often offers several potential benefits:
- smaller incisions;
- less postoperative pain;
- a shorter hospital stay;
- an earlier return to everyday activities;
- smaller postoperative scars;
- a potentially lower risk of certain wound complications.
Laparoscopy does not automatically mean that an operation is simple or free from risk. A substantial internal operation can be performed through small incisions. Recovery depends on the organ being treated and the extent of surgery, not only on the size of the external wounds.
How should you prepare for laparoscopy?
Before surgery, the patient attends a consultation with the surgeon. The doctor reviews the symptoms, diagnosis, previous examination results, existing medical conditions and current medication.
Depending on the planned operation, the patient may need:
- blood and urine tests;
- an electrocardiogram;
- ultrasound, computed tomography or other imaging;
- an anaesthesiologist consultation;
- reports from other specialists;
- additional examinations for chronic medical conditions.
Tell the surgeon and anaesthesiologist about all chronic conditions, allergies, previous operations and previous experiences with anaesthesia.
Provide a complete list of medicines and supplements, including those used occasionally. Information about blood-thinning medication, diabetes medication and medicines used for weight management is particularly important. Do not stop taking prescribed medication without medical instructions.
Follow the hospital’s instructions regarding eating and drinking before surgery. The required fasting period may vary depending on the procedure, anaesthesia and the patient’s health.
What type of anaesthesia is used?
Laparoscopic surgery is usually performed under general anaesthesia. The patient is asleep and does not feel pain during the operation. The anaesthesiologist and anaesthesia team continuously monitor vital functions.
Monitoring may include:
- oxygen levels in the blood;
- breathing and the level of carbon dioxide in exhaled air;
- heart activity;
- blood pressure;
- body temperature;
- other parameters depending on the operation and the patient’s condition.
Before surgery, the anaesthesiologist assesses the patient’s health and the risks associated with anaesthesia. The individual plan depends on the operation, age, existing medical conditions and other relevant factors.
How is laparoscopic surgery performed?
After general anaesthesia has started, the surgeon normally makes a small incision close to the navel. Carbon dioxide is introduced into the abdomen to create space between the abdominal wall and internal organs. This improves visibility and allows the instruments to be used more safely.
The laparoscope and its camera are inserted through the incision. If surgical treatment is required, instruments are inserted through additional small incisions.
At the end of the procedure, the instruments are removed, the gas is released and the incisions are closed using stitches, clips or another appropriate method. Dressings are applied to the wounds.
The length of surgery varies considerably. A diagnostic procedure is generally shorter, while a complex therapeutic operation may take several hours. The surgeon can explain the anticipated duration before the procedure.
Can laparoscopic surgery be converted to open surgery?
In some situations, the surgeon may need to convert the laparoscopic procedure to open surgery with a larger incision. This may be required because of bleeding, severe inflammation, adhesions, unexpected anatomy or an insufficient view of the operating area.
Conversion to open surgery does not mean the operation has failed. It is a safety decision made when the procedure cannot be completed safely through a laparoscopic approach.
This possibility is usually discussed with the patient before surgery.
How might you feel after surgery?
After surgery, the patient is transferred to a recovery area. Drowsiness, shivering, nausea, thirst, throat irritation and pain around the surgical area may occur while waking up.
During the first few days, patients may experience:
- pain or pulling around the incisions;
- abdominal bloating;
- tiredness;
- minor bruising around the wounds;
- nausea or reduced appetite;
- pain in the shoulder area.
Shoulder pain after laparoscopy may be caused by irritation of the diaphragm from the gas used during surgery. It normally improves gradually.
Pain intensity varies between patients. The hospital will provide instructions on appropriate pain relief.
How long does recovery after laparoscopy take?
Recovery depends on the type of procedure. A patient may feel considerably better within several days after a minor diagnostic laparoscopy. Full recovery after therapeutic surgery may take several weeks.
Recovery is influenced by:
- the type and extent of surgery;
- the patient’s age and general health;
- existing medical conditions;
- any complications;
- the nature of the patient’s work;
- physical restrictions prescribed by the surgeon.
Many patients can leave hospital on the day of surgery or the following day, but this is not possible after every operation. The clinical team makes the decision according to the procedure and the patient’s condition.
When can you return to work?
Return to work should be planned individually. It may be possible relatively soon after a minor diagnostic procedure. Several weeks may be required after more extensive surgery.
Office work can generally be resumed earlier than physically demanding work. If the job involves heavy lifting, strenuous activity, driving or safety-critical duties, the timing should be discussed with the surgeon.
Do not drive while:
- you are still affected by anaesthesia or medication;
- pain restricts your movement;
- you cannot perform an emergency stop safely;
- your doctor has not permitted you to resume driving.
You should also check your insurer’s requirements.
What should you do during recovery?
Follow the instructions provided by the treating hospital. General recommendations may include:
- gradually resuming walking and everyday activities;
- avoiding prolonged immobility;
- drinking sufficient fluids unless medically restricted;
- taking prescribed medication;
- caring for the wounds according to the instructions;
- avoiding heavy lifting until permitted by the surgeon;
- attending the scheduled follow-up appointment.
Increase physical activity gradually. Small external wounds that appear to have healed do not necessarily mean that the internal tissues have healed completely.
Possible risks of laparoscopy
Laparoscopy is widely used, but no surgical procedure is entirely free from risk.
Possible complications include:
- bleeding;
- wound or deeper infection;
- injury to a blood vessel, bowel, bladder or another organ;
- blood clots in the veins of the legs;
- pulmonary embolism;
- complications associated with anaesthesia;
- a hernia at an instrument insertion site;
- the need to convert to open surgery;
- the need for further treatment or another operation.
The individual risk depends on the type of operation and the patient’s health. Before surgery, the surgeon and anaesthesiologist explain the most relevant risks and expected benefits.
When should you seek urgent medical attention?
Contact the treating hospital or seek urgent medical attention if you develop:
- increasing or very severe pain;
- fever or chills;
- repeated or persistent vomiting;
- significant abdominal swelling;
- redness, increasing swelling, pus or bleeding around a wound;
- sudden pain and swelling in one leg;
- shortness of breath;
- chest pain;
- coughing up blood;
- fainting, confusion or severe weakness.
Call 113 immediately in Latvia in the event of severe breathing difficulty, chest pain, impaired consciousness or another life-threatening condition.
Laparoscopy for gallstones
Removal of the gallbladder, known as cholecystectomy, may be recommended for symptomatic gallstones or recurrent inflammation of the gallbladder. The operation can often be performed laparoscopically.
The entire gallbladder is usually removed rather than only the stones inside it. If the gallbladder remains, stones can form again. The need and appropriate timing of surgery are determined after the surgeon reviews the symptoms and examination results.
Laparoscopic hernia repair
Certain inguinal, umbilical and other abdominal wall hernias can be repaired laparoscopically. During surgery, the weak or open area is closed or reinforced. A surgical mesh may be used depending on the individual situation.
A laparoscopic approach is not necessary or suitable for every patient. The method depends on the type, size and location of the hernia, previous surgery, the patient’s health and the surgeon’s assessment.
Read more about the symptoms and treatment of abdominal hernias in our article about abdominal hernias.
How much does laparoscopy cost?
The cost cannot be determined from the surgical approach alone. It depends on the diagnosis, the specific operation, anaesthesia, materials, required examinations and length of hospital stay.
The first step is therefore a surgical consultation. Once the diagnosis and proposed treatment have been assessed, the location of surgery, preparation and expected costs can be clarified.
Republikas laukuma klīnika provides surgical consultations and, where necessary, preparation for surgery. Laparoscopic operations are performed at another appropriately equipped medical institution. The surgeon will explain the location and organisation of the operation during the consultation.
Surgical consultation before laparoscopy
If you have been diagnosed with gallstones, an abdominal wall hernia or another condition that may require laparoscopic surgery, the first step is a consultation with a surgeon.
During the consultation, the surgeon will:
- discuss your symptoms;
- review previous examination results;
- perform a clinical examination;
- determine whether additional tests are required;
- explain the available treatment options;
- assess whether laparoscopic surgery is suitable;
- explain preparation and recovery;
- prepare a further treatment plan.
Book a surgical consultation in central Riga or call 28002363.
Republikas laukuma klīnika is located at Republikas laukums 3–18, Riga, on the ground floor of the Centra nams building. The entrance is on the side facing the Ministry of Agriculture.
Frequently asked questions
Is laparoscopy an operation?
Yes. Laparoscopy may be a diagnostic procedure or a therapeutic operation. Although small incisions are used, it is still a surgical intervention.
Is laparoscopy performed under general anaesthesia?
Laparoscopic surgery is usually performed under general anaesthesia. The individual anaesthesia plan is determined according to the operation and the patient’s health.
How many incisions are required?
The number depends on the operation. One incision is normally used for the camera and several additional small incisions may be needed for surgical instruments.
Does laparoscopy leave scars?
Yes, but they are generally small. Their appearance depends on the size of the incisions, healing, infection and the individual tendency to develop prominent scars.
Why does my shoulder hurt after laparoscopy?
The gas used during surgery may irritate the diaphragm and cause referred pain in the shoulder. It normally improves gradually. Severe pain accompanied by shortness of breath or chest pain requires urgent medical assessment.
How long will I stay in hospital?
Some patients can leave hospital on the day of surgery or the following day. A longer stay may be required after more extensive surgery.
How long should I avoid heavy lifting?
There is no single period that applies to every patient. It depends on the operation and tissue healing. Follow the instructions provided by your surgeon.
Is laparoscopy always better than open surgery?
No. Laparoscopy often offers advantages, but open surgery may be safer or more appropriate in certain situations. The surgical approach is selected individually.
Do I need a referral?
A referral is generally not required for a private surgical consultation. Bring previous examination results, hospital discharge summaries and a list of your current medicines.
