Laparoscopy (keyhole surgery) – How it’s 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’re 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 NHS 111 for advice.

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.

Page last reviewed: 01 August 2018
Next review due: 01 August 2021

Laparoscopy – Better Health Channel

Summary

Read the full fact sheet

• Laparoscopy is a medical procedure used to examine the interior of the abdominal or pelvic cavities for the diagnosis or treatment (or both) of a number of different diseases and conditions.
• Laparoscopy examines the interior of the abdominal or pelvic cavity using a slender tube (laparoscope) inserted through a small incision.
• The small incisions mean that recovery time is relatively rapid.

Laparoscopy (or peritoneoscopy) is a medical procedure used to examine the interior of the abdominal or pelvic cavities for the diagnosis or treatment (or both) of a number of different diseases and conditions. The advantage of laparoscopy is that only a small incision is required; this is why laparoscopy is also known as ‘keyhole surgery’.

Laparoscopy examines the interior of the abdominal or pelvic cavity using a slender tube (laparoscope) inserted through a small incision. The laparoscope contains fibre-optic camera heads or surgical heads (or both).

The laparoscope transmits images to a video screen in the operating room. Prior to the advent of laparoscopy, doctors had to make large openings and cut through layers of tissue in order to examine internal organs. Laparoscopy greatly reduces the patient’s recovery time.

Problems diagnosed or treated by laparoscopy

Some of the many problems that may be diagnosed or treated by laparoscopy include:

• Female infertility – laparoscopy allows doctors to check for problems such as scar tissue, endometriosis and fibroid tumours, and to see if the uterus, fallopian tubes and ovaries are abnormal in any way.
• Other problems of the female reproductive system – including pelvic floor and vaginal prolapse. Some types of hysterectomy can also be performed using laparoscopic surgery.
• Ectopic pregnancy – the embryo lodges and grows within the fallopian tube. The developing embryo will eventually rupture the fallopian tube unless it is surgically removed.
• Adhesions – the presence of scar tissue within the pelvic cavity.
• Diseases of the urinary system – laparoscopy can be used to investigate or treat (or both) cancerous and non-cancerous conditions of the kidney, blockages of the ureter, bladder disease and incontinence.
• Cancers of the internal organs – cancers of the liver and pancreas can be diagnosed using laparoscopy and laparoscopic surgery can be performed for some colorectal cancers.
• Ascites – or fluid inside the abdominal cavity; laparoscopy can help determine the cause.
• Other problems – diseased organs (such as the gallbladder and appendix) can be removed with laparoscopy, and hernias can be repaired.

Medical issues to consider

Before the procedure, you need to discuss a range of issues with your doctor or surgeon including:

• The likely outcome of surgery
• The possible risks and complications of laparoscopy
• Medical history, including allergic reactions to any drugs or prior problems with anaesthesia.

Operation procedure

Laparoscopy can be performed under local or general anaesthetic, depending on the nature of the procedure. After the incision is made (usually next to the navel), the laparoscope is inserted into the abdominal cavity. Either carbon dioxide or nitrous oxide gas is then passed into the cavity to separate the abdominal wall from the underlying organs. This makes examination of the internal organs easier.

Anywhere between one and three more incisions are made to allow access to other surgical instruments, for example, a laser. Once a diagnosis is made or the problem is removed (or both), the instruments are taken out, the gas allowed to escape and the incisions sewn shut. The stitches may need to be removed by the doctor at a later stage or else they will dissolve by themselves.

Immediately after the laparoscopy

After the procedure, you can expect:

• Soreness around the incision site. You may need painkilling medication
• Shoulder pain, caused by the gas pumped into the abdominal cavity
• A sensation of abdominal bloating
• Nausea
• Abdominal cramps
• Constipation
• For pelvic procedures only, light bleeding or discharge from the vagina
• Patients are advised not to drive home following laparoscopy due to the medication given prior to the procedure – make sure you have a relative or friend to take you home from hospital or call a taxi
• Most symptoms of laparoscopic surgery resolve within one or two days – if not, see your doctor.

Possible complications of laparoscopy

All surgery carries some degree of risk. Some of the possible complications following laparoscopy include:

• Cardiac arrhythmias
• Puncture of internal organs or the body’s main artery (aorta)
• Bleeding into the abdominal cavity
• Blood clots in the veins of the legs
• Allergic reactions to the anaesthetic
• Ascites – temporary fluid leakage from surgical wounds
• The necessity to switch from laparoscopic to open surgery in the case of unforeseen complications.

Taking care of yourself at home

Be guided by your doctor but general suggestions include:

• Most patients are able to resume normal activities within a few days to one week.
• Don’t engage in any strenuous physical activity for about a week or so.
• Remove your bandages the following day. Keep wounds dry.
• Following a pelvic laparoscopy, use sanitary napkins instead of tampons to cope with any vaginal bleeding or discharge.
• If you experience high fever, chills, vomiting, difficulties urinating, increasing redness at the incision site or a worsening of pain, contact your doctor immediately.

Long-term outlook

The small incisions mean that recovery time is quite fast. Most patients can return to their normal activities within one week of surgery. Postoperative pain resolves within a few days and the scarring is minimal.

Laparotomy treatment

The surgical alternative to laparoscopy is open surgery (laparotomy). Instead of a few small incisions, the abdomen is opened with one large cut. The main disadvantages of laparotomy are the extended hospital stay (up to one week or so) and the long recovery time. A person who undergoes open surgery can expect at least six weeks of convalescence.

Compared to laparoscopy, laparotomy has increased risks of infection and adhesions. The resulting scars from open surgery are also much more extensive.

Where to get help

• Your doctor
• Your surgeon

This page has been produced in consultation with and approved
by:

Recovery after laparoscopy

Surgeon
of the surgical department No. 1
Markevich E. V.

Laparoscopy is a low-traumatic surgical intervention. Since large incisions are not made, the time for tissue and organ regeneration is greatly reduced. But on the other hand, the endoscopic method of surgery involves the injection of gas into the abdominal cavity so that it is possible to obtain a sufficient overview during the necessary manipulations. And this affects the body, should be taken into account in the rehabilitation period.

After the usual uncomplicated laparoscopic surgery, the patient is admitted to the intensive care unit, where he spends the next 2 hours of the postoperative period to ensure adequate recovery from anesthesia. In the presence of concomitant pathology or features of the disease and surgical intervention, the length of stay in the intensive care unit may be increased. Then the patient is transferred to the ward, where he receives the prescribed postoperative treatment.

During the first 4-6 hours after surgery, the following symptoms may also appear: moderate nagging pain in the lower abdomen, nausea, vomiting, dizziness, frequent urge to urinate. These manifestations are considered normal, pass after a while. Severe pain must be anesthetized. During this period, the patient should not drink and get out of bed. Until the morning of the next day after the operation, you can drink plain water without gas, in portions of 1-2 sips every 10-20 minutes with a total volume of up to 500 ml.

The patient can stand up 4-6 hours after the operation. You should get out of bed gradually, first sit for a while, and, in the absence of weakness and dizziness, you can get up and walk around the bed. For the first time, it is recommended to get up in the presence of medical personnel (after a long stay in a horizontal position and after the action of medications, orthostatic collapse is possible – fainting).

The next day after the operation, the patient can freely move around the hospital, start taking liquid food: kefir, oatmeal, diet soup and switch to the usual mode of drinking liquids.

For the first 7 days after surgery, it is strictly forbidden to consume any alcoholic beverages, coffee, strong tea, drinks with sugar, chocolate, sweets, fatty and fried foods.

If there is a need during the operation, a drainage tube is placed, which allows the removal of the ichor. In the normal course of the postoperative period, the drainage from the abdominal cavity is removed the next day after the operation. Drainage removal is a painless procedure, carried out during dressing and takes a few seconds.

It is recommended to sleep on your back, and only in case of good health, no pain in the stitches, and if there is no drainage tube, it is allowed to sleep on your side. But it is forbidden to lie on the stomach.

Also in the postoperative period, especially the first two days, there may be discomfort in the throat: these are the consequences of the introduction of an anesthesia tube. There may also be pain in the cervical and shoulder regions, they are caused by the fact that during the operation there was a pressure of carbon dioxide on the diaphragm.

In the first month after the operation, the functions and general condition of the body are restored. Careful adherence to medical recommendations is the key to a full recovery of health. The main directions of rehabilitation are – compliance with the regime of physical activity, diet, drug treatment, wound care.

Compliance with the regime of physical activity.

After surgery, it is recommended to limit physical activity for a period of 1 month (do not carry weights of more than 3-4 kilograms, exclude physical exercises that require tension in the abdominal muscles). This recommendation is due to the peculiarities of the formation of the process of the scar of the muscular-aponeurotic layer of the abdominal wall, which reaches sufficient strength within 28 days from the moment of surgery. 1 month after the operation, there are no restrictions on physical activity.

Diet.

Dieting is required up to 1 month after laparoscopic surgery. It is forbidden to eat heavy food: fatty, spicy, fried foods that are cooked in a large amount of vegetable, butter. It is necessary to refuse cooking on animal fat; pickled, smoked products, canned food; fatty meat, lard; fresh pastries, confectionery, sweets, as these products cause an increase in gas formation in the intestines; legumes that lead to flatulence; alcohol. Recommended regular meals 4-6 times a day. New foods should be introduced into the diet gradually, after 1 month after the operation, it is possible to remove dietary restrictions on the recommendation of a doctor.

Medical treatment.

Laparoscopic surgery usually requires minimal medical treatment. Pain after surgery is usually mild, but some patients require the use of analgesics for 2-3 days. Taking medications should be carried out strictly according to the instructions of the attending physician in an individual dosage.

Care of postoperative wounds.

In the hospital, postoperative wounds located at the insertion sites of the instruments will be covered with special stickers. In stickers with a protective film, it is possible to take a shower from 48 hours after surgery. It is better not to allow water to enter the seams. Bathing or swimming in pools and ponds is prohibited until the stitches are completely healed. Usually, taking a bath is allowed after 1 month.

Stitches after laparoscopic cholecystectomy are removed 7-10 days after the operation. This is an outpatient procedure, the removal of stitches is carried out by a doctor or dressing nurse.

Any operation may be accompanied by undesirable effects and complications. Wound complications:

• Subcutaneous hemorrhages (bruises) that go away on their own within 7-10 days. Special treatment is not required.
• Possible reddening of the skin around the wound, the appearance of painful seals in the wound area. Most often it is associated with a wound infection. In the event of such symptoms, it is necessary to consult a doctor as soon as possible. Late treatment may lead to wound festering, which usually requires surgical intervention under local anesthesia (debridement of the festering wound), followed by dressings and possible antibiotic therapy.
• 5-7% of patients may develop hypertrophic or keloid scars. This complication is associated with the individual characteristics of the reaction of the patient’s tissue and, if the patient is dissatisfied with the cosmetic result, may require special treatment.
• 0.1-0.3% of patients may develop hernias in places of trocar wounds. This complication is most often associated with the characteristics of the patient’s connective tissue and may require surgical correction in the long term.

Physiotherapy

Physiotherapy after laparoscopy is aimed at restoring the health of tissues damaged during surgery. Features of physiotherapy depend on the purpose of the intervention and the operated organ. If laparoscopy was performed as a diagnostic method, then physiotherapy is not performed, they are not needed. Carrying out physiotherapeutic measures helps to soften the connective tissue. As a result, the pain syndrome decreases, the adhesive process from laparoscopic procedures is eliminated

If you follow the doctor’s recommendations during the recovery period after laparoscopy, the patient’s rehabilitation will be significantly accelerated.

Laparoscopy: features of the recovery period | “Best Clinic”

Recovery after laparoscopy

Laparoscopy has many advantages over traditional open surgery. But do not forget to follow the recommendations during the recovery period.

Laparoscopy is a minimally invasive surgical intervention performed using modern endoscopic instruments and techniques. This method has many advantages over traditional open operations. One of them is a short rehabilitation period and a quick recovery of the patient’s ability to work.

• Soreness at the puncture site and in the abdomen. Pain after laparoscopy is relative. Pain in the area of ​​​​the sutures, which disappear within a few days, is considered normal.
  If you are concerned about intense pain, you should consult a doctor to clarify the condition and the possible prescription of painkillers. It is not recommended to take any measures on your own so as not to provoke the development of complications.

• Weakness, nausea, flatulence. These symptoms are normal and occur as a reaction of the body to an intervention. After laparoscopy, they last 2-3 days and disappear without the use of drugs.
• Stitches after laparoscopy. Postoperative punctures heal quickly and without complications. The stitches are usually removed after 10-14 days. The remaining scars will gradually dissolve, and then become completely invisible.
• Diet. For some time after laparoscopy, and preferably the entire first day, it is necessary to refrain from eating. Only non-carbonated water is allowed to drink. Over the next two days, easy-to-digest foods can be included in the diet: lean meat, fish, broth, low-fat kefir, yogurt, rice, crackers. You can return to normal nutrition on the 4th day after laparoscopy.
• Physical activity. You can get up and walk after examination and permission from the doctor. On the first day after the operation, it is better to refrain from active movements, limit movements (to the toilet, around the ward). In the following days, physical activity can be gradually increased. Active physical activity should be postponed for 1-2 weeks.
• Sex. Sexual intercourse is allowed after 1-2 weeks. However, for patients who underwent surgery for gynecological pathology, there may be additional restrictions, which the doctor must definitely tell about.
• Vaginal discharge and restoration of the menstrual cycle. Allocations can be in a small amount for up to two weeks. An increase in the amount of discharge may indicate a developing complication. In this case, you must immediately inform your doctor. The normal menstrual cycle is restored in a few days or weeks after the operation.
• Pregnancy after laparoscopy. If laparoscopy was performed for infertility with a therapeutic and diagnostic purpose and was completed successfully, then pregnancy can be planned a few months after the operation. If additional drug therapy is carried out in the postoperative period, then only the attending physician can determine the preliminary timing of the conception of a child.