Traditionally, during an abdominal operation the surgeon makes a ‘cut’ or an ‘incision’ to approach the diseased part. This means cutting through muscles of the abdominal wall. At the end of the operation, the layers that have been divided are stitched together. Longer the incision more is the pain the patient suffers after the operation and longer is the scar.
Disadvantages of ‘open’ operations
Some of the drawbacks of open operations include:
- More postoperative pain,
- Longer hospitalisation,
- Slower overall recovery,
- Prolonged time taken to get back to normal activities and work &
- Increased risk of respiratory complications like pneumonia and infection in the wound.
Laparoscopic operations are performed through tiny incisions no longer than ½ cm or 1 cm. The total length of the incisions is only about 4 cm! Furthermore, the same four incisions are adequate for performing the operation irrespective of the body habitus of the patients – tall or short, fat or slim.
During laparoscopic operations the surgeon makes a small (about 1-cm) incision and places a short tube called a cannula through the abdominal wall. This cannula is connected to a special pump called the insufflator that pumps carbon dioxide gas inside the abdomen. As the abdomen gets filled up with the gas, the abdominal wall is lifted up, thus providing the surgeon a space to work in.
To look inside the abdomen, the surgeon passes a rod-like telescope through the cannula. The telescope is connected to a miniature video camera that picks up the picture of the inside of the abdomen and transmits it to a television screen.
The surgeon then carries out the operation with the help of special, long instruments introduced inside the abdomen through other cannulas and by observing the picture of the operative site on the television screen. It is important to appreciate that the actual laparoscopic operation being carried out is more or less identical to the open procedure. The major difference is that the steps are performed with the help of specialized equipment and therefore can be carried out through small incisions.
What are the advantages of laparoscopic surgery?
- Less pain from the incisions after surgery
- Shorter hospital stay
- Shorter recovery time
- Faster return to normal diet
- Faster return to work or normal activity
- Better cosmetic healing
- Patients with existing pulmonary disorders may not tolerate gas in the abdominal cavity. In such instances the operation may need to be converted to an open procedure.
- Increased pressure inside the abdomen due to the gas compresses the major blood vessels and increases the risk of clotting in the veins in the legs (deep vein thrombosis). Some of the clots may slip and block the circulation in the lungs (pulmonary embolism). Patients undergoing laparoscopic surgery are made to wear a pair of special stockings or are fitted with special boots that massage the calf intermittently during surgery. These precautions reduce the risk of deep vein thrombosis.
- The cannulas or trocars used laparoscopic surgery may injure important internal organs or blood vessels. The risk of such injuries is increased in patients who have a history of prior abdominal surgery. However, these injuries are very rare.
- When dense adhesions are present inside the abdomen as a result of previous abdominal surgery there is an increased risk of injury to intestines.
- Improperly or inadequately sterilised instruments pose a risk of infection in the wounds – sometimes with organisms such as atypical mycobacteria. One or many of the small incisions may fail to heal and keep discharging pus. This complication needs to be treated by a surgeon experienced in dealing with such a problem.
A surgeon always takes precautions to ensure that the complications are avoided altogether. However, it is important to appreciate that no surgery is 100% safe and complications do occur – almost all of which are unforeseen. Before undergoing any surgery it is essential to discuss with the surgeon and fully understand the benefits as well as the risks involved.