Mr Ash Rohatgi

Laparoscopy is a minimally invasive surgical technique which allows the surgeon to operate without the need for deep or large incisions in the skin. This means the recovery period is generally shorter, there is less pain after the operation, and scarring is reduced significantly for the patient. This technique is also known as keyhole surgery.

Why is laparoscopy done?

Laparoscopy can be used to both treat and diagnose a range of conditions across specialties such as surgery, orthopaedic surgery, gynaecology, gastroenterology, and urology. Laparoscopy may be used in investigation, to check symptoms and attempt to reach a diagnosis, for example in cases of ovarian cysts, fibroids, pelvic inflammatory disease, and appendicitis. Laparoscopy can also be used to take a biopsy (a small sample of tissue) meaning it can be used to investigate certain cancers, e.g liver cancer, ovarian cancer, pancreatic cancer, and many more.

As a surgical technique, laparoscopy is especially useful as it allows for minimal scarring and a shorter recovery period, which is advantageous to the patient. Laparoscopy can be used as a surgical technique in many situations, such as :

• Weight loss surgery
• Removal of the gallbladder (a treatment for gallstones)
• Appendectomy (removal of the appendix)
• Repairing stomach ulcers
• Hysterectomy
• Treating ectopic pregnancy
• Removal of organs affected by cancer

How is laproscopy performed?

Laparoscopy is performed under general anaesthetic, which relaxes the muscles and reduces pain. The surgeon makes small incisions in the abdomen and inserts a laparoscope, which is a small camera attached to the end of a thin tube, allowing the surgeon to see inside the abdomen through a projection on a TV monitor in front of them.
The first incision is made in the navel and the abdomen will be inflated in order to make the organs easier to view. A second incision may also be made at the pubic hairline, as an additional opening for surgical instruments. The surgeon uses these small instruments to perform surgery, looking at the TV monitor for a clear view of the area they need to operate on.
The procedure normally takes around 30 to 60 minutes and patients are required to stay in the recovery room for an hour after the surgery is performed. You will be mointored by a nurse and can normally be discharged about four hours after surgery.

How do you prepare for laparoscopy?

• You should not eat or drink anything for 6-12 hours before the procedure.
• You should not smoke a few days before the prodedure takes place. Smoking can delay the healing process.
• You should remove any nail polish before surgery.
• You should not wear jewellery (wedding rings can be worn).
• You should wear loose-fitting clothing because you will experience some cramping and tenderness folllowing surgery.
• You should stop taking blood-thinning medicine a few days before surgery.

What tests are typically done before laparoscopy?

Before undergoing a laparoscopy, you may have to do some tests so that the doctor can gather information about your health. Some of the following tests may be performed:

• pathology report
• cytology slides
• tissue specimens
• lab work
• film reports
• previous X-rays from another facility

Some doctors may also request an ultrasound, CT scan or MRI scan.

Laparoscopy aftercare

As laparoscopy is a minimally invasive procedure, you can usually go home either on the same day or the day following surgery. Someone will need to accompany you home as you will be advised not to drive for the 24 hours following the procedure. You also cannot drink alcohol for 24 hours after surgery. We recommend these tips as aftercare following a laproscopy:

• You may remove the bandage the morning after surgery.
• Avoid strenuous activities such as jogging, weight lifting or aerobic exercise until your doctor approves these types of activities.
• Try to walk each day, as this will boost blood flow and prevent constipation and pnuemonia.
• Avoid lifting anything which may cause strain, such as heavy grocery bags, a backpack or dog food bags. 
• You can shower 24 to 48 hours after surgery. You should wait to have a bath until 2 weeks following surgery, unless your doctor says otherwise. You should pat dry the wound.
• Don´t worry if your urine is green because a blue dye may have been used to check if the fallopian tubes are open.
• You may feel some bloating, cramps and shoulder cramps after surgery. These symptoms are nothing to worry about.
• Take regular naps as you may feel more tired than usual after the surgery.

Recovery from laparoscopy depends on the type of procedure performed. After diagnostic laparoscopy, for example, you may be able to resume normal activity after five days. After minor surgery, such as ulcer repair, normal activity may be resumed in around three weeks.

Major surgery, such as hysterectomy or organ removal (e.g kidney) typically takes longer – up to 12 weeks. Your surgeon or doctor will advise you on how to clean your stitches and keep wounds clean.

Expect to feel tired or somewhat drained after surgery for a few days, but this should pass as your body uses less and less energy as the recovery process goes on. If you experience any pain, you can take over-the-counter medication pain relief to reduce it.

What are the advantages of a laparoscopy?

There are several advantages of a laproscopy, making it more favourable than open surgery. Some advantages are as follows:

• small incisions
• reduced scarring/less wounds
• reduced infection rate
• a shorter hospital stay (around 2 nights)
• faster recovery time (around 2 to 3 weeks)
• less pain and bleeding following operation

However, some surgeons prefer to use traditional methods because a laproscopy has limitations (due to limited range of movement), it increases the risk of complications and sometimes has incomplete clearance.

What are the risks of laparoscopy?

Like most surgeries, a laparoscopy involves some risk. Some of the risks include:

• Hernia
• Bleeding
• Blood clots
• Peritoneal trauma
• Inflammation or infection
• Potential need for blood transfusion
• Damage to internal structures including the stomach, bowel, bladder or ureter
• Hypothermia is a risk because of increased exposure to cold, dry gases during insufflation
• Trocar injuries- these types of injuries are produced when there is insertion into the abdominal cavity. Some include umbilical hernias, umbilical wound infections and abdominal wall hernias. These risks are more likely to affect people who have a previous abdominal surgeries or low BMI (body mass index).

What are the alternatives to laparoscopy?

Laparoscopy is a minimally invasive technique which is used as an alternative to traditional open surgery. Open surgery may be necessary in certain situations and your surgeon will speak to you regarding your options before making a decision as to which type of surgery will be performed.

Endoscopy is the use of cameras to relay images from inside the body. The device used, known as an endoscope, is a long, thin, and flexible tube that has a camera at one end as well as a light source.

An endoscopy can be used to diagnose a wide range of conditions, and the results are interpreted by a specialist. Whether the results are good or bad clearly depends on what symptoms are being investigated, and on which part of the body the endoscopy is being performed.

What does it involve?

Endoscopes are inserted into the body via a natural opening (the mouth, nose, or the anus). There are different types of endoscopy depending on the site and function of the procedure. For example, if the bowel is to be investigated, it is referred to as a colonoscopy; if the airways are to be examined, the procedure is referred to as a bronchoscopy.

An endoscopy can also be used for surgery, as in the case of laparoscopic surgery. In this situation, the laparoscope (a specific type of endoscope) is inserted through small incisions. Once inserted, the endoscope is able to send images from the inside of the subject’s body back to a TV screen to be examined in close detail.

How is endoscopy performed?

Laparoscopy is performed under general anaesthetic, which relaxes the muscles and reduces pain. The surgeon makes small incisions in the abdomen and inserts a laparoscope, which is a small camera attached to the end of a thin tube, allowing the surgeon to see inside the abdomen through a projection on a TV monitor in front of them.
The first incision is made in the navel and the abdomen will be inflated in order to make the organs easier to view. A second incision may also be made at the pubic hairline, as an additional opening for surgical instruments. The surgeon uses these small instruments to perform surgery, looking at the TV monitor for a clear view of the area they need to operate on.
The procedure normally takes around 30 to 60 minutes and patients are required to stay in the recovery room for an hour after the surgery is performed. You will be mointored by a nurse and can normally be discharged about four hours after surgery.

How is endoscopy performed?

Laparoscopy is performed under general anaesthetic, which relaxes the muscles and reduces pain. The surgeon makes small incisions in the abdomen and inserts a laparoscope, which is a small camera attached to the end of a thin tube, allowing the surgeon to see inside the abdomen through a projection on a TV monitor in front of them.
The first incision is made in the navel and the abdomen will be inflated in order to make the organs easier to view. A second incision may also be made at the pubic hairline, as an additional opening for surgical instruments. The surgeon uses these small instruments to perform surgery, looking at the TV monitor for a clear view of the area they need to operate on.
The procedure normally takes around 30 to 60 minutes and patients are required to stay in the recovery room for an hour after the surgery is performed. You will be mointored by a nurse and can normally be discharged about four hours after surgery.

What is an endoscopy used for?

An endoscopy is most commonly used to investigate symptoms and help to diagnose conditions relating to the digestive system, although it can be deployed to produce images and aid with many other parts of the body, including the respiratory system, the urinary tract, and the female reproductive system. An endoscope can also be used to assist with surgery.

The most common symptoms that endoscopy investigates include the following:

• abdominal pain
• nausea and vomiting
• unexplained weight loss
• diarrhoea
• blood in the stool
• vomiting blood

How can you prepare for an endoscopy?

You may be required to avoid food and liquids for a period beforehand, depending on what type of endoscopy you are undergoing. In the case of a colonoscopy, you might be given laxatives to help you evacuate any stool beforehand. You may also be required to stop taking certain medication, such as blood thinners, to prevent excess bleeding from the procedure.

What does a typical endoscopy procedure feel like?

The procedure usually only causes mild discomfort, although a local anaesthetic is also sometimes used. It is normally performed with the patient conscious, although sedatives can be deployed to help you relax. Antibiotics are sometimes used to reduce risk of infection.

It is not usually painful, but it may feel uncomfortable. The procedure typically lasts between 15 to 45 minutes, which will depend on which endoscopic procedure is being performed. 

Which specialist performs endoscopic procedures?

A gastroenterologist will typically be responsible for performing endoscopic procedures.

What should I expect following my endoscopy?

If you have been given a sedative, expect to stay in hospital for up to two hours after your endoscopy procedure has finished.

Are there any side effects?

Patients who undergo an endoscopy will not receive all of their results immediately afterwards, but will receive them no later than a week after their procedure.

What is the difference between an endoscopy and a capsule endoscopy?

A normal endoscopy involves the gastroenterologist inserting an endoscope through the patient’s mouth, whereas a capsule endoscopy sees the patients swallow a pill-sized capsule-like camera, which transmits images whilst it travels through the patient’s digestive tract.

What can’t I do before an endoscopy?

It is very important that patients avoid swallowing anything six to eight hours before the procedure.

Can I eat as normal after my endoscopy?

The good news is that patients will be able to eat after their endoscopy as soon as they are discharged from hospital. However, they will be advised to eat as slowly as possible and to decrease their meal size.

Upper gastrointestinal (GI) surgery is surgery performed to treat pathologies of either the upper gastrointestinal tract (small bowel), gall bladder, liver, pancreas or oesophagus.

The upper gastrointestinal (GI) includes the oesophagus (the food pipe), the duodenum (the first part of the small intestine) and stomach.

Why is upper gastrointestinal (GI) surgery done?

The upper gastrointestinal tract is vulnerable to several conditions that may need surgical treatment Upper GI surgery can be done as a:

Oesophagectomy : A surgery to treat oesophageal tumours, and it involves removing all or part of the oesophagus.

Gastrectomy : A surgery to treat stomach tumours. This involves the full or parial removal of the stomach and nearby lymph nodes.

Minimally invasive laparoscopic (keyhole) surgery : This can be used for resection (removal) of stomach and oesophageal tumours.

A doctor might recommend upper gastrointestinal (GI) surgery if a patient suffers from symptoms including bloating, abdominal pain, heart burn, swallowing difficulties and acid regurgitation. The condition is first evaluated using diagnostic techniques to find the underlying conditions.

Symptoms that may motivate someone to find out if upper gastrointestinal (GI) surgery is right for them may be due to conditions such as:

• Inflammation of the stomach
• Gastritis or duodenum
• A H.pylori infection
• Gastroesophageal reflux disease (GERD)
• Peptic ulcers (sores)

Other diseases affecting the motility (ability to move) and the function of the oesophagus.

Symptoms can be caused by stomach tumours or oesophageal tumours. Depending on the location and the stage of the cancer, surgery might be needed for the treatment and management of the cancer.

Preparation for Upper GI surgery

There are several diagnostic procedures to evaluate conditions that may need upper GI surgery as treamment, including:

• Upper GI endoscopy , a procedure used to diagnose and treat certain upper GI conditions or problems. It uses special instruments with a laser attachment and camera.
• Oesophageal pH monitoring , this measures how often the stomach acid enters the oesophagus. It is most commonly used to diagnose gastroesophageal reflux disease (GERD).
• Oesophageal manometry is used to assess the function of the sphincter, the muscle at the lower end of the oesophagus.

These diagnostic techniques can be used to evaluate some upper GI symptoms for example:

• swallowing difficulties
• abdominal pain
• benign (non-cancerous) or malignant (cancerous) tumours.

Upper GI surgery aftercare

Post upper GI surgery patients may need someone to help with heavier jobs such as food shopping gardening or vacuuming for a few weeks.

Some patients feel more confident staying with or having a relative or friend stay with them. Patients are often encouraged to do regular, daily exercise in order to stay active. This reduces the risk of blood clots forming in the legs.

Aftercare

After laparoscopic hernia surgery, patients can normally return home the same day, providing they are not experiencing a lot of pain, nausea or vomiting. You can expect to be a bit sore for the first couple of days after surgery, but this can be managed with rest and painkillers.

You should be able to walk around after surgery, working up to more strenuous activity slowly over the following two weeks. It is important to eat high-fibre foods during recovery to avoid constipation and straining on the toilet.

Laparoscopic hernia repair is a minimally-invasive surgery performed with general anaesthesia. A laparoscope is a flexible, thin instrument with a light source and camera on the end. It is inserted through small incisions made in the abdomen, depending on where the hernia is. The surgeon is then able to use this camera to guide the surgical repair.

Why is it done?

Laparoscopic hernia surgery is less invasive than open surgery and leaves just three small scars instead of one large one. As a result, there is less pain following surgery and a quicker recovery period. Patients are able to return to normal activities sooner than after having open hernia repair surgery.

What does it involve?

During laparoscopic hernia surgery, the abdomen is inflated with carbon dioxide gas to allow a better view for the surgeon. The surgeon performs the repair of the hernia using stitches and synthetic mesh which provide reinforcement of the abdominal walls. Once repaired, the small incisions are closed with stitches or surgical tape. These stitches will dissolve over time and do not require later removal.

How do you prepare for laparoscopic hernia surgery?

Before laparoscopic hernia surgery is recommended by your specialist, you will have had a thorough physical examination, an MRI scan and an ECG to assess your cardiac health. You will also be given general anaesthesia for this surgery and you won’t feel anything during the procedure. As such, food, drink and certain medications will have to be stopped for a certain period before the operation.

Aftercare

After laparoscopic hernia surgery, patients can normally return home the same day, providing they are not experiencing a lot of pain, nausea or vomiting. You can expect to be a bit sore for the first couple of days after surgery, but this can be managed with rest and painkillers.

You should be able to walk around after surgery, working up to more strenuous activity slowly over the following two weeks. It is important to eat high-fibre foods during recovery to avoid constipation and straining on the toilet.

Alternatives to this treatment

Hernias may also be repaired using open surgery or robotic repair surgery. Open surgery involves a larger incision being made to access the site of the hernia. The hernia is then pushed back into the correct position, reinforced with either stitches or synthetic mesh. Robotic repair is also performed laparoscopically, but the surgeons sits at a special console where they control the movements of the surgical instruments from this console.

Gastric cancer is a growth of abnormal and malignant (cancerous) cells in the stomach. Gastric cancer is difficult to detect in its early stages and sometimes, there are no symptoms. In general, when the symptoms occur, the tumour can be well advanced.

The most common symptoms are heaviness after meals, heartburn, abdominal pain, nausea, vomiting, loss of appetite and weight, difficulty swallowing or bleeding, among others
Gastric cancer surgery is part of stomach cancer treatment.

The most common treatment is the removal of part or all of the stomach, and when necessary, other organs or lymph nodes that have been affected.

Gastric surgery is not always the definitive solution to cure the disease, but it can also be used to reduce the symptoms and damage it causes in the body.

Other treatment options include radiotherapy and chemotherapy. A multidisciplinary team is required and this can involve oncologists, radiation oncologists, pathologists, radiologists, surgeons and gastroenterologists.

What does it consist of?

This surgery consists of removing the cancer, the nearby lymph nodes and part of the stomach – the amount of tissue removed depends on the severity of the disease. The stage of the condition at the time of diagnosis and the position of the cancer is key to determining the most effective surgery.
When undergoing a subtotal (partial) gastrectomy, or a total gastrectomy, your surgeon might recommend open surgery or keyhole surgery.

If the cancer has advanced to an incurable state, a patient can be offered palliative surgery which consists of alleviating cancer symptoms. This surgery prevents bleeding from the tumour and the tumour blocking the stomach.

Types of surgeries

Endoscopic resection : Endoscopic mucosal resection and endoscopic submucosal resection can only be performed to treat some very early-stage cancers. This type of surgery consists of inserting an endoscope through the mouth, down the throat and into the stomach and then removing the tumour and some healthy tissue surrounding it.

Subtotal (partial) gastrectomy : This operation is recommended if the cancer is found in the lower section of the stomach, but the procedure can be used in some cases where the upper section of the stomach needs removing.

Total gastrectomy : If the cancer has spread throughout the entire stomach, a total gastrectomy will be performed and this involves removing the entire stomach, nearby lymph nodes and the surgeon may also need to remove parts of other nearby organs such as the oesophagus, intestines or pancreas. After the removal of the stomach, the oesophagus is connected with the small intestine to allow the patient to eat.

Preparation for surgery

You will enter the hospital several hours before surgery and have your medical history and blood checked. You will need to fast for at least 8 hours before surgery.

Aftercare

After the operation, you are taken to intensive care or a high dependency recovery unit and you’ll be given anaesthetic and painkillers to manage pain. Surgical incision wounds are dressed and you’ll be advised on how to manage the healing wounds and avoid infection once you leave.

It’s not possible to eat or drink after surgery, and you will be given fluids through a drip for 24-48 hours. In around a week or two after surgery, you can expect to be able to eat small amounts. A dietician will advise you on what to eat once you are discharged from the hospital. Patients can experience side effects such as nausea, heartburn, diarrhoea, and abdominal pain and this is due to food moving too quickly through the intestines.

It is very important that patients avoid swallowing anything six to eight hours before the procedure.