Laparoscopy or keyhole surgery is a minimally invasive surgical procedure that is performed by making small incisions in the abdominal wall. Laparoscopy is done with the help of a thin tube-shaped instrument called a laparoscope. This tool is equipped with a camera and light at the end.
Laparoscopic procedures are performed for diagnostic or treatment purposes. Through this method, the doctor will be able to see a number of abnormalities, such as infections, cysts, fibroids, and adhesions, in the abdominal or pelvic organs. In addition, this procedure can also be applied for the purposes of taking tissue samples in a biopsy examination.
Indication Laparoscopy
The doctor will consider a laparoscopic procedure with the following objectives:
- Check for or treat tumor growths in the abdomen or pelvis.
- Treating endometriosis, ectopic pregnancy, or pelvic inflammatory disease.
- Look for the cause of the emergence of pain in the pelvis.
- Take a tissue sample for a biopsy.
- Perform a tubal ligation (surgery on the fallopian tube).
- Treating a hiatal hernia or inguinal hernia.
- Check for cysts, adhesions, fibroids, or infections in the reproductive organs that make it difficult for a woman to get pregnant.
- Removing problematic organs such as the uterus, spleen, gallbladder, ovaries, or appendix.
Warning Laparoscopy
Before undergoing laparoscopic surgery, the doctor will ask about the medical history and examine the patient's physical condition. Patients are advised to tell their doctor if they have drug allergies, have bleeding problems, are taking blood thinning medications (eg aspirin and warfarin), or are pregnant.
Laparoscopy is not recommended if the patient has cancer or hernia in the abdomen, or has had surgery in these areas, as it is very risky. Patients must follow the instructions given by the doctor regarding when to fast before the laparoscopic procedure, as well as the schedule for taking medicines.
Preparation Laparoscopy
Laparoscopy is performed by a surgeon with the help of an anesthesiologist. One hour before the operation, the patient will be asked to urinate to empty the bladder. Fluid intake and a sedative (sedative) will be given through an IV that is injected into a vein in the arm.
The doctor will take the patient's blood as a sample. Several other tests may be performed, such as an electrocardiogram (ECG), X-rays, lung function tests, and others. The type of test carried out will be adjusted to the age and health condition of the patient at the time of surgery.
The anesthesiologist will anesthetize the patient with an injection to fall asleep. There are several procedures that doctors perform after the patient is anesthetized, including:
- Trim pubic hair.
- Clean the stomach with a special antiseptic solution.
- Insert a breathing apparatus through the throat.
- A catheter may also be inserted into the bladder through the urethra (urethra).
- In female patients, the doctor will perform a pelvic exam first before inserting a thin tube called a cannula into the uterus through the vagina. The cannula is used to move or shift the uterus and ovary, so as not to block the field of view into the abdominal cavity during the examination.
Procedure Laparoscopy
Laparoscopic surgery begins by making a small incision (about 5-10 mm) in the abdominal wall as the entrance for the laparoscope. The doctor may make more than one incision to insert another instrument into the abdomen. This procedure generally takes 30-90 minutes, depending on the patient's condition.
After the incision is made, the doctor will insert carbon dioxide gas, or if helium gas is not available, into the abdomen with the help of a medical instrument such as a needle that has a cavity in the middle. This gas is used to pump the stomach wall up and away from the internal organs, so the doctor can see the contents of the stomach clearly.
After that, the doctor will use a laparoscope and some other medical equipment to repair the damage, take tissue samples, or to remove tumors and cysts. Sometimes, the laser is also often attached to the laparoscope to support surgery.
After the operation is complete, the laparoscope is pulled out and the gas that was pumped is expelled from the stomach. The incisions made at the beginning of the procedure will also be closed with stitches, then wrapped in a bandage. These incisions leave very small scars, and will go away on their own over time.
After Laparoscopy
After surgery, the patient will undergo a short recovery period in the ward of two to four hours. The doctor will check the patient's blood pressure, body temperature, oxygen levels, and heart rhythm. If the condition is stable and safe, the patient is allowed to go home and carry out activities as before. To speed up wound healing, patients are advised to avoid strenuous activities for a week after surgery.
Effect Samping Laparoscopy
Although laparoscopy is relatively safe, this procedure still has side effects. Approximately 1-2 percent of patients who undergo laparoscopy experience mild complications such as infection, nausea, vomiting and bruising. In addition, there are also several other complications that can occur after undergoing laparoscopic surgery:
- Damage to major arteries.
- Serious allergic reaction to anesthetics.
- Clots in the blood vessels.
- Damage to organs, such as the intestines or bladder.
- The entry of carbon dioxide into the blood vessels as a side effect of the use of gas.