Laparoscopy is a term given to a group of operations that are performed with the aid of a camera placed in the abdomen. Originally, laparoscopy was used for gynecological procedures such as tubal ligation.

This technique was then adapted for removal of the gallbladder (laparoscopic cholecystectomy) and the appendix (laparoscopic appendectomy). Additionally, exploratory laparoscopy has often been used for diagnostic purposes to view the abdomen after abdominal trauma and in cases of abdominal illness.

Now the laparoscope also allows physicians to perform minimally invasive surgery with just a small incision in the abdomen. This technology, known as laparoscopic assisted surgery, enables the minimally invasive removal of the colon or the kidney (for living donors in kidney transplants), and weight reducing procedures such as gastric bypass and vertical banding gastroplasty (VBG).

Finally, large operations such as liver and pancreatic resections may begin with laparoscopy to rule out the presence of additional tumors (metastatic disease) that would make it difficult to cure the disease through surgery. For complex laparoscopic operations, patients should consult with their primary health care provider to find a center of excellence in the specific operation.

How the test is performed

The procedure is usually done in the hospital, under general anesthesia, and after informed consent has been obtained. A catheter (a small flexible tube) is inserted through the urethra into the bladder. An additional tube may be passed through the nostril and into the stomach to remove intestinal contents (N-G tube). The skin of the abdomen is cleansed, and sterile drapes are applied.

A small incision is made above or below the navel to allow the insertion of a trocar (essentially a tube extending from inside the abdomen to the outside), which allows passage of a video camera. Prior to insertion of the trocar, a needle is inserted into the incision and carbon dioxide gas is injected to elevate the abdominal wall, and thereby create a larger space to work in. This allows for easier viewing and manipulation of the organs.

After an adequate amount of gas is instilled, the laparoscope is inserted, and the organs of the pelvis and abdomen are examined. Additional small incisions are made for instruments that allow the surgeon to move the abdominal organs, cut tissue, suture, and staple structures to safely and effectively perform the necessary procedure.

Following the examination, the laparoscope is then removed, the incisions are closed with sutures, and bandages are applied. Depending upon the operation performed, a drain may be left through one of the incisions to allow for removal of accumulated fluid.

How to prepare for the test
You cannot have any food or fluid for 8 hours before the test. You must sign a consent form.

For infants and children:
The preparation you can provide for this test depends on your child’s age and experience. For general information regarding how you can prepare your child, see the following topics:

  • Infant test or procedure preparation (birth to 1 year)  
  • Toddler test or procedure preparation (1 to 3 years)  
  • Preschooler test or procedure preparation (3 to 6 years)  
  • Schoolage test or procedure preparation (6 to 12 years)  
  • Adolescent test or procedure preparation (12 to 18 years)

How the test will feel
Under general anesthesia, no pain will be felt during the procedure, however the incisions site may throb and be slightly painful afterward. A pain reliever may be given by your physician.

With local anesthesia, you may feel a prick and a burning sensation when the local anesthetic is given. Pain may occur at the incision site. Afterward, the incisions may throb for several hours and be slightly painful. A pain reliever will be administered by your physician.

Additionally, you may experience shoulder pain for a few days, since the gas can irritate the diaphragm, which shares some of the same nerves as the shoulder. Finally, you may experience an increased urge to urinate since the gas can put pressure on the bladder.

The specific procedure performed may preclude the ability to drink liquids or eat solid foods, until it is considered safe to do so by your health care provider.

Why the test is performed
Laparocopic operations are performed for the same reasons that open (laparotomy) procedures are performed.

What abnormal results mean

  • Specific to the operation performed

What the risks are
There is a risk of puncturing an organ, which could cause leakage of intestinal contents, or bleeding into the abdominal cavity. These complications often result when the doctor switches from laparoscopy to an open surgical procedure (laparotomy) during an operation. Severe injury may result in infection and/or a requirement for blood transfusion.

Special considerations
The ability to perform laparoscopic surgery is limited by the presence of previous abdominal surgery. Often prior surgery induces scar formation, which prevents the safe passage of the trocars into the abdomen, and may prevent the abdominal wall from being effectively distended by the gas instillation.

Johns Hopkins patient information

Last revised: December 6, 2012
by Dave R. Roger, M.D.

Medical Encyclopedia

