A laparoscope consists of a long lens with a small video camera attached to it. Additionally, a strong light source travels down the laparoscope, providing ample light inside the abdominal cavity. The laparoscope is inserted into the belly allowing the surgeon to view the organs with excellent clarity. The picture from the laparoscope is transmitted to a television monitor which allows all the members of the surgical team to closely follow the progress of the operation. Normally the laparoscope is inserted through the belly button. The main reason for this is that the belly button provides the shortest distance from the skin to the inside of the abdominal cavity. Additionally, it is relatively easy to hide the incision inside the belly button. Sometimes surgeons will place the laparoscope elsewhere, such as when there is suspected scar tissue underneath the belly button from previous surgeries, or when dealing with a large mass that lies up against it.
To improve visibility inside the abdomen, carbon dioxide gas is used to expand the abdominal cavity. This elevates the abdominal wall away from the intestines and other organs, allowing the surgeons to see clearly and use their instruments more safely and effectively. The carbon dioxide gas is used because it is inert, i.e. there is no risk of explosion or reaction to the process of surgery. Additional instruments are introduced through additional 0.5 to 1cm incisions on the belly. They are passed through rigid sleeves called trocars. The trocars facilitate the switching of instruments and prevent carbon dioxide to escape from the abdomen. It varies how many incisions and trocars are placed into the abdomen and they can be from one to seven, but the average is about two to three, not including the incision in the belly button.
Laparoscopy has several advantages to the patient. Some of them include:
- Faster recovery
- Less pain
- Smaller incisions
- Early return to normal activities
- Shorter hospital stay
Certain patients can even be treated in the office without the need for general anesthesia or a hospital admission. Because of minimal discomfort and enhanced convenience, many women decide to go home on the day of surgery, however some choose to stay in the hospital overnight. Laparoscopy also has several advantages for the surgeon. Some of them include:
- Excellent visibility
- Magnification of the lens
- Finer dissection
- All members of the surgical team can see what is going on
The team is actually more important in laparoscopy than during traditional laparotomy because the equipment used is more complex and requires more expertise. The surgeons cooperate closely with the nurses who often handle the equipment and the scrub techs who hand the proper instruments to the surgeons during the case. In addition, the patient needs to be tilted back so that the intestine will fall upwards and away from the surgical field. This requires some modification in anesthesia techniques.
The anesthesiologist is also critical when it comes to management of the patient during and after surgery. Many of the medications that are used during and after surgery have a strong effect on the outcome and general well being in the hours immediately after surgery. Some of these effects include nausea and vomiting, paralysis of the intestines causing bloating and a "gassy feeling," constipation, drowsiness and pain. By optimizing the medications used during and after surgery, all these effects can be minimized effectively.
