Laparoscopy, also called laparoscopy, is undoubtedly one of the greatest surgical advances of the XNUMXth century. Much less invasive than laparotomy, it is used for diagnostic and / or operative purposes in many digestive, gynecological or even urological pathologies.

Developed in the 70s by gynecologists, laparoscopy consists of making small incisions on the abdominal wall in order to introduce an endoscope, a small flexible tube fitted with a light source and a mini-camera. magnifying effect, as well as possible surgical instruments in the event of operative laparoscopy. Laparoscopy thus makes it possible to observe the various digestive organs (liver, colon, gall bladder, etc.), genitals (uterus, ovaries, fallopian tubes) or urinary organs. It makes it possible to diagnose various pathologies, even to treat them without having to open the abdomen (laparotomy).

Laparoscopy is performed in the hospital, under general anesthesia.

The surgeon begins by making a small incision near the navel to insert the endoscope into the abdomen. The images are viewed on a screen connected to the camera attached to the optical system. Gas (generally CO2) is then injected into the abdomen to distend it and thus have more visibility and room, for a possible intervention.

In the event of an operative laparoscopy, other small incisions are made to introduce trocars (instrument holders) through which various surgical instruments will be slipped during the operation.

At the end of the laparoscopy, the instruments are removed, the gas is evacuated, and the incisions are closed with stitches.

As a diagnostic technique, laparoscopy is used in many situations:

• in case of abdominal or pelvic pain, in addition to an ultrasound;
• to find the cause of internal bleeding, blockage, or fluid buildup;
• in cancer diagnosis, to examine the abdominal and pelvic organs, lymph nodes, but also to take tissue samples for biopsy;
• to diagnose a cyst, assess endometriosis lesions;
• during a fertility check-up;
• etc.

As an interventional technique, laparoscopy is used in many digestive pathologies:

• appendicitis;
• acute cholecystitis (inflammation of the gallbladder);
• inguinal hernias;
• benign colon polyp;
• splenectomy;
• diverticulitis;
• gastrectomy partial;
• benign stomach tumors with uncertain prognosis (GIST, for gastrointestinal tumor stroma);
• obesity surgeries (gastric band, sleeve gastrectomy, bypass);
• etc.

And gynecological:

• treatment of endometriosis lesions;
• ovarian cyst removal;
• ovarian tumor removal;
• management of an ectopic pregnancy;
• hysterectomy (removal of the uterus);
• treatment of adhesions;
• cure of prolapse;
• sterilization;
• etc.

Operative suites

Painful phenomena in the abdomen and which may extend to the shoulders are common after laparoscopy. They are due to the presence of gas in the stomach but are well calmed by the analgesic treatment.

The duration of hospitalization depends on the nature of the laparoscopy (diagnostic or operative) and the intervention performed.

The results

Due to its minimally invasive nature, laparoscopy has many advantages over conventional surgery: (laparotomy):

• precision of gesture thanks to the camera;
• reduction of post-operative pain;
• decreased risk of infection;
• decreased risk of scarring hernias;
• decreased risk of intraperitoneal adhesions;
• reduction of the length of hospitalization and the period of convalescence;
• faster resumption of transit;
• aesthetic benefit with much smaller scars;
• etc. 

The risks

In addition to the risks associated with general anesthesia, the main risks of laparoscopy are infection or the formation of a hematoma at the incisions. The risk of phlebitis and pulmonary embolism is exceptional.