Laparoscopy surgery: a step-by-step guide for patients

What is laparoscopic surgery?

Laparoscopic surgery is a minimally invasive procedure designed to treat any kind of abdominal condition or disease. It’s commonly referred to as keyhole surgery and involves the use of a camera and specialised tools to carry out the required treatment.

The image below illustrates the areas of the abdomen that would see incisions as part of laparoscopic surgery:

How laparoscopy works and why it is minimally invasive

During laparoscopic surgery, the surgeon makes a selection of small incisions up to two centimetres wide. A specialised device (called a trocar) is then used to provide internal access to the abdomen or abdominal organs, depending on the treatment needed.

This method is different to open surgery which sees one or two larger incisions made to provide access to the abdomen.

Laparoscopy vs open surgery: what is the difference?

While we looked at the differences with regards to the size of the incision sites, this isn’t the only difference between laparoscopic and open surgery. Laparoscopic surgery also makes certain abdominal tissue and other parts of the abdomen easier to reach.

The recovery time and return to everyday activities following laparoscopic surgery is often reported to be faster than open surgery. Depending on the specific area of the body that was treated, laparoscopic patients can often return to work within one to three weeks of the procedure.

All this isn’t to say laparoscopy is better than open surgery. Your specific issue and the recommendations from your consultant on the best place for incision will inform which method is best for you.

The image below illustrates the difference between the laparoscopic and open incision sites for gallbladder surgery:

When in laparoscopy recommended?

The type of recommended laparoscopy is generally dependent on the specific treatment needed. For example, diagnostic laparoscopy may be the preferred method to diagnose endometriosis whereas a hernia laparoscopy would likely be recommended for diagnostics or when a patient has bilateral hernias (on both the left and right sides of the abdomen).

A laparoscopy may also be used as the best option to take biopsies from internal organs, but it all depends on the specific issue and needs of the patient.

Common reasons patient are referred

Among the most common reasons patients are referred for a laparoscopic procedure are:

• Laparoscopic cholecystectomy (removal of the gallbladder and treatment of gallstones)
• Treatment of hernias including inguinal, ventral, umbilical, and incisional
• For the diagnosis of gynaecological conditions including fibroids, endometriosis, and adhesions
• The investigation of ongoing pelvic pain.¹

When laparoscopy may not be suitable

While a laparoscopic procedure can benefit lots of different patients, there are a few occasions where it may not be suitable. These include:

• For patients with breathing issues (such as severe COPD) and other pre-existing co-morbidities (chronic, long-term health conditions)
• Patients with an increased risk of forming blood clots
• Patients who have had major abdominal surgeries in the past.

How to prepare for your laparoscopy procedure

Preparation for a laparoscopy will depend on the specific type of procedure you need. Most patients will be asked to stop smoking (if they smoke), while others may be asked to stop taking certain medications or undertake a fast.

Your pre-operative assessment

This is an opportunity for your consultant to assess your overall health and whether you’re a suitable candidate to undergo the necessary procedure. If the treatment requires anaesthetic, an anaesthetist evaluation may also be needed.

Fasting, medication advice, and what to bring

Depending on the type of laparoscopy procedure needed, patients will be given instructions on how to prepare. The majority of laparoscopic procedures require the patient to undergo general anaesthetic. These patients will need to fast six hours before they’re admitted to hospital. Water is allowed up to two hours before surgery.

With regards to medication, preparing for surgery will depend entirely on the specific type of laparoscopic procedure needed. This will be clearly set out by your consultant.

Arranging someone to drive you home

You won’t be able to drive yourself home after a laparoscopic procedure. This is due to the lingering effects of general anaesthetic slowing reaction times and causing drowsiness. Instead, you’ll need to ask a friend or family member to drive you home, or organise for a taxi to pick you up. If you need help organising a taxi, our friendly reception staff will be happy to help.

What happens during laparoscopy surgery?

As with the preparation for a laparoscopic procedure, what to expect on the day of your surgery varies depending on the specific type of laparoscopy you need. For example, if you’re having a laparoscopy to investigate or diagnose a condition, the procedure usually takes around an hour. Patients having a laparoscopy to treat a condition can expect the procedure to last longer.

Step 1: Anaesthetic and preparation

As the majority of laparoscopic procedures require general anaesthetic, this needs to be administered before patients are admitted to theatre for surgery. At Practice Plus Group Hospital, Ilford for example, this is done in a dedicated anaesthetic room. Here, a cannula is inserted to allow the anaesthetic to be administered. Once the patient is asleep, they’re moved into a position relevant to the specific type of laparoscopic procedure required.

Step 2: Small incisions and insertion of surgical instruments

At Practice Plus Group, it is of utmost importance that the dignity of all our patients is maintained and protected at all times. As such, once the anaesthetic has been administered and the patient is asleep, they are covered in a warming blanket before being transferred to theatre.

Once in theatre, the incision site markings made by the consultant are checked before the surgery begins. Please note that these incisions sites vary depending on the type of surgery needed. The most common incision sites are through the belly button but sometimes the side, top or bottom of the abdomen is best.

Step 3: Inflating the abdomen with carbon dioxide gas

Once the incisions are made, carbon dioxide gas is then pumped into your stomach. This allows the surgeon a better view of what’s going on internally while also providing the space needed for the surgery. The amount of gas used is dependent on the patient’s size and tolerance.

Step 4: Inspection, diagnosis, and treatment

Depending on the type of laparoscopic procedure you need, a laparoscope (a thin, long, rigid camera) is passed through the initial incision to project internal images onto a screen. For patients receiving treatment – rather than investigation – further incisions may be needed for certain surgical instruments to access specific areas.

Step 5: Closing the incisions

Once the procedure is finished, the gas is let out of the stomach and the incisions are closed using stitches or clips. A dressing will then be applied on these cuts to help encourage fast healing.

Risks and complications to be aware of

A laparoscopy is considered to be a very safe procedure, but as with any type of surgery, there are some risks. These include:

• Infection and bleeding
• Organ injury
• Complications from anaesthesia.

With that said, the frequency of complications arising from laparoscopic procedures is minimal. According to the Royal College of Obstetricians and Gynaecologists, approximately two in 1,000 women (0.2%) experience complications from the procedure.²

Common minor risks (pain, bruising, small amount of bleeding)

One of the most frequently reported side-effects of a laparoscopy is bruising, particularly around the incision sites. These are usually mild and will heal over the course of a week or so.

The risks of your specific laparoscopic procedure will be clearly set out for you by your consultant during your initial consultation.

Recovery after laparoscopy surgery

The time it takes for you to recover will vary depending on the type of laparoscopy procedure you’ve had. Generally speaking, patients that have had a diagnostic and investigative laparoscopy procedure can expect a full recovery within two-three weeks. On the other hand, those that have had surgery may take a couple of months to fully recover.

What to expect in the first 24 hours

In the first 24 hours after your laparoscopy, you’ll need to keep your wounds dry. You will be able to shower after this initial 24 hours but make sure the water isn’t too hot as this can cause the wounds from the incisions to bleed.

Drink plenty of water and try to move around as much as you can without causing too much discomfort. Taking pain medication can help manage any residual pain or discomfort.

You’ll need to avoid the following post-surgery:

• Smoking
• Drinking alcohol for at least 72 hours
• Driving until you can perform an emergency stop without pain
• Having a bath until the wounds from the incisions have healed
• Taking flights longer than four hours for three months.

Benefits of laparoscopy for patients

From a faster recovery to the reduced risk of complications, we explore the benefits of having a laparoscopic procedure below.

Smaller incisions and quicker recovery

This is often labelled as the main benefit to a laparoscopy over more traditional open surgery. The reason for this is the minimally invasive nature of the procedure. Rather than one large incision, with a laparoscopy, two or three smaller incisions are made. This causes less trauma to surrounding muscles and tissue and, in turn, helps to encourage a faster recovery.

Reduced risk of complications

With laparoscopic procedures, there’s a reduced risk of infection as internal organs and structures are less exposed to the external environment during surgery. As the incision sites are smaller than open surgery, not only is there a reduced risk of scarring, but also of complications from bleeding and subsequent blood loss.

Where to get laparoscopy surgery

Laparoscopic procedures are available at the following Practice Plus Group hospitals:

• Barlborough
• Emersons Green
• Plymouth
• Southampton
• Portsmouth
• Ilford
• Gillingham – (currently only for hernia surgery)
• Devizes

How to book your laparoscopy with Practice Plus Group

Booking your laparoscopic procedure with Practice Plus Group depends on whether you’re an NHS or private patient.

For NHS patients
A referral is needed from your GP before you can proceed to booking a consultation with us. Once you have this, please give our friendly team of advisors a call on 0333 999 7641 or complete an online enquiry form.

For private patients paying for themselves
Private patients can self-refer for their laparoscopy. Simply give us a call on 0330 060 0003 or complete an online enquiry form to start your healthcare journey. We’ll be in touch within a few days to get you booked in for your consultation. From there, your procedure will usually take place within 4-6 weeks.

For private patients with health insurance
As with self-pay patients, those with private medical insurance can refer themselves for a laparoscopy with us. However, before anything can be booked in, you’ll need to confirm laparoscopic procedures are covered under the terms of your specific health insurance policy. This can be done by calling your insurance provider to confirm. If laparoscopy is included, you’ll be given an authorisation code that you’ll need to quote to us when booking your consultation.

Meet our laparoscopy surgeons

From Plymouth to Barlborough, at Practice Plus Group we have a range of specialists ready and willing to help with your specific laparoscopic procedure. We’ve featured Erika below but if you want to see who’s available, please take a look at our Consultants page.

Erika Birgiolaite, Consultant General Surgeon

Practises at: Practice Plus Group Hospital, Ilford

Qualifications:
– Master of Medicine, Lithuanian University of Health Sciences, 2014
– General Surgery, Lithuanian University of Health Sciences, 2019

Specialities:
– Laparoscopic cholecystectomy,
– Laparoscopic inguinal and ventral hernia repair surgery
– General surgeries and procedures

Erika talks about why she became a surgeon and how she supports her patients

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Acknowledgements

James Wood, Content Specialist