Laparoscopy is a relatively new surgical method, which has developed in the second half of the 20th century. It enjoys a great popularity among the doctors and patients thanks to its great advantages, but it is also important to keep in mind that laparoscopy has certain disadvantages.


Before laparoscopy, the interventions of abdominal surgery have been performed by classic "laparotomic" approach. This means that the surgeons opened the abdomen by a long cut. The resulting opening served the surgeons to access the deeper abdominal organs that have been operated. In the end of the intervention, the cut has been closed by many stitches. This approach resulted in longer-healing and more painful wound that healed with a larger scar. The post-operative period needed longer bed rest and convalescence.


Laparoscopy is basically an endoscopic method. Abdominal surgery is performed not through one large cut, but through few small holes that serve for insertion of a camera and working tools. The camera and a light source helps to visualize the inside of the abdominal cavity and navigate the surgeon who controls the working tools from outside.  The laparoscopic instruments can do many things - cutting, trimming, taking biopsies and stopping bleeding.


After the operation, the small holes are sewn. This takes only few stitches, leaving no big wound and only minimal scar. This significantly reduces the post-operative convalescence and the patient may usually go home within days.


First, the patient is put to sleep by an anesthesiologist. After that, a small incision is carried out in the navel. This incision is used to insert a needle into the abdominal cavity. The needle is hollow and enables to inflate the abdominal cavity with a gas, usually the carbon dioxide. The inflation significantly improves the visibility and increase the operation space. The needle is later removed and a tubular device (a trocar) is inserted instead. The trocar serves for insertion of video camera with a light source into the abdomen. When this is ready, other holes (usually two) are created in the abdominal wall and other trocars are inserted. These trocars serve for insertion of the surgical instruments and the main operation can begin.


The laparoscopic approach is used both for diagnostic and therapeutic procedures. Diagnostic laparoscopy enables the examiner to visualize the inside of abdominal cavity and look for any abnormalities including visible cancers or metastases. In addition, it is possible to obtain samples for histological examination from any unknown or suspicious lesion. Therapeutic laparoscopy is aimed to cure a pathological condition including gallbladder removal, hernia surgery, appendectomy, gynecological surgery, gastric banding and many, many other interventions.


The laparoscopy has naturally also some disadvantages. In particular, it largely depends on the skills and experience of the surgeon, because he operates indirectly. If there is an acute condition (e.g. bleeding), the surgeon must react quickly and precisely, which is not always easy during laparoscopic approach.


Laparoscopy has many advantages over classic laparotomy. It leaves only few less-visible scars and allows faster healing and significantly shorter convalescence period. The intestinal activity is restored more quickly after the operation and the patient may be earlier discharged from the hospital.


Jiri Stefanek, MD  Author of texts: Jiri Stefanek, MD
 Sources: basic text sources