Laparoscopic surgery is a minimally invasive diagnostic and therapeutic procedure that involves inserting a laparoscope and surgical instruments through small incisions in the abdomen. This allows physicians to visually observe internal abdominal structures and perform surgeries. Combined with imaging display systems, it enables precise tissue excision, suturing, or lesion removal, significantly reducing the trauma associated with traditional open surgery.
The main purposes include diagnosing unexplained abdominal pain, performing gynecological or gastrointestinal surgeries, and treating specific organ diseases. Compared to conventional surgery, laparoscopic procedures offer advantages such as smaller wounds and faster recovery, and are now widely used in general surgery, gynecology, and urology.
They can be categorized into diagnostic laparoscopy and therapeutic laparoscopy based on function. Diagnostic procedures are used to confirm the location and extent of lesions, while therapeutic surgeries directly address the pathology, such as gallbladder removal, ovarian cystectomy, or intestinal anastomosis. During surgery, carbon dioxide gas is injected into the abdomen to separate the abdominal wall from internal organs and expand the visual field.
The mechanism involves transmitting real-time images via high-resolution cameras, with specialized instruments for delicate operations. Surgeons control the bent instruments through a monitor to perform suturing, hemostasis, and other actions. At the end of the procedure, the gas is released, and only 0.5 to 1.5 centimeters of skin is sutured or left unsutured.
Common indications include:
Other applicable situations include liver cyst drainage, staging of abdominal lymph node metastasis, and adhesion separation surgeries. In some cases, preoperative assessment with additional imaging techniques such as ultrasound or CT scans is required.
The procedure is usually performed under general anesthesia, with 3 to 4 incisions of 0.5 to 1.2 centimeters in the abdomen, one for the laparoscope and the others for instrument channels. The operation duration depends on complexity, generally ranging from 1 to 3 hours, with longer times for complicated cases.
Postoperative observation is required for 4 to 6 hours before resuming diet, and hospital stay typically lasts 1 to 3 days. In special cases such as liver surgery, hospitalization may extend to 5 to 7 days. During recovery, strenuous activities should be avoided, but gradual resumption of daily activities can begin after one week.
The primary benefits include minimal trauma and less bleeding, with single-incision surgeries reducing tissue damage by over 60%. Patients can usually be discharged within 24 to 48 hours post-surgery, with recovery times shortened by 50% to 70% compared to traditional open surgeries.
Additional advantages include:
Possible complications include:
Serious risks include intra-abdominal infection and deep vein thrombosis. Elderly or obese patients may have increased anesthesia risks. In rare cases, due to unclear anatomy, conversion to open surgery may be necessary, with a conversion rate of about 2%-5%.
Contraindications include:
Preoperative assessments should include coagulation tests and abdominal imaging. Patients with compromised cardiopulmonary function should have anesthesia risks evaluated. Pregnant women in late pregnancy or those with severe obesity may require adjusted surgical strategies.
Compared to traditional open surgery, laparoscopy reduces infection risk but requires higher technical skill. Compared to laparoscopic-assisted surgery, pure laparoscopy can completely avoid large incisions, though complex cases may require combined small incision auxiliary channels.
In gynecological treatments, ovarian cystectomy via laparoscopy and medication form a treatment ladder: cysts larger than 5 cm or suspected malignancy are recommended for surgery, while smaller cysts can be monitored or hormonally managed.
Studies show that laparoscopic cholecystectomy has a complication rate below 4%, with recovery times over 7 days shorter than traditional surgery. The 5-year recurrence rate for therapeutic ovarian cystectomy is approximately 8%-12%, with no significant difference compared to open surgery.
In cases of local resection of colorectal cancer, the 30-day complication rate for laparoscopy is below 15%, comparable to robotic surgery with the Da Vinci system, but at a lower cost.
Alternatives include:
When choosing alternatives, consider lesion location and patient condition. For example, severely obese patients may prioritize robotic-assisted surgery, while elderly patients might opt for staged treatments due to anesthesia risks.
What preparations are needed before laparoscopic surgery?
Preoperative assessments include blood tests, imaging examinations (such as ultrasound or CT scan), and anesthesia risk evaluation by the physician. Patients should fast for 8 hours and refrain from drinking for 4 hours before surgery. They should also inform the doctor of current medications, especially anticoagulants, to reduce bleeding risks during surgery. On the day of surgery, patients need to change into hospital gowns and remove all jewelry and metal objects.
When can I resume normal activities after surgery?
Generally, light activities such as walking can begin 1-2 days postoperatively, but lifting heavy objects or strenuous exercise should be avoided for at least 2 weeks. The total recovery time varies depending on the type of surgery; for example, gallbladder removal typically takes 1-2 weeks, while gastrointestinal surgeries may require 4-6 weeks. Surgeons will provide specific advice based on individual recovery progress.
How can I relieve shoulder and neck pain after surgery?
The CO2 gas used during surgery may irritate the diaphragm, causing shoulder and neck discomfort, which is common. Doctors often prescribe painkillers, and patients can also use warm compresses, gentle shoulder movements, or elevate the upper body while resting to alleviate symptoms. These symptoms usually subside within 3-4 days; if pain persists or worsens, medical attention should be sought immediately.
What are the key points for wound care after laparoscopic surgery?
The wounds should be kept clean and dry, avoiding contact with contaminants. Usually, daily dressing changes are unnecessary. Small wounds may be secured with adhesive tapes, while larger ones require suture removal. If redness, swelling, pus, abnormal discharge, or fever occurs, prompt medical consultation is necessary. Complete wound healing typically takes 1-2 weeks; during this period, soaking the wound (e.g., bathing) should be avoided.
Is there a difference in recurrence rates between laparoscopic and traditional open surgery?
Recurrence rates mainly depend on the nature of the disease rather than the surgical method. However, laparoscopic surgery, with smaller incisions and less tissue damage, generally reduces the risk of infection and adhesions, indirectly decreasing the need for secondary surgeries caused by complications. For example, long-term recurrence rates of ovarian cysts treated laparoscopically are comparable to open surgery, but recovery times are significantly shorter.
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