What is Laparoscopic Surgery?

The Tulane Medical Center has a long history of performing laparoscopy in urology. Laparoscopy is a technique for performing major abdominal surgery through several tiny (0.5 to 1 cm) incisions instead of the large 12-inch incisions that have been used in the past. Laparoscopy involves a high resolution video camera so organs, such as kidneys, adrenals, prostate, and ureters, can be visualized with a 1-cm telescope and manipulated with instruments through these small 0.5 to 1-cm incisions on the abdomen. Because of their small size, these incisions produce less discomfort after laparoscopy than the scar associated with large incisions required for open surgery. With laparoscopy, the need for pain medication, the length of hospital stay, and the recovery time are greatly reduced. Laparoscopic surgery requires general anesthesia. Although laparoscopic surgery is easier on the patient than open surgery, it requires great skill and technique therefore requiring specialized training.

Laparoscopy is established in the mainstream of urologic surgery. Indeed, it is becoming increasingly clear that almost all aspects of retroperitoneal surgery, be it kidney, ureter, adrenal gland, prostate, or lymph nodes, can now be achieved laparoscopically with far less injury and pain to the patient. Minimally invasive surgery is superseding open surgery at major medical centers throughout the world. In the new millennium, the old craft of open, large-incision surgery has an diminishing role in the treatment of urologic disease.

Benefits of Laparoscopic Surgery

  • Several documented benefits in comparison with traditional open surgery have been demonstrated including:
  • Less postoperative pain
  • Less blood loss
  • Shorter hospital stay
  • Favorable cosmetic result / smaller scars
  • Earlier return to work and normal daily activities

Laparoscopic surgery cannot be performed if you have:

  • Uncorrectable coagulopathy
  • Intestinal obstruction
  • Abdominal wall infection
  • Suspected malignant ascites

Also, relative contraindications include morbid obesity, extensive prior abdominal or pelvic surgery, ascites, pregnancy, severe chronic obstructive pulmonary disease (COPD), and severe cardiac arrhythmias or heart disease.

Complications

Complications are decreased in experienced surgeons who perform laparoscopy on a routine basis. The estimated complication rate of laparoscopic surgery is less than 5%. The associated mortality rate is about 0.3% and conversion rate was 1-5%. Risks of surgery include bleeding, infection, injury to adjacent organs such as liver, bowel, spleen, or pancreas, as well as possible conversion to open surgery. Most intraoperative complications (2.5%) are vascular and bowel injuries, while postoperative complications (3%) were predominantly blood clots and wound infections. Conversion to open surgery may be necessary to safely complete the planned procedure, which occurs < 5% in experienced hands.