12. The role of laparoscopy in abdominal surgery

Question 1

Advantages of laparoscopy

Answer 1

• Reduced haemorrhage
• Smaller incision site: reduced pain and shortened recovery.
• Less pain means fewer post-operative medications
• Longer procedure times, but shorter recovery times thus shorter hospitall stays
• Reduced exposure of external contaminants

Question 2

Disadvantages

Answer 2

• Limited range of motion for the surgeon
• Poor depth of perception
• Reduced ability for the surgeon to feel the actual tissue in their hands, making judgement calls harder and delicate procedures such as knots and sutures more challenging
• Fulcrum effect: laparoscopic surgery is a non-intuitive motor skill. The tool end points
move in the opposite direction of the surgeon’s hands.

Question 3

Risks associated with laparoscopic surgery

Answer 3

• Trocar injuries - usually penetration of vessels
• Increased risk of hypothermia and peritoneal trauma due to gabs exposure during insufflation
• Patients with existing pulmonary disorders may not tolerate pneumoperitoneum generated with insufflation
• Insufficient CO2 removal after insufflation: gas exerts a force on the diaphragm and the phrenic nerve, this produces pain.
• Coagulation disorders and dense adhesions from previous abdominal surgery may pose added risk for laparoscopic surgery

Question 4

Diagnostic laparoscopy indications

Answer 4

• Lower abdominal pain with suspected acute appendicitis or ruptured ovarian cyst
• Upper abdominal pain with suspected perforated ulcer

Question 5

Elective diagnostic procedures

Answer 5

• Investigation of fertile problems
• Investigation of chronic abdominal pain
• Biopsy of lymph nodes in suspected malignancies

Question 6

Common procedures, not diagnostic:

Answer 6

• Cholecystectomy

* Appendectomy