Laparoscopic surgery is a minimally invasive diagnostic and therapeutic procedure that involves inserting a laparoscope and surgical instruments through small incisions in the abdomen, allowing physicians to visually observe internal structures and perform surgeries. This technique combines imaging display systems to accurately carry out tissue excision, suturing, or lesion removal, significantly reducing the trauma associated with traditional open surgeries.
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 minimal trauma and rapid recovery, and are now widely used in general surgery, gynecology, and urology.
They can be divided into diagnostic laparoscopy and therapeutic laparoscopy based on function. Diagnostic procedures are used to confirm the location and extent of lesions, while therapeutic procedures directly address the lesions, 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 enlarge the operative field.
The mechanism involves transmitting real-time images via high-resolution cameras, combined with specially designed instruments for delicate operations. Surgeons control the bending instruments on a monitor to perform suturing, hemostasis, and other actions. At the end of the procedure, the gas is expelled, and only a 0.5 to 1.5 cm skin incision or no incision at all is needed for wound closure.
Common indications include:
Other applicable situations include liver cyst drainage, staging examinations of abdominal lymph nodes, and adhesiolysis. In some cases, preoperative assessment with additional imaging techniques such as ultrasound or CT scans is necessary.
The surgery is usually performed under general anesthesia, with the surgeon making 3 to 4 incisions of 0.5 to 1.2 cm in the abdomen, one for inserting the laparoscope and the others as channels for instruments. The operation duration varies depending on complexity, typically lasting 1 to 3 hours, with more complex cases potentially longer.
Postoperative observation is required for 4 to 6 hours before resuming diet, with hospital stays generally lasting 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 return to normal activities can usually begin after 1 week.
The main advantages include minimal trauma and less bleeding, with single-incision surgeries reducing tissue damage by over 60%. Patients can typically be discharged within 24 to 48 hours post-surgery, with recovery times shortened by 50% to 70% compared to traditional open surgeries.
Additional benefits include:
Potential 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 function tests and abdominal imaging. Patients with cardiopulmonary insufficiency 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 rates but requires higher technical skills. Compared to laparoscopic-assisted surgery, pure laparoscopy can completely avoid large incisions, but complex cases may require combined small incision-assisted channels.
In gynecological treatments, ovarian cystectomy via laparoscopy and medication therapy form a treatment ladder: cysts larger than 5 cm or suspected malignancy are recommended for surgery, while smaller cysts may be monitored or treated hormonally.
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 about 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 equipment 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 may 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 scans), 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 daily activities after surgery?
Generally, light activities such as walking can start 1-2 days post-surgery, but lifting heavy objects or vigorous exercise should be avoided for at least 2 weeks. The total recovery time varies depending on the type of surgery; for example, laparoscopic gallbladder removal typically requires 1-2 weeks, while laparoscopic gastrointestinal surgeries may take 4-6 weeks. Surgeons will provide specific advice based on individual recovery.
How can I relieve shoulder and neck pain after surgery?
The carbon dioxide gas used during surgery can irritate the diaphragm, causing shoulder and neck discomfort, which is common. Doctors often prescribe pain relief medications, and patients can also use warm compresses, gentle shoulder movements, or elevate the upper body while resting to alleviate symptoms. These usually subside within 3-4 days; if pain 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 contamination, but daily dressing changes are generally unnecessary. Small wounds may be secured with adhesive tapes, while larger ones may require sutures. 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 infection and adhesion risks, indirectly decreasing the need for secondary surgeries caused by complications. For example, the long-term recurrence rate of ovarian cystectomy via laparoscopy is comparable to open surgery, but patient recovery time is significantly shorter.
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