Laparoscopy : What is it and what is it for?
Dr Claude Allouche, gynecologist 
Ahuza Clinic, Raanana, Israel
058 726 02 64
Laparoscopy (in Hebrew: laparoscopia לפרוסקופיה):
- is a surgical procedure to examine and operate on the organs located inside the abdomen without having to open the abdominal wall.
- It is performed using a camera and surgical instruments inserted into the abdominal cavity through small incisions.
- Unlike a laparotomy, it does not require opening the abdominal wall and minimizes the risks of bleeding, infection and post-operative pain.
- It therefore has the advantage of limiting scarring.
- It takes place in the operating room under general anesthesia
- Small incisions of 5 to 10 mm in diameter are made on the skin, allowing a video camera and small surgical instruments to be introduced into the abdomen.
COELIOSCOPY: FOR WHICH DISEASES?
It is indicated for the diagnosis and treatment of:
GYNECOLOGICAL DISEASES:
- ectopic pregnancy,
- infertility,
- Ovarian Cyst,
- pelvic infection,
- removal of the ovary,
- removal of the tube,
- fibroid,
- hysterectomy,
- organ descent,
- pelvic cleaning,
- endometriosis…
DIGESTIVE DISEASES:
- appendicitis,
- cholelithiasis,
- inguinal hernia,
-acute cholecystitis…
UROLOGICAL DISEASES:
- abnormality of the urinary tract,
- undescended testicle…
CANCEROLOGY: monitoring and surgery of certain cancers…
BARIATRIC SURGERY:
- Gastric Band,
- sleeve gastrectomy,
- gastric bypass…
Laparoscopy : HOW IS IT CARRIED OUT?
BEFORE
- In Israel, it is first of all your doctor or your kupat holim gynecologist who will indicate the indication for laparoscopic surgical intervention and refer you to a hospital where it can be performed.
- He will therefore write you a hafnaya (הפניה) in which the summary of your file will be included with the requested intervention.
- With this hafnaya it will then be up to you to make an appointment in the hospital you have chosen for a “trom nitouah” consultation (טרום ניתוח) that is to say intervention programming where you will meet a surgeon .
- It is up to the latter to make the final decision on the type and method of laparoscopic intervention or not based on their experience and the data in your file.
- He will open a hospital file and schedule the date of the intervention with you.
- Information and consent forms for the procedure and anesthesia will be given to you and you must return them signed on the day of the procedure
- Please note that if the hospital in which you want to have an operation does not belong to your koupat holim, you will first need to obtain form 17 (tofes 17 טופס 17) from the secretariat of your koupat
- Before the operation, you will meet the surgeon and the anesthesiologist to prepare for the laparoscopy.
- The day before or the morning of the operation, you must come to the hospital on an empty stomach.
You will then be asked to take an antiseptic shower and put on a sterile gown, and you will be given a tranquilizer if necessary.
COELIOSCOPY: HOW IS THE INTERVENTION PERFORMED ITSELF?
- Laparoscopy is carried out under general anesthesia.
- You will then be intubated and a urinary catheter will be inserted into your bladder.
- Surgical skin painting with an antiseptic is then carried out with the installation of sterile fields
- In certain cases, a “lower approach” is put in place: A thin rigid guide (hysterometer) is introduced into the uterus through natural channels to be able to mobilize the latter during the laparoscopic intervention and better expose the organs to be operated on .
- Using a needle or a trocar (long, hollow surgical instrument) placed at the level of the navel, the surgeon infuses carbon dioxide to lift your abdominal wall by pushing out the intestines.
- Through the same incision, an optical fiber connected to a digital camera is then inserted into the abdomen, allowing the surgeon and his assistants to view on a large screen all the organs located inside your abdomen and to follow precisely every gesture made.
- When laparoscopy is carried out to operate and not only as an examination, other trocars are then introduced under visual control into the abdominal wall to pass the surgical instruments.
- In general, these trocars have a diameter of 5 or 10 mm and allow the insertion of scissors, forceps, coagulation systems, needles and needle holders so that they can operate with a closed stomach.
- In certain cases (uncontrolled hemorrhage, significant adhesions, operative complications, etc.), it may be necessary to convert laparoscopy into laparotomy, that is to say, to switch to a classic procedure with opening of the abdomen. Even if this eventuality is quite rare, the patient must be warned of this possibility when scheduling the laparoscopy because the duration of hospitalization and the operative consequences are no longer the same.
Laparoscopy lasts from 30 minutes to several hours depending on the procedure performed.
- COELIOSCOPY: WHAT HAPPENS AFTER?
- After a laparoscopy, you will be monitored for an average of 2 hours in the recovery room.
- Certain post-operative side effects linked to anesthesia (nausea, vomiting, drowsiness) or linked to surgery (abdominal pain, gas) may appear.
- Complications are rare (bleeding, infection, wound, phlebitis, pulmonary embolism).
- The duration of hospitalization depends on the nature of the laparoscopy and the progress of the procedure. You can leave the same day or within 5 days.