Written and peer-reviewed by physicians—but use at your own risk. Read our disclaimer.

banner image

amboss

Trusted medical answers—in seconds.

Get access to 1,000+ medical articles with instant search
and clinical tools.

Try free for 5 days

Laparoscopic surgery

Last updated: December 2, 2019

Summary

Laparoscopic surgery is a minimally invasive technique used to perform surgical procedures within the abdominal cavity, utilizing specialized instruments introduced through small incisions made on the abdominal wall. The abdominal cavity is first accessed using a trocar or a Veress needle, most commonly in the midline (peri-umbilical region). The peritoneal cavity is then insufflated with carbon dioxide (CO2). A fiber-optic instrument (laparoscope) is inserted into the first trocar to visualize the abdominal cavity and to allow for other ports to be created under direct vision. Laparoscopy is often the preferred diagnostic procedure for most elective gastrointestinal and gynecological surgeries. It is contraindicated in patients with shock, cardiac/pulmonary failure, and in cases of dilated bowel loops/perforation peritonitis. There are several advantages of laparoscopy over laparotomy as the incisions used are much smaller (e.g., less postoperative pain, fewer respiratory complications). However, the surgery is technically more challenging and complications (e.g., hemorrhage, bowel injury) are difficult to control laparoscopically. Complications unique to laparoscopy (secondary to CO2 insufflation of the peritoneal cavity) include hypercarbia, pneumothorax, pneumomediastinum, venous air embolism, and postoperative shoulder pain. Proper patient selection and good surgical technique minimize the risks and complications of laparoscopy.

Indications

References:[1][2][3][4][5][6]

Contraindications

References:[7][8][9][10][11][12][13]

We list the most important contraindications. The selection is not exhaustive.

Procedure/application

  • Anesthesia: general anesthesia (most common), spinal anesthesia with/without epidural anesthesia may be used in some cases
  • Access to the peritoneal cavity (laparoscopic entry): A trocar/Veress needle is inserted through the abdominal wall (generally midline) into the peritoneal cavity.
    • Trocar: An instrument with a sharp conical end that is used to establish a portal of entry into a body cavity.
  • Creating a pneumoperitoneum: The peritoneal cavity is insufflated with carbon dioxide (CO2).
    • Allows visualization of abdominal contents and creation of operative space
    • Raises intra-abdominal pressure due to the insufflation of gas within a closed cavity
  • Creation of other port sites
  • Removal of instruments and trocars
  • Evacuation of pneumoperitoneum
  • Closure of the port sites: Fascia of port sites > 5 mm must be sutured at the end of the surgery.

References:[3][7][14][15][16][17][18]

Advantages and disadvantages of laparoscopy

  • Advantages of laparoscopy over laparotomy include:
  • Disadvantages of laparoscopy are mainly technical:
    • The surgical field is converted to a two-dimensional image on a monitor.
    • Technically more challenging than laparotomy
    • Difficulty in controlling intra-operative hemorrhage
    • Laparoscopy-specific complications (see below)

References:[3][8]

Complications

Most intra-operative complications (pneumothorax, respiratory acidosis, air embolism) are indications to convert the procedure to a laparotomy (open procedure).

References:[1][9][11][12][17][17][17][19][20][21][22][23][24][25]

We list the most important complications. The selection is not exhaustive.

References

  1. Ballehaninna UK. Exploratory Laparoscopy. In: Roberts KE, Exploratory Laparoscopy. New York, NY: WebMD. http://emedicine.medscape.com/article/1829816. Updated: January 29, 2016. Accessed: April 4, 2017.
  2. Bardawil T. Operative Laparoscopy. In: Isaacs C, Operative Laparoscopy. New York, NY: WebMD. http://emedicine.medscape.com/article/1848486-overview. Updated: December 27, 2015. Accessed: April 4, 2017.
  3. Holzheimer RG, Mannick JA, Sayek I, Onat D, Lerut T. Surgical Treatment: Evidence-Based and Problem-Oriented. W. Zuckschwerdt Verlag GmbH. ; 2001
  4. Gould J, Ponsky TA, Blatnik J. Instruments and Devices Used in Laparoscopic Surgery. In: Post TW, ed. UpToDate. Waltham, MA: UpToDate. https://www.uptodate.com/contents/instruments-and-devices-used-in-laparoscopic-surgery.Last updated: February 18, 2016. Accessed: April 4, 2017.
  5. Walsh RM, Heniford BT. Role of laparoscopy for Hodgkin's and non-Hodgkin's lymphoma. Semin Surg Oncol. 1999; 16 (4): p.284-292.
  6. Gray HJ. Cancer of the Ovary, Fallopian Tube, and Peritoneum: Staging and Initial Surgical Management. In: Post TW, ed. UpToDate. Waltham, MA: UpToDate. https://www.uptodate.com/contents/cancer-of-the-ovary-fallopian-tube-and-peritoneum-staging-and-initial-surgical-management.Last updated: November 22, 2016. Accessed: April 4, 2017.
  7. Marks J. Diagnostic Staging Laparoscopy: General Principles for Staging Primary Digestive Malignancies. In: Post TW, ed. UpToDate. Waltham, MA: UpToDate. https://www.uptodate.com/contents/diagnostic-staging-laparoscopy-general-principles-for-staging-primary-digestive-malignancies.Last updated: August 10, 2016. Accessed: April 4, 2017.
  8. Guidelines for Diagnostic Laparoscopy. https://www.sages.org/publications/guidelines/guidelines-for-diagnostic-laparoscopy/. Updated: April 1, 2010. Accessed: April 4, 2017.
  9. Bishoff JT, Kavoussi LR, Leavitt DA. Atlas of Laparoscopic and Robotic Urologic Surgery. Elsevier ; 2017
  10. Kamine TH, Papavassiliou E, Schneider BE. Effect of abdominal insufflation for laparoscopy on intracranial pressure. JAMA Surg. 2014; 149 (4): p.380-382. doi: 10.1001/jamasurg.2013.3024 . | Open in Read by QxMD
  11. Perrin M, Fletcher A. Laparoscopic abdominal surgery. Contin Educ Anaesth Crit Care Pain. 2004; 4 (4): p.107-110. doi: 10.1093/bjaceaccp/mkh032 . | Open in Read by QxMD
  12. Crozier TA. Anaesthesia for Minimally Invasive Surgery. Cambridge University Press ; 2004
  13. Shayani V, Siegert C, Favia P. The role of laparoscopic adhesiolysis in the treatment of patients with chronic abdominal pain or recurrent bowel obstruction. JSLS. 2002; 6 (2): p.111–114.
  14. Bajwa SJ, Kulshrestha A. Anaesthesia for laparoscopic surgery: General vs regional anaesthesia. J Minim Access Surg. 2015; 12 (1): p.4-9. doi: 10.4103/0972-9941.169952 . | Open in Read by QxMD
  15. Arthurs GJ, Sudhakar M. Carbon dioxide transport. Contin Educ Anaesth Crit Care Pain. 2005; 5 (6): p.207-210. doi: 10.1093/bjaceaccp/mki050 . | Open in Read by QxMD
  16. Hamood MA, Mishra RK. Different port closure techniques in laparoscopy surgery. World Journal of Laparoscopic Surgery. 2009; 2 (3): p.29-38.
  17. Whelan RL, Fleshman JW Jr, Fowler DL, Are Ch, Talamini MA, Ludwig KA. The Sages Manual: Perioperative Care in Minimally Invasive Surgery. Springer ; 2006
  18. Neuhaus SJ, Gupta A, Watson DI. Helium and other alternative insufflation gases for laparoscopy. Surg Endosc. 2001; 15 (6): p.553-560. doi: 10.1007/s004640080060 . | Open in Read by QxMD
  19. Kavic MS, Levinson CJ, Wettr PA, Ott DE. Prevention & Management of Laparoendoscopic Surgical Complications. Society of Laparoendoscopic Surgeons ; 1999
  20. Mendoza KCh, Suarez GC, Suguimoto A. Anesthesia crisis in laparoscopic surgery: Bilateral spontaneous pneumothorax: Diagnosis and management, case report. Rev Colomb Anestesiol. 2015; 43 (2): p.163-166. doi: 10.1016/j.rcae.2015.01.006 . | Open in Read by QxMD
  21. Kouritas VK, Papagiannopoulos K, Lazaridis G, et al. Pneumomediastinum. J Thorac Dis. 2015; 7 (Suppl 1): p.S44-49. doi: 10.3978/j.issn.2072-1439.2015.01.11 . | Open in Read by QxMD
  22. Prevention & Management of Laparoendoscopic Surgical Complications.
  23. Ott DE. Subcutaneous emphysema: beyond the pneumoperitoneum. JSLS. 2014; 18 (1): p.1-7. doi: 10.4293/108680813X13693422520882 . | Open in Read by QxMD
  24. Gordy S, Rowell S. Vascular air embolism. Int J Crit Illn Inj Sci. 2013; 3 (1): p.73-76. doi: 10.4103/2229-5151.109428 . | Open in Read by QxMD
  25. Holzheimer RG. Laparoscopic procedures as a risk factor of deep venous thrombosis, superficial ascending thrombophlebitis and pulmonary embolism: case report and review of the literature. Eur J Med Res. 2004; 9 (9): p.417-422.