Laparoscopy

Laparoscopy is a small operation to look inside your tummy (abdomen) and the area between your hips (pelvis). Laparoscopy is also known as keyhole surgery or minimally invasive surgery.

A laparoscopy can help diagnose certain types of cancer. It is also a common procedure used to treat and diagnose many other non cancerous conditions.

What is a laparoscopy?

A laparoscopy involves your surgeon making several small cuts (incisions) instead of a large incision across your abdomen. The surgeon places hollow tubes inside the incisions. These are called ports. Your surgeon puts a thin tube with a light and a camera called a laparoscope through one of the ports in your abdomen.

You have a laparoscopy under a general anaesthetic in the operating department. This means you are asleep during the procedure and will not feel anything. It can take between 30 minutes and two hours. You usually have a laparoscopy as a day case, so you can go home later the same day.

Some laparoscopic operations use a robot. This is called robotic surgery or robotic assisted surgery. This is where the surgeon sits at a console and directs the robotic arms to perform the surgery.

Below is a picture of robotic surgery for prostate cancer.

Why might I have a laparoscopy?

You might have a laparoscopy to diagnose your cancer. This includes cancers that start or spread to the:

• stomach
• pancreas
• liver
• ovaries
• bile duct
• gall bladder
• tummy lining (peritoneum)

Before your laparoscopy

You usually have a pre assessment appointment before your laparoscopy. This is to check that you are fit enough for the procedure and to have an anaesthetic. A nurse weighs you and takes your blood pressure, pulse and temperature.

You might also have:

• blood tests to check your blood levels and how well your blood clots
• a heart trace (ECG)
• a chest x-ray

The pre assessment staff will give you more information and explain exactly what will happen before and on the day of your procedure. They will also ask you to sign a consent form. You can ask any questions you might have

Preparing for your laparoscopy

Tell your doctor if you’re taking medicine that changes how your blood clots. These include:

• aspirin
• clopidogrel
• arthritis medicines
• warfarin or heparin
• apixaban or rivaroxaban
• ticagrelor

Your doctor tells you if you need to stop your medicines or change the amount (dose) before the laparoscopy. It’s a good idea to take a list of the medicines you are taking. 

You can’t eat for 6 hours before the operation. You might be able to have water for up to 2 hours beforehand. The hospital staff will give you instructions about this.

Tell your doctor if not eating could be a problem for you, for example if you have diabetes.

Having a laparoscopy

On the day of your laparoscopy, you ususlly meet your nurse first. They go over your medical history and check if you have any allergies. They also take the following measurements:

• blood pressure

• heart rate

• temperature

• oxygen levels (saturation)

Before the operation, you will meet the surgeon and the anaesthetist and sign a consent form if you haven’t done so already.

Your nurse will tell you when to change into a hospital gown. You do this nearer the time you go to the operating room (theatre). You may be able to take along your own dressing gown and slippers.

When it’s your turn, your nurse takes you to the operating theatre.

In the operating room

You lie on the operating bed and the anaesthetist puts a small plastic tube called a cannula into a vein in the back of your hand or arm. At a similar time, other staff in the operating theatre attach some monitoring equipment to you. Such as a blood pressure cuff and clip on your finger to measure your oxygen levels and heart rate.

The anaesthetist then injects the anaesthetic through the cannula. You then drift off to sleep.

Your surgeon makes several small cuts called incisions across your tummy. Each cut is around 1cm long. 

You usually have:

• one near your tummy button

• one or two lower on your tummy

Your surgeon puts gas (carbon dioxide) into your tummy. This makes it easier for the surgeon to see your organs, including the liver  the stomach  and gallbladder .

Hollow tubes called ports are placed inside the cuts to hold them open and allow the laparoscope to pass through easily. Your surgeon puts the laparoscope through one of the ports. They put other surgical instruments through the other ports, such as an ultrasound probe. There are several instruments they might use, and this will depend on what your surgeon sees.

Your surgeon can see the inside of your abdomen and pelvis on a TV screen.

They look for signs of cancer in the:

• lining of your tummy and pelvis

• surface layer of organs in your tummy and pelvis

They may take biopsies and fluid to send to the laboratory to check for cancer cells if they see any abnormal areas.

After they have finished, your surgeon removes the instruments and ports. They then close the small holes with stitches or surgical glue.

After the laparoscopy

You wake up in the recovery area and then go back to the ward where you stay for a few hours. You can usually go home the same day.

You might have fluids through a drip into your cannula. Once you’re awake and drinking, your nurse stops the drip and removes the cannula. You should be able to eat and drink normally once you feel able to.

You might have some pain in your:

• tummy for a few days

• shoulder for a day or two due to the gas in your tummy

Your nurse will give you medication to relieve the pain while you are in the hospital. And explain what you can take when you are at home, such as paracetamol and ibuprofen.

You usually have paper stitches over the wounds or dissolvable stitches. You also have a waterproof dressing over them, or you might have a type of special skin glue.

Your nurse will show you how to look after the wounds and explain how long you should keep your dressing on for.

Because you have had an anaesthetic, you’ll need someone to take you home and stay with you overnight. For 24 hours after a general anaesthetic you shouldn’t:

• drive

• drink alcohol

• operate heavy machinery

• sign any legally binding documents

After your surgery, your surgeon may also recommend that you:

• avoid having a bath for about 2 weeks after your laparoscopy, until the wound has healed (you can still shower)

• do not drive for 48 hours or until you can drive comfortably and do an emergency stop. Check your insurance cover with your insurers

• should not fly for 48 hours after having a laparoscopy

Possible risks

Most people won’t have problems from this type of operation. Your doctor makes sure the benefits of having it outweigh the risks. Your nurse will give you a number to call if you have any problems.

Some of the possible risks include:

A wound infection

There is a risk of infection at the site where the cuts were made with this operation. Contact your healthcare team or 24 hour hospital advice line if you have:

• a high temperature or feel unwell

• any redness or swelling around your wound or it’s leaking fluid

Bleeding

You might notice a small amount of blood from the cuts. This usually heals up on its own. Rarely there might be damage to a major blood vessel. If this happens you might need another operation. You might also need a blood transfusion. 

Blood clot

Signs of a blood clot include pain, swelling and redness where the clot is. Feeling breathless can be a sign of a blood clot on the lung.

Contact your advice line or doctor straight away if you have any of these symptoms.

Tummy pain

You may have some cramping or pain in your tummy after the test. This is due to the carbon dioxide. The pain or discomfort should go away after a few hours. You may also experience some pain or tenderness if you had some tissue removed. 

Tear in your bowel

Very rarely you might get a small tear (perforation) in the first part of your small bowel. If this happens it’s likely you would need surgery to repair the tear.

Your nurse will tell you what to look out for. They’ll also give you a number to contact if you have any problems.

An allergic reaction

There is a risk of having an allergic reaction to the anaesthetic. This can cause problems with your breathing, heart rate and blood pressure. If this happens, the staff will give you medicines to control the reaction.

Getting your results

One to two weeks after the test you should get the results from your specialist.

Waiting for test results can make you anxious. You might have the contact details of a specialist nurse who you can speak to for information and support if you need to. It may also help to talk to a close friend or relative about how you feel.