Laparoscopic Surgery

Laparoscopic surgery is a minimally invasive surgical technique in which a surgeon operates inside the abdomen or pelvis through several small cuts, rather than one large opening.

The surgeon inserts a laparoscope (a thin tube with a tiny camera on its tip) through one of the small cuts. The camera sends live images to a monitor, so the surgeon can see inside the body without opening it widely. Thin surgical instruments are passed through the other cuts to perform the operation. Because the cuts are small — usually less than the width of a finger — the surrounding muscles and tissues are disturbed far less than in traditional open surgery.

Laparoscopic surgery is used across a wide range of conditions affecting the abdomen, pelvis, and reproductive organs. Surgeons choose this approach when the target area can be safely reached through small cuts and the patient is well enough to tolerate general anaesthesia (medicine that puts you fully to sleep).

• Gallstones (hard deposits in the gallbladder) — the most common reason for this surgery worldwide
• Appendicitis (inflammation of the appendix)
• Hernia repair (closing a gap or weakness in the abdominal wall)
• Gastro-oesophageal reflux disease, or GORD (persistent stomach acid rising into the food pipe)
• Colorectal conditions, including bowel cancer, diverticular disease (small pouches in the bowel wall), and inflammatory bowel disease
• Endometriosis (tissue similar to the womb lining that grows outside the womb)
• Ovarian cysts (fluid-filled sacs on the ovary)
• Removal of the uterus (hysterectomy)
• Kidney removal or kidney donor procedures
• Bariatric surgery (weight-loss procedures such as gastric sleeve or gastric bypass)
• Biopsy (taking a small tissue sample) to diagnose an unexplained mass or condition in the abdomen

This approach is not always suitable. Your surgeon will recommend traditional open surgery instead in certain situations:

• Severe internal bleeding that needs to be controlled very quickly
• Very dense scar tissue (adhesions) from previous abdominal operations that makes it unsafe to work through small cuts
• Certain large tumours that cannot be safely removed through small openings
• Conditions where the body cannot safely tolerate the gas used to inflate the abdomen during the procedure
• Emergency situations where speed is more important than cut size

Laparoscopic surgery is generally considered safer than open surgery for the same conditions, but like any operation it carries recognised risks.

• Pain or discomfort at the cut sites, which usually settles within a few days
• Shoulder or upper back ache caused by carbon dioxide gas (used to inflate the abdomen) pressing on the diaphragm (the breathing muscle under the lungs) — this is temporary
• Infection at a wound site or, less often, inside the abdomen
• Bleeding during or after the operation
• Blood clots in the legs (deep vein thrombosis) or lungs (pulmonary embolism) — a risk with any abdominal surgery
• Accidental injury to a nearby organ, blood vessel, or bowel during insertion of instruments
• Hernia at one of the small cut sites in the weeks or months after surgery
• Reaction to general anaesthesia, such as nausea, sore throat, or, rarely, more serious effects
• Conversion to open surgery — if complications arise during the procedure, the surgeon may need to make a larger cut to continue safely; this is a precaution, not a failure

Good preparation helps the surgery go smoothly and reduces the chance of complications. Your surgical team will give you specific instructions, but the following steps are typical.

Before the day of surgery, patients are usually asked to fast (have nothing to eat or drink) for a number of hours — the exact duration depends on the hospital's anaesthesia protocol and what time the operation is scheduled. Smoking significantly slows wound healing and raises the risk of chest infection after any surgery under general anaesthesia; most surgical teams advise stopping as early as possible before the procedure. Alcohol should also be avoided in the days leading up to the operation. Some medications — particularly blood thinners, anti-inflammatory painkillers, and certain diabetes drugs — may need to be paused; the medical team will review everything you take and advise accordingly. Always tell the team about any supplements or herbal remedies as well.

Pre-operative (before surgery) tests help the team assess your fitness for anaesthesia and surgery. Common tests include:

• Blood tests to check overall health, blood count, clotting ability, and organ function
• An EKG (electrocardiogram — a tracing of the heart's electrical activity) to check heart rhythm
• A chest X-ray if the team needs to assess the lungs or heart
• Imaging such as CT (computed tomography) or USG (ultrasound) to map the area to be operated on
• A pregnancy test for women of childbearing age

On the day of surgery, the typical sequence of events is as follows:

• You arrive at the hospital and change into a surgical gown.
• A nurse checks your vital signs (pulse, blood pressure, temperature, oxygen level) and confirms your identity and consent.
• An intravenous (IV) line is placed in a vein in your arm to deliver fluids and medications.
• You are taken to the operating theatre and positioned on the surgical table.
• The anaesthesiologist (specialist in anaesthesia) administers general anaesthesia; you fall asleep and feel nothing during the procedure.
• The surgical team cleans and drapes the skin over the abdomen.
• The surgeon makes a small cut, usually near the navel (belly button), and inserts a hollow needle or port to pump carbon dioxide gas into the abdomen, gently lifting the abdominal wall away from the organs to create a working space.
• The laparoscope is inserted through this first port; additional small cuts are made for the working instruments, usually two to four more depending on the operation.
• The surgeon performs the planned procedure while watching the monitor.
• Once finished, the gas is released, the instruments are removed, and the small cuts are closed with stitches, staples, or surgical glue.
• You are moved to the recovery area, where nursing staff monitor you as the anaesthesia wears off.

Recovery from laparoscopic surgery is generally faster than from open surgery for the same procedure, but how quickly each person recovers depends on the specific operation performed, their overall health, and whether any complications arose. Your medical team will guide you through each stage.

• Monitoring after the operation: You will spend time in a recovery area — and sometimes an overnight ward — so that nurses can watch your vital signs, pain level, and the wound sites as the anaesthesia wears off. Some procedures allow discharge on the same day; others require a hospital stay of one or more nights.
• Pain management: Mild to moderate discomfort at the wound sites and the temporary shoulder ache from residual gas are normal. The team will manage this with appropriate pain relief; it is important to report pain that feels severe or worsening.
• Movement: Gentle, short walks are usually encouraged soon after surgery to help circulation and reduce the risk of blood clots. Strenuous activity, heavy lifting, and vigorous exercise are restricted for a period decided by your surgeon.
• Wound care: The small cuts should be kept clean and dry according to the team's instructions. Signs of infection — increasing redness, swelling, warmth, discharge, or fever — should be reported promptly.
• Diet: Many patients can return to normal eating sooner than after open surgery, but this varies with the type of operation. Some procedures, such as bowel or bariatric surgery, require a gradual reintroduction of food.
• Driving and work: You will not be able to drive until the anaesthesia and any strong pain medication have fully cleared your system, and until you can react normally in an emergency — your team will tell you when this is safe. Return to desk work is often sooner than return to physical labour.
• Follow-up appointments: A post-operative check is usually scheduled to review wound healing, discuss any pathology (laboratory analysis of removed tissue) results, and plan the next steps in your care.
• When to seek urgent help: Go to a doctor or emergency department promptly if you develop a high fever, severe abdominal pain, persistent vomiting, heavy bleeding from a wound site, difficulty breathing, or a leg that becomes painful and swollen.