Laparoscopic Surgery

How a laparoscopic operation is performed

Gas is introduced into the abdominal cavity to create working space, and a camera and instruments are inserted through several small incisions. The camera image is shown magnified on a monitor, which helps to see small vessels and the boundary of healthy tissue. The removed tumor is taken out through a small incision, usually in a special bag.

If during the operation it becomes clear that it is safer or more reliable to continue open, the surgeon switches to an open approach. This is called conversion; the decision is made for the safety and completeness of the operation; conversion itself is not a complication, although it is sometimes needed because of one.

Benefits

• less surgical trauma and less blood loss;
• faster recovery — a shorter hospital stay after a laparoscopic procedure;
• timely start of further treatment, if it is needed: faster recovery can help, and the timing is set by your general condition;
• smaller scars — from the small incisions and the short incision used to remove the specimen.

When open surgery is chosen

• large tumors or tumors invading neighboring organs;
• emergencies — obstruction, perforation, when the patient’s condition and the circumstances of the procedure require open surgery;
• dense adhesions after previous operations;
• complex reconstructions — for example, with a hilar liver tumor;
• retroperitoneal sarcomas and cytoreductive surgery for carcinomatosis — because of size and extent;
• radical hysterectomy for cervical cancer — the large randomized LACC trial showed that recurrences occur more often after laparoscopic surgery.

Which operations are performed laparoscopically

When the tumor location and extent of the procedure allow it, the following are performed laparoscopically:

• colon operations — “Bowel Cancer Surgery”;
• rectal operations — “Rectal Cancer Surgery”;
• liver resections and ablation — “Liver Metastases Surgery”, “Liver Cancer Surgery”, “Radiofrequency Ablation”;
• simultaneous bowel and liver operations — “Simultaneous Bowel and Liver Surgery”;
• adrenal tumor removal — “Adrenal Tumor Surgery”;
• operations for endometrial cancer — “Uterine Cancer Surgery”;
• small bowel resections and gallbladder cancer operations — “Small Bowel Cancer Surgery”, “Gallbladder Cancer Surgery”.

Hospital stay and recovery

Recovery follows the enhanced recovery (ERAS) protocol: early mobilization, early eating, controlled pain relief. The length of the hospital stay depends on the extent of the operation; after a laparoscopic procedure it is usually shorter than after an open one of the same extent.

Risks and complications

A laparoscopic operation carries the same main risks as an open operation of the same extent: bleeding, infection, anastomotic leak, thrombosis. Risks specific to the approach:

• conversion — switching to open surgery if that is safer;
• injury to vessels or bowel while the instruments are being inserted;
• hernia at an incision site later on.

I will explain the risks in your particular case at the consultation.

What the cost depends on

The cost depends first of all on the type and extent of the operation, and also on the approach, the number of days in the hospital and the tests. The exact amount is named once the treatment plan has been defined. The payment can be split into parts — installments are available. The in-person consultation is free. More details are on the page “Cost of Surgery: What It Depends On”.

What documents are needed and how to book

• CT or MRI discs with reports — the discs themselves;
• the pathology report;
• summaries of previous operations — whether laparoscopy is possible depends on them;
• recent blood tests.

Book a consultation by phone or through the form. If you are from another city, send the documents in advance — how to do this is described on the page “Online Oncologist Consultation”.