If your physician is recommending a laparoscopic or endoscopic procedure, you need to understand what this means for you, the patient. Laparoscopic surgery is also called "minimally invasive surgery" and involves performing surgical tasks through small incisions in the abdominal or pelvic cavities. The surgeon gains access to the targeted area using a device called a "trocar" - a cylindrical tube that guides equipment and a camera system (laparoscope) into the cavity. The trocar may have another rod inside it with a surgical blade on the end that makes the incision at the same time as the trocar is inserted. Alternatively, a small incision is made with a scalpel first, and then a blunt or bladeless trocar is inserted thereafter. In most surgeries, two trocars are used, although sometimes as many as four can be used for more complicated procedures. Non-flammable carbon dioxide gas is injected into the abdominal cavity to elevate the abdominal wall above the internal organs to create a working and viewing space; this process is called "insufflation". The trocars form a barrier to keep the gas from leaking out during the procedure. Once the trocars are in place and insufflation is complete, the surgical team then performs surgical tasks by threading thin instruments through the trocars.
Choosing laparoscopic surgery over conventional surgery has many advantages for you, the patient. Smaller incisions mean that healing time is much shorter, and there will be smaller scars. You will be under anesthesia for a much shorter time than for conventional surgery, so the recovery time is faster. But any surgery carries risk. With laparoscopic surgeries, injuries can result from trocar insertion. It is often difficult for the surgeon to estimate how much pressure will be required to apply to the trocar during insertion, and the anatomy of each patient is different. There have been cases where tissue, blood vessels or organs have been lacerated or perforated by the trocar itself (whether it has a blade or is blunt). This can result in complications during the procedure itself, or that become apparent a few days after the procedure (such as infection).
Our company, Innovamed, makes a device called the Laprostop® that can be attached to the outside of the trocar and helps the surgeon control the insertion depth of the trocar. The Laprostop can also be sutured into place so that the trocar remains more laterally and vertically stable during the procedure. This provides the surgeon additional control.
It's your job to arm yourself with information and get your questions answered about laparoscopic procedure. Here are some suggested questions to ask your surgeon ahead of time:
- How long have you been doing this type of surgery?
- How many procedures have you done?
- What type of trocars will be used and how many?
- Where will they be inserted?
- What happens when the trocars are inserted?
- If the trocar nicks tissue, an organ or a blood vessel, how will you know? What measures are then taken to address the injury?
- How are trocars held in place?
- Have you considered using the Laprostop device during the procedure?