What is Laparoscopic (Closed) Surgery / Procedure?

Today, cameras used in every field with technological developments have started to be used in health. It is a method of seeing the intra-abdominal organs with camera systems and performing abdominal surgeries with instruments inserted through tiny holes (0.3 - 1 cm) in the abdominal wall. Cameras transfer images to a monitor in the operating room. It also provides a detailed field of view by magnifying the image about 15-20 times.

In order to create a large area in the abdomen through these tiny holes, carbon dioxide (CO2) gas is injected into the abdomen and the abdomen is inflated. Then, depending on the type of surgery to be performed, 1-4 0.3-1 cm wide incisions are made in the appropriate places on the skin and new tubes are inserted. “Long surgical instruments” are inserted through these newly inserted tubes and the planned surgery is performed. At the end of some surgeries, an extended incision may be made to remove the operated organ, cyst or tumor. After the operation, the gas given into the abdomen is drained.

 

Laparoscopy is a surgical procedure that is generally performed for both treatment and diagnosis. Laparoscopy offers a faster recovery compared to other surgical methods and significantly reduces the risk of complications that may occur during or after surgery.

Can Laparoscopic (Closed) Surgery / Procedure Be Performed in Areas Other Than the Abdomen?

Yes, it can, but the name of the procedure changes. For example, if it is to be applied in the chest cavity, it is called Thoracoscopy, and similar technology and methods are applied in the procedures.

Can Laparoscopic Procedures be Performed in Children at Any Age?

Yes, it can be done. Laparoscopic surgeries can be performed on one-day-old babies and 18-year-olds. However, it should never be forgotten that both surgery and anesthesia require a much wider and deeper experience than in the adult age group. Because the body size in children is not fixed, but variable and very small. The technological devices used are many and detailed and this situation requires more knowledge, experience and dexterity. This method, which is very safe and successful in safe hands, may cause more complications in unsafe hands.

Which Surgeries Can Be Performed Laparoscopically (Closed) in Children?

In short, all abdominal surgeries can be successfully performed with this method. The main surgeries are listed below;

• Inguinal Hernia (Inguinal Hernia)
• Diagnosis and treatment of undescended testicle (Nonpalpable - testicle that does not come to hand) surgeries
• Appendicitis Surgery
• Gallbladder (Gallstone) surgeries
• Gastro Esophageal Reflux
• Tumors and cysts of the kidney
• UPJ (Uretero Pelvic Stenosis) surgery
• Pylor stenosis in infants
• Congenital stomach and intestinal obstructions
• Stomach perforation
• Ovarian (Ovarian) torsion in girls, cysts and tumors
• Intra-abdominal and pelvic tumors (Neuroblastoma, Ovarian cysts and tumors... )
• Splenectomy (removal of the spleen) surgery
• Nephrectomy (removal of the kidney) surgery
• Laparoscopic Varicocele surgery
• Obesity surgeries
• Liver Hydatid Cyst

Which Surgeries Can Be Performed Thoroscopically (Closed) in Children?

• Pneumothorax (Air Leakage)
• Chest Wall Pathologies
• Pectus Excavatum (Shoemaker's Chest)
• Pectus Carinatum (Shoemaker's Chest)
• Thoracic Tumors (neuroblastoma, Lung Cysts...)
• Thymoma
• Congenital Pathologies of the Lung (Lobar Emphysema, Bronchial Cysts, Pulmonary Sequestration...)
• Empyema
• Hydatid Lung Cyst

How are Laparoscopy (Closed) Surgeries Performed?

During laparoscopy, the surgeon makes an incision (5-10 mm) below the belly button and then inserts a small tube called a cannula into this incision. The cannula is used to inflate the individual's abdomen with carbon dioxide gas. This gas allows the doctor to see your abdominal organs more clearly. After inflating the abdomen with carbon dioxide gas, the surgeon inserts the laparoscope through the incision through channels (3-15 mm) called trocars. The camera at the end of the laparoscope displays the images on a screen, allowing real-time visualization of the individual's organs.

The number and size of incisions made during laparoscopy may vary depending on the disease and the age (size) of the patient. These incisions make it possible to insert other instruments into the abdominal cavity, such as another surgical instrument that the surgeon needs to use to perform a biopsy.

Are There Risks of Laparoscopic (Closed) Surgeries?

Bleeding, infection and damage to intra-abdominal organs, which are more common in open surgeries, can also be seen in laparoscopic surgeries, although to a lesser extent. However, in experienced hands, these conditions are much lower than in open surgery. On the other hand, in inexperienced hands, these risks are much higher than in open surgery, because laparoscopy requires much more extensive knowledge and experience than open surgery.

Complications occur when the trocars used to insert the telescope and other surgical instruments are inserted into the abdomen or during the surgical intervention. During the insertion of the telescope and trocars into the abdomen, large vessel and intestinal injuries may occur in patients who have had previous abdominal surgery. During surgical intervention, bowel, bladder, ureter and vascular injuries may occur. In the treatment of some of these complications, it may be necessary to open the abdomen. Another complication of laparoscopy is that the planned surgery cannot be performed due to technical impossibilities and open surgery is returned.

The most common major complications (risks) can be listed as follows;

Although much less likely than open surgery, bleeding, vascular injuries and infection may occur.

Organ injuries may occur. (Especially: bladder (urinary bladder), uterus, intestines and urinary tract)

Postoperative infection of the incision site

Does Laparoscopic (Closed) Surgery Require a Different Preparation Compared to Open Surgery?

No, no special preparation is required, as in open surgery, special tests and imaging procedures are performed for each surgery.

General anesthesia is commonly given for this type of surgery. This means that the individual will sleep throughout the procedure and will not feel any pain. During general anesthesia, an intravenous (intravenous) line is inserted into one of the individual's veins. Through this intravenous line, the anesthesiologist can give the patient special medications and provide necessary hydration with fluids.

How Long Does Laparoscopic (Closed) Surgery Take?

Depending on the type of surgery to be performed and, in particular, the knowledge and experience of the surgeon performing the procedure, laparoscopic surgeries in children can take anywhere from 15 minutes to several hours. For example, an inguinal hernia repair may take 15 minutes, while a gastroesophageal reflux surgery may take 1.5-2 hours. It should be noted that laparoscopic surgeries performed by inexperienced surgeons can take much longer than open surgeries.

Is there pain after laparoscopic (closed) surgery?

After laparoscopy, your doctor will recommend that you take painkillers and antibiotics. It is very important to take these medications regularly to control pain and protect the body against infection.

Depending on the procedure or surgery performed, children can resume their normal lives and go to school within a few hours to a few days.

What is the recovery process like after laparoscopic (closed) surgery?

In laparoscopic surgery, the recovery period is much shorter than with traditional surgical techniques. Due to the use of general anesthesia, patients may experience symptoms such as nausea, vomiting, and weakness in the first few hours. For this reason, patients are usually kept under nursing supervision for a few hours. Before leaving the hospital, the physician provides the patient with necessary information about the medications they should take, the movements they should avoid, and other important considerations. Nowadays, self-dissolving sutures are generally used for the incisions made during laparoscopy. For sutures that are not made in this way, an appointment is made to remove the sutures a certain period of time after the surgery. Sore throat may be observed in the first few days after the operation. This is due to the irritation of the throat caused by the breathing tube used during general anesthesia. In addition, pain and discomfort may be experienced in the areas where the incisions were made. For these reasons, painkillers are usually prescribed by the doctor. Some of the gas used to inflate the abdomen during surgery may remain in the abdomen. For this reason, gas pain and abdominal cramps may be experienced. In addition, shoulder pain may also be experienced due to gas. These discomforts usually resolve on their own within 1-2 days as the gas is absorbed by the body and expelled. Following the doctor's recommendations, it may be necessary to avoid getting water on the incision sites for a certain period (usually 72 hours). The time it takes to return to daily life and work varies depending on the purpose of the laparoscopy procedure.

What are the advantages of laparoscopic (closed) surgery over open surgery?

• Less pain
• Less bleeding
• Fewer infections
• Fewer surgical scars, or even no scars at all
• Shorter hospital stay
• Faster and easier recovery
• Quicker return to daily activities

What is Robotic Surgery?

It is still performed using cameras and instruments inserted through small incisions, but the instruments are held by robotic arms rather than the surgeon and their assistants. The surgeon sits in a separate location and controls the robot using joystick-like controls while watching a 3D screen. All surgeries performed with laparoscopy can also be performed with a robot, but due to the high cost, its use is limited. In adults, it has no advantage over traditional laparoscopy except for a few types of surgery. In children, its use is quite limited.

When Can You Return to Normal Life After Laparoscopic Surgery?

Your doctor will tell you this. For minor operations, this period is 1-2 days, and for larger surgeries, it may be a little longer. Your doctor may tell you to avoid strenuous exercise or activity.

***The information provided here has been compiled for the purpose of informing visitors, particularly families, about the content of the website. None of the information should be considered as advice by visitors and should not lead to any decisions or actions. Families concerned about this issue should have their child examined by a pediatric surgeon and consult with them directly before making any decisions.