How is laparoscopic surgery performed?

In laparoscopic surgery, the surgeon works by inserting a camera and special instruments through small incisions in the abdomen. The view inside is displayed on a screen. This approach can be used both to investigate a condition and to treat it. Small scars on the skin do not necessarily mean that the operation inside was minor.

For suitable patients, this approach can make movement and recovery after surgery easier. However, it is not equally suitable for every condition or every patient. The choice is based on examination and test results, the purpose of the operation, previous procedures and overall health.

How do the camera and instruments enter the abdomen?

The operation is usually performed under general anaesthesia. You are asleep while the anaesthetist monitors your breathing, circulation and other vital signs. The first small incision in the abdomen is often made near the navel. Its position may vary depending on the type of operation and any previous scars.

A laparoscope is a thin instrument with a light and camera that shows the inside of the abdomen. Watching the screen, the surgeon separates tissues, seals blood vessels and carries out the necessary procedure. Additional small incisions are made for the other instruments. The number and position of the incisions depend on the work to be done; they are not the same for everyone.

The instruments pass through the abdominal wall through special access tubes. The medical term for this access device is a trocar. The camera and operating instruments can move through separate access points. This arrangement allows the surgeon to work inside the abdomen from different directions.

One incision may need to be enlarged to remove an organ or tissue. It is therefore normal for the incisions not all to be the same size after surgery. Enlarging an access point to remove tissue is a different decision from converting the entire operation to an open procedure.

Why is carbon dioxide introduced into the abdomen?

Space is needed to work between the abdominal wall and the organs. Carbon dioxide is introduced into the abdomen at a controlled pressure to create this space. The gas is not used to burn tissue or treat the disease. Its role is to create an area that allows the surgeon to see and move the instruments.

Most of the gas is released at the end of the operation. In the following days, you may feel bloated and have discomfort that spreads to the shoulder. This may be related to irritation of the diaphragm, which separates the abdomen from the chest, and often settles gradually. Shoulder pain accompanied by chest pain or shortness of breath should not be treated as ordinary gas discomfort.

The pressure created inside the abdomen and the position in which the body is held during surgery are taken into account in the anaesthetic plan. If you have heart or lung disease, tell the team during your preoperative assessment. Small incisions do not remove the need to prepare for general anaesthesia.

Which operations use this approach?

Gallbladder removal and some hernia operations are among the procedures performed laparoscopically. Certain conditions affecting the colon, rectum and stomach, as well as some adrenal gland problems, can also be treated this way. The organ involved does not determine the approach on its own; the nature of the condition and the extent of the procedure are assessed.

You can see an example of gallbladder removal using fine instruments in the Mini-laparoscopic cholecystectomy video. This surgical recording is intended for adults and contains footage of an operation. The instrument and incision sizes shown apply to that procedure and are not a fixed rule for all laparoscopic operations.

Bowel surgery may involve more extensive work, such as removing a diseased section and joining the remaining ends. These steps are shown in the Laparoscopic low anterior resection video, in which part of the rectum is removed. This is also a surgical recording intended for adults. Watching such footage is not a requirement for consenting to treatment; the technique can also be explained in words.

Sometimes laparoscopy is performed solely to assess the inside of the abdomen and take tissue for analysis. This is called diagnostic laparoscopy. Unlike an operation intended to treat a condition, its main purpose is to obtain more precise information; the next step is planned according to the findings and test results.

What does switching to open surgery mean?

During the operation, the surgeon may find that continuing through small access points is not appropriate. Reasons may include adhesions from a previous operation, where tissues stick together, severe inflammation, difficulty identifying the anatomy clearly or bleeding. In this situation, the surgeon switches to direct access through a larger incision.

This decision is not, in itself, a failure. The aim is to complete the operation safely. However, conversion is sometimes needed to manage a complication that has already occurred; it is important to distinguish between the reasons. After the operation, the surgeon should explain what was found and why the approach was changed.

The possibility of switching to open surgery is discussed before the operation as part of the consent process. Previous abdominal surgery does not make laparoscopy impossible for everyone, but it may affect the plan for gaining access and proceeding with the operation. This possibility cannot be assessed precisely by looking at the skin scar alone.

What should you watch for after surgery through small incisions?

Incision tenderness, tiredness and some bloating can be expected in the first few days. The length of the hospital stay and the time needed to return to everyday activities depend on the operation performed inside. A recovery plan for gallbladder surgery should not be applied to major bowel surgery. Internal healing may take longer than the appearance of the skin wound suggests.

Dr. Ilgar Ismayilov performs laparoscopic surgery for gallbladder conditions, hernias, and diseases of the colon, rectum and stomach.

Contact your surgeon urgently if you develop increasing abdominal pain, fever, persistent vomiting, spreading redness around the wound or pus. New pain and swelling in one leg also need assessment. Sudden shortness of breath, chest pain, loss of consciousness and serious bleeding require emergency care. Small-looking incisions are no reason to wait at home with these symptoms.