Laparoscopy / keyhole surgery

What is a laparoscopy?

A laparoscopy (keyhole) is a minimally invasive surgery performed under general anaesthesia with a 1cm cut in the umbilicus and three to four 0.5cm cuts in the abdomen. The abdomen is inflated with carbon dioxide gas, and a laparoscope (camera) is inserted through the umbilicus with other instruments inserted through the smaller cuts, so as to perform the surgery. 

Laparoscopic surgery is frequently performed for gynaecological conditions including:

• Uterine fibroids                                              
• Ovarian cysts                                     
• Adenomyosis                                    
• Hydrosalpinx
• Endometriosis   
• Infertility   
• Uterine and ovarian cancers                                    

Laparoscopy is generally a safe and commonly done procedure. Overall risk of complications is low but can be higher in certain conditions e.g. endometriosis, obesity, previous abdominal surgeries, previous infections, cancers – you should discuss these with your gynaecologist. 

Risks of laparoscopy include:

Common (affecting 1-5% of patients):

• Subcutaneous emphysema (trapping of gas underneath the skin)
• Shoulder tip pain
• Wound bruising/ infection
• Port site metastasis following cancer surgery (Cancer cells in the wound area)
• Conversion to open surgery

Uncommon (affecting 0.1-1% of patients):

• Hernia at the site of entry 
• Abdominal wall vascular injury 
• Absence of pathology / Negative laparoscopy
• Major haemorrhage (Major bleeding)
• Damage to bowel, bladder, ureter or uterus which would require immediate repair by laparoscopy or laparotomy (uncommon). However, up to 15% of injuries might not be diagnosed at the time of laparoscopy and require further procedures later on
• Deep venous thrombosis (blood clot in the leg) or pulmonary embolism (blood clot in the lung)
• Anaesthetic complications

Rare (affecting <0.1% of patients)

• Failure to gain entry into the abdomen
• Major vessel injury
• Brachial plexus neuropathy (nerve injury to the arm)
• Pulmonary / Gas embolism (Gas bubble formation in lung vessels)
• Pneumothorax / Pneumo-mediastinum (air in the spaces around the lungs)
• Serious adverse reactions to general anaesthesia, including cardiorespiratory complications

Death: the risk is approximately less than 3-8 in 100,000.

Photo credit: BruceBlaus / Wikimedia Commons