There are many misconceptions among doctors and patients concerning laparoscopy, the most common of which are discussed here.
1. Visualization of the abdomen and pelvis is poor through the laparsoscope.
Laparoscopy actually provides better visualization of the abdomen and pelvis when compared to the view obtained via an “open” approach. Before the advent of videolaparoscopy (laparoscopic images are transmitted and seen on a video monitor), visualization was indeed poor as the surgeon viewed the abdomen through the small eyepiece on the laparoscope. Videolaparoscopy provides excellent magnification of abdominal structures, and the laparoscope’s small diameter allows it to be placed in very small or obstructed areas, which would be inaccessible to the human eye. The inflation of the abdomen with CO2 during laparoscopy allows for separation of abdominal structures which are lying on top of one another during an “open procedure.” All of these factors allow for more precise detection and treatment of intraabdominal abnormalities.
2. Patients with multiple previous abdominal surgeries cannot have a laparoscopic procedure.
Laparoscopy can be safely performed in patients with multiple prior surgeries regardless of the size or location of the prior skin incisions. Special techniques are available, including the use of a microlaparoscope (2.7mm in diameter), which allow for safe entry into the abdomen in an area free of adhesions and scar tissue. After safe entry into the abdomen, scar tissue and adhesions can be removed, and the intended procedure completed. Drs. Nezhat have successfully operated via laparoscopy on thousands of patients who have had multiple abdominal surgeries performed elsewhere (with some patients having had as many as 19 prior surgeries).
3. Patients with large ovarian cysts, fibroids, etc., cannot have their procedure performed by laparoscopy because of the small incisions.
Removal of large abdominal structures can safely and effectively be performed by laparoscopy. For instance a cylindrical device called a morcellator can be placed through a small laparoscopic incision and used to cut large fibroids (even as big as a soccer ball) into multiple circular strips and removed. Alternatively, large ovarian cysts can be dissected free from the ovary without disrupting or rupturing the cyst. The cyst is then placed in a collapsible laparoscopic bag and removed from the body.
4. Patients with severe adhesions and scar tissue cannot undergo a laparoscopic procedure.
As discussed above in section 2, special techniques, such as the use of a microlaparoscope (2.7mm in diameter), are available to gain safe entry into the abdomen. Once inside, the visualization and magnification provided by the laparoscope coupled with the separation of abdominal structures by CO2 inflation, allows for clear identification, isolation, and treatment of adhesions. The microsurgical principles employed during laparoscopy also greatly decrease the risk of developing future adhesions from the surgery itself.
5. Patients with severe endometriosis cannot effectively be treated by laparoscopy.
Endometriosis of any kind is actually treated much more effectively by laparoscopy. Endometriosis can be present in a variety of forms. Certain lesions are very small (a few mm in size) and cannot easily be seen by the naked eye, or are in locations (such as underneath the uterus) which are sometimes inaccessible without the laparoscope. Severe endometriosis can cause adhesions, the treatment of which is described above, or can infiltrate deeply into tissues. When these deep lesions are in hard to find places, laparoscopy is the only method for effective treatment. Infiltration of endometriosis near vital structures such as the bowel, bladder, ureter, or blood vessels requires incredibly precise treatment to prevent injury to those structures and bleeding. The magnification of the laparoscope combined with the flexibility and precision of cutting tools such as the CO2 laser permits this type of treatment.
6. Patients that are too thin or very overweight cannot have a laparoscopic procedure.
Laparoscopic tools are available in a variety of sizes and lengths, and when the techniques used to enter the abdomen are adjusted according to the patient’s body type, laparoscopy can be performed safely and effectively. Once the abdomen is inflated with CO2 gas, the view obtained is not dependent on the weight of the patient. In addition, when laparoscopy is compared to “open” procedures in this group of patients, recovery is more rapid and the risk of complications is decreased.
7. Major procedures like hysterectomy are too complex to be performed by laparoscopy.
With the advances in laparoscopic surgical skills and equipment, most procedures performed by an “open” abdominal approach, are now safely and effectively performed by laparoscopy. This includes such gynecologic surgeries as hysterectomy, myomectomy, and pelvic reconstructive procedures. It is true, however, that laparoscopy has a steeper learning curve, requiring a different level of surgical skills, and at times more specialized equipment. Drs. Nezhat are pioneers in the field of minimally invasive surgery and have been successful in adapting many open procedures to laparoscopy. They constantly strive to improve laparoscopic techniques and equipment in order to provide better patient care and teach physicians all over the world their innovative techniques.
8. If bleeding or other complications occur during a laparoscopy, the procedure must be converted to an “open” surgery.
As stated above, the majority of procedures performed through an “open” approach can safely and effectively be performed via laparoscopy. When complications occur during a laparoscopy, the same techniques that would be employed for their treatment during an open procedure are performed laparoscopically. The same principles apply to any type of surgical procedure regardless of the approach taken: prevention of complications with good surgical technique, with prompt diagnosis and treatment when complications do occur.
9. Laparoscopic procedures are longer than their “open” counterparts, placing patients at risk due to increased anesthesia exposure.
When performed by experienced endoscopic surgeons, laparoscopic procedures can be performed as quickly and safely as “open” procedures. However, even if the duration of the procedure was longer, the risk of a small additional exposure to anesthesia is far outweighed by the benefits of much faster recovery, decreased risk of infection and blood clots, and reduced need for postoperative hospitalization and narcotics use afforded by laparoscopy.
10. Patients with previous or current abdominal infection cannot undergo laparoscopy. A history of previous or current abdominal infection is not a contraindication to performing laparoscopy.
Laparoscopic procedures are just as safe as their “open” counterparts in these situations. Laparoscopy offers the additional advantage of a decreased risk of postoperative infection due to the small incision size and decreased handling of intraabdominal organs.