What is a Laparoscopic Surgery?

 With technological advancements, cameras used in various fields are now utilized in healthcare as well. Laparoscopic surgery involves the use of camera systems to view internal abdominal organs and perform surgeries through small incisions, 0.3-1 cm in diameter, made in the abdominal wall. These cameras transmit images to a monitor in the operating room and provide a detailed view by magnifying the image 15-20 times.

To create a spacious area inside the abdomen, carbon dioxide (CO2) gas is introduced, inflating the abdomen. Depending on the type of surgery to be performed, 1-4 new tubes, 0.3-1 cm in diameter, are placed at appropriate sites on the skin. Long surgical instruments are then inserted through these tubes to carry out the planned surgery. At the end of some surgeries, an extended incision may be made to remove the operated organ, cyst, or tumor. After the surgery, the gas is evacuated from the abdomen.

Laparoscopy is a surgical method performed for both treatment and diagnostic purposes. Compared to other surgical methods, laparoscopy offers faster recovery and significantly reduces the risks of complications during or after surgery.

Can Laparoscopic Surgery Be Applied to Areas Other Than the Abdominal Region?

Yes, it can be performed. However, the name of the procedure changes. For example, if performed in the thoracic cavity, it is called thoracoscopy, and similar technology and methods are used.

Can Laparoscopic Surgery Be Performed on Children of All Ages?

Yes, it can be performed on children of all ages, from newborns to 18-year-olds.

Which Surgeries Can Be Performed Laparoscopically in Children?

All abdominal surgeries can be successfully performed using laparoscopic methods. Some of the main surgeries include:

• Inguinal hernia (groin hernia)
• Undescended testis
• Diagnosis and treatment of non-palpable (non-detectable) testis
• Appendectomy
• Gallbladder (gallstone) surgeries
• Gastroesophageal reflux
• Kidney tumors and cysts
• UPJ (ureteropelvic junction obstruction) surgery
• Pyloric stenosis in infants
• Congenital stomach and intestinal obstructions
• Stomach perforation
• Ovarian torsion, cysts, and tumors in girls
• Intra-abdominal and pelvic tumors (neuroblastoma, ovarian cysts, and tumors)
• Splenectomy (removal of the spleen)
• Nephrectomy (removal of the kidney)
• Laparoscopic varicocele surgery
• Obesity surgeries
• Hydatid cyst of the liver

Which Surgeries Can Be Performed Thoracoscopically in Children?

• Pneumothorax (air leak)
• Chest wall pathologies
• Pectus excavatum (sunken chest)
• Pectus carinatum (pigeon chest)
• Thoracic tumors (neuroblastoma, lung cysts)
• Thymoma
• Congenital lung pathologies (congenital emphysema, bronchial cysts, pulmonary sequestration)
• Empyema
• Hydatid cyst of the lung

How Are Laparoscopic Surgeries Performed?

During laparoscopy, the surgeon makes a 5-10 mm incision below the navel (umbilicus) and inserts a small tube called a cannula into this incision. The cannula is used to inflate the patient's abdomen with carbon dioxide gas. This gas allows the doctor to have a clearer view of the abdominal organs. After inflating the abdomen with carbon dioxide gas, the surgeon inserts the laparoscope through the incision via channels called trocars (3-15 mm). The camera at the end of the laparoscope transmits images to a screen, allowing real-time visualization of the patient's organs.

The number and size of incisions made during laparoscopy can vary depending on the disease and the patient's age. These incisions also allow the surgeon to insert other instruments needed for the surgery, such as biopsy tools, into the abdominal cavity.

What Are the Potential Complications of Laparoscopic Surgeries?

Although less common than in open surgery, complications such as bleeding, infection, and damage to internal organs can occur in laparoscopic surgeries. These complications generally occur during the insertion of the telescope and other surgical instruments or during the surgical procedure itself. Injuries to major vessels or bowel injuries in patients with previous abdominal surgeries can occur during the insertion of the telescope and trocars. During surgery, injuries to the bowel, bladder, ureters, and vessels can be seen. Some of these complications may require conversion to open surgery for treatment. Another complication of laparoscopy is the inability to perform the planned surgery due to technical difficulties, leading to conversion to open surgery.

The main complications include:

• Although less likely than in open surgery, bleeding, vascular injuries, and infections can occur.
• Organ injuries may occur (bladder, uterus, bowel, and urinary tract).
• Postoperative infection at the incision site.

Is Special Preoperatif Preparation Required for Laparoscopic Surgery Compared to Open Surgery?

No, special preparation is not required. As with open surgery, specific tests and imaging procedures are performed for each surgery.

General anesthesia is commonly used for these surgeries, meaning the patient will be asleep and feel no pain during the procedure. An intravenous (IV) line is placed in one of the patient's veins, allowing the anesthesiologist to administer medications and fluids for hydration.

How Long Does Laparoscopic Surgery Take?

The duration varies depending on the surgery. Laparoscopic surgeries in children can range from 15 minutes to several hours. For example, inguinal hernia surgery takes about 15 minutes, while gastroesophageal reflux surgery can take 1.5-2 hours.

Is There Pain After Laparoscopic Surgery?

After laparoscopy, the doctor will recommend pain relievers and antibiotics. It is crucial to follow these recommendations to control pain and prevent infections. Depending on the procedure, the child can return to normal activities and school within a few hours to a few days.

What Is the Recovery Process After Laparoscopic Surgery?

Recovery time in laparoscopic surgery is much shorter compared to traditional surgical techniques. Due to general anesthesia, patients may experience nausea, vomiting, and fatigue in the first few hours. Patients are usually monitored by nurses for a few hours. Before leaving the hospital, the patient is provided with information about the medications to take, movements to avoid, and other important instructions. Self-dissolving stitches are often used for the incisions made during laparoscopy. If non-dissolvable stitches are used, a follow-up appointment will be scheduled to remove them. Throat pain may occur for the first few days due to irritation from the breathing tube used during general anesthesia. There may also be pain and discomfort at the incision sites. Pain relievers are typically prescribed to manage this discomfort. Some gas may remain in the abdomen after surgery, causing gas pain and abdominal cramps, which resolve on their own within 1-2 days as the gas is absorbed and expelled by the body. Patients should avoid getting the incision sites wet for a certain period (usually 72 hours) as advised by the doctor. Return to daily and work activities varies depending on the purpose of the laparoscopy.

What Are the Advantages of Laparoscopic Surgeries Over Open Surgeries?

• Less pain
• Less bleeding
• Lower risk of infection
• Smaller surgical scars
• Shorter hospital stay
• Faster and easier recovery
• Quicker return to daily activities