From the Guidelines
Laparoscopic surgery is the preferred approach for emergency laparotomy due to its association with lower mortality, less overall morbidity, and shorter length of stay compared to open surgery. This is based on the most recent and highest quality study available, which was published in 2023 1. Essential information for laparoscopic surgery includes understanding that patients typically experience less pain, shorter hospital stays, and faster recovery compared to open surgery.
Key Considerations
- Surgeons must master proper trocar placement techniques, maintain pneumoperitoneum (usually with carbon dioxide at 12-15 mmHg), and develop advanced hand-eye coordination for manipulating instruments while viewing a monitor.
- Common instruments include laparoscopes, graspers, scissors, clip appliers, and energy devices like monopolar/bipolar electrocautery, ultrasonic devices, and vessel sealers.
- Potential complications include vascular or visceral injury during access, gas embolism, pneumothorax, and port site hernias.
- Patient positioning is crucial, with Trendelenburg position often used for pelvic procedures and reverse Trendelenburg for upper abdominal surgeries.
- Proper patient selection is important, with relative contraindications including severe cardiopulmonary disease, multiple previous abdominal surgeries, and uncorrected coagulopathy.
Postoperative Care
- Surgeons should be prepared to convert to open surgery if necessary for patient safety.
- Postoperatively, patients may experience shoulder pain from diaphragmatic irritation by residual carbon dioxide, which typically resolves within 24-48 hours.
- A systematic review and meta-analysis published in 2017 found that laparoscopic approach was associated with significantly fewer post-operative complications compared to open surgery (18.2% vs. 53.5% respectively) and shorter hospital stay (mean difference −5.35 days) 1. However, the most recent study published in 2023 takes precedence in guiding clinical practice 1.
From the Research
Benefits of Laparoscopic Surgery
- Faster recovery and return to normal activities 2
- Reduced hospital stay 2
- Less pain compared to open surgery 3
- Improved visualisation for the surgeon, allowing for more precise and accurate surgery 3
- Lower rate of wound infections and reduction in perioperative morbidity 2
Risks and Complications of Laparoscopic Surgery
- Longer operating times 3
- Use of complex and expensive equipment 3
- Possibility of new types of complications and increased risk of standard operative morbidity 3
- Risk of venous thromboembolism (VTE) after surgery 4
Preoperative Care for Laparoscopic Surgery
- Preoperative care refers to the physical and psychosocial care that prepares a patient to undergo surgery safely 5
- Preoperative tests and clinical assessments can be undertaken during a preoperative outpatient appointment 5
- Patient information will also be provided at this time 5
Techniques for Safe Laparoscopic Surgery
- Safe laparoscopic entry and safe bipolar diathermy techniques are essential for minimising risks 3
- Surgical proficiency in safe laparoscopic entry and laparoscopic tubal surgery can lead to the confidence to undertake more complex procedures 3