What Is Laparoscopic Surgery and In Which Cases Is It Preferred?

Laparoscopy, commonly known as "closed surgery," is a surgical method performed using a camera and thin instruments inserted through several small incisions in the abdominal wall. It is widely used in gynecology for both diagnostic and therapeutic purposes. In this article, we explain how laparoscopy is performed, in which situations it is preferred, and what factors are considered.

How Is Laparoscopy Performed?

The procedure is carried out under general anesthesia. Carbon dioxide gas is introduced into the abdominal cavity through an approximately one-centimeter incision made at the navel to create a working space; then, an optical system with a camera at its tip is inserted. The internal abdominal view is projected onto a screen in an enlarged form. One to three thin surgical instruments are inserted through one to three five-millimeter incisions made in the lower abdominal area to complete the procedure. At the end of the surgery, the gas is released, and the small incisions are closed.

In Which Situations Is It Used?

• Removal of ovarian cysts
• Removal of fibroids (laparoscopic myomectomy)
• Treatment of endometriosis lesions and chocolate cysts
• Surgical treatment of ectopic pregnancy
• Removal of the uterus (laparoscopic hysterectomy)
• Evaluation of tubal patency and pelvic adhesions in infertility investigations
• Investigation of unexplained chronic pelvic pain
• Tubal ligation or removal
• Emergency situations such as ovarian torsion

Advantages Compared to Open Surgery

Studies have shown that laparoscopy has certain advantages over open surgery in suitable patients: because the incisions are small, postoperative pain is generally less, hospital stay is shorter, return to daily life is usually faster, and wound site complications are less frequent. The magnification provided by the camera allows detailed visualization of tissues. However, the extent of these advantages varies from person to person, depending on the scope of the procedure and accompanying conditions; it is not accurate to promise the same recovery time for everyone.

Is It Suitable for Every Patient?

No. In some cases, open surgery may be a safer option. These include widespread adhesions due to multiple previous abdominal surgeries, very large masses, inability to tolerate intra-abdominal gas pressure due to advanced heart or lung disease, and certain conditions suspected of cancer. Additionally, a surgery started laparoscopically may need to be converted to open surgery based on the surgeon's safety assessment. This is not a complication but a decision prioritizing patient safety and is explained to the patient before surgery.

Risks and Possible Complications

As with any surgical intervention, laparoscopy carries risks. Although uncommon, bleeding, infection, injury to adjacent organs (intestines, bladder, urinary tract, blood vessels), anesthesia-related problems, and hernia development at incision sites have been reported. Shoulder and back pain related to the gas introduced into the abdomen is common during the first one to two days and usually resolves on its own. Discussing these risks in detail before surgery and answering all your questions are essential parts of informed consent.

Preoperative Preparation

Before surgery, blood tests, chest X-rays, and electrocardiography are requested if necessary; anesthesia evaluation is performed. It is important to inform the doctor about regularly used medications, especially blood thinners. Quitting or reducing smoking before surgery is beneficial for lung function and wound healing. The fasting period before surgery is applied according to the anesthesia team's instructions.

Recovery Process

Most patients are discharged on the same day or the next day, depending on the extent of the procedure. Getting up early and taking short walks contribute to the improvement of bowel movements and reduce the risk of blood clots. Mild abdominal bloating, tenderness at the incision sites, and fatigue are expected findings in the first days. The duration of avoiding heavy lifting and strenuous exercise varies depending on the surgery performed and will be specified at discharge. In case of fever, increasing abdominal pain, redness or discharge at the incision site, nausea-vomiting, or difficulty urinating, you should seek medical attention without delay.

What Is the Difference from Hysteroscopy?

Laparoscopy is directed at the abdominal cavity, while hysteroscopy targets the uterine cavity. Hysteroscopy involves no incisions; a thin optical system is inserted through the cervix to directly visualize the inside of the uterus. Problems such as intrauterine polyps, submucosal fibroids, uterine septum, and adhesions can be evaluated and treated this way. In some patients, both methods are applied in the same session; for example, in infertility investigations, both the uterine cavity and abdominal cavity can be assessed during the same surgery.

Postoperative Nutrition and Wound Care

After the effects of anesthesia wear off, usually liquid foods are started first, and normal nutrition is resumed as bowel movements return. In the first days, consuming fiber-rich foods and adequate fluids helps prevent straining due to constipation. Keeping the incision sites dry and clean, timing of showering, and dressing needs are explained at discharge. Since the incisions are small, the scars fade significantly over time; however, scar appearance varies according to the individual's skin type.

What Questions Should You Ask?

• Why is this surgery recommended for me, and what are the alternatives?
• Which organs are planned to be operated on during the procedure?
• What is the likelihood of converting to open surgery in my case?
• How long should I take a break from work and sports after surgery?
• How will my fertility and menstrual cycle be affected?
• When should I come for a follow-up, and under what symptoms should I seek earlier medical attention?

Having these questions answered before surgery helps you face the process more comfortably and enter the recovery period with realistic expectations.

This article is prepared for general informational purposes and does not replace a medical examination. Please consult a physician for your complaints.