September 13, 2013
Dear Mayo Clinic:
I am 74, and I need to have my gallbladder removed. My doctor recommends having it done with laparoscopic surgery. How is this different from regular surgery? Is it safe? What kind of recovery can I expect?
Laparoscopic surgery is done using several small incisions instead of one larger incision. The procedure has been proven safe and effective for gallbladder removal, as well as a variety of other abdominal operations. Shorter recovery time is one of the benefits of laparoscopic surgery, along with a lower risk of problems after surgery.
In traditional, or open, surgery to remove the gallbladder, the surgeon makes one incision that is about six inches long in the abdomen below the ribs on the right side. The gallbladder is removed through that incision.
With laparoscopic surgery — also called minimally invasive surgery — the surgeon makes four small incisions in the abdomen. A tube with a tiny video camera is inserted through one of the incisions. While watching a magnified view of the image projected from that camera on a video monitor in the operating room, the surgeon inserts surgical tools through the other incisions and uses the tools to remove the gallbladder.
One of the advantages of laparoscopic surgery is that the image on the monitor is magnified, clear and well-lit for everyone in the room to see. As a result it is actually easier for the entire surgical team to see what's happening during laparoscopic surgery than it is during open surgery. Because they can see with the same clarity as the surgeon, all team members are able to anticipate what's coming next and prepare for each step in the process.
To ensure a consistently clear image from the camera, carbon dioxide often is used to gently inflate the abdomen during laparoscopic surgery. After surgery the gas is evacuated and any residual gas is absorbed quickly into the body with few, if any, side effects.
Surgeons began using laparoscopic surgery techniques several decades ago. Over the last ten years, the technology has advanced rapidly. Today laparoscopic surgery is a common and widespread practice, especially for gallbladder and appendix removal. There are a variety of benefits patients receive from having this type of procedure.
The length of a hospital stay required after laparoscopic surgery typically is shorter than after open surgery. Many patients leave the hospital the same day or the following morning. The risk of infection, problems with incisions, postoperative hernia and other complications is lower after laparoscopic approach. People who have laparoscopic surgery also lose less blood as a result of surgery and often have less pain after surgery. Many return to work and other daily activities in a matter of days rather than weeks.
Although it can be useful in many cases, laparoscopic surgery may not be right for everyone, depending on your medical and surgical history. In the past, having previous abdominal surgery could make laparoscopic surgery difficult, due to scar tissue. Now, however, many surgeons are able to safely perform laparoscopic surgery on people who have had other abdominal operations.
As you consider laparoscopic surgery, talk to your surgeon about whether or not it is a good fit for you. Also, ask the surgeon how much experience he or she has doing this type of procedure. In the hands of a well-trained and experienced surgeon, laparoscopic surgery often is an excellent choice for gallbladder removal.
— Michael Kendrick, M.D., Surgery, Mayo Clinic, Rochester, Minn.