MedicsWhat is laparoscopic surgery?
Operating through keyholes with very long chopsticks while watching TV. Dr. Leo Gordon blames ten famous physicists for the difficulties, none of whom agreed to it.
The short answer
Laparoscopic surgery, a.k.a. keyhole or minimally invasive surgery, is done through a few small incisions instead of one large one. The surgeon inflates your abdomen with carbon dioxide to make room (you are, briefly, a balloon), slides a thin camera called a laparoscope through one port, and operates with long, narrow instruments while watching a video monitor. It's surgery by remote control, minus the remote.
Greatest hits
Gallbladder removal (laparoscopic cholecystectomy, first done in the mid-1980s and now the standard), appendectomy, hernia repair, many colon, stomach and gynecologic operations, and weight-loss surgery.
What's in it for you
Compared with open surgery for the same operation, patients typically get less pain, smaller scars, fewer wound infections, shorter hospital stays and a faster return to normal life. Not every patient or operation qualifies, and some laparoscopic operations are switched to open surgery partway through for safety. That's not a failure; it's the surgeon choosing to see with their own eyes.
Why surgeons find it maddening
The instruments pivot at the abdominal wall, so when the surgeon's hand moves left, the tip moves right (the fulcrum effect, or as surgeons call it, “why is it doing that”). The image can be flat, the range of motion is limited, and much of the direct feel of tissue is gone: the “tissue sense” Dr. Gordon mourns in Out of Touch. Mastering it takes years, and a sense of humor helps.
Frequently asked questions
Is laparoscopic surgery major surgery?
It can be. The incisions are small, but the operation inside may be the same as the open version, with general anesthesia and similar risks, just usually an easier recovery.
Why does my shoulder hurt after laparoscopic surgery?
The carbon dioxide used to inflate the abdomen can irritate the diaphragm, and the brain files that pain under “shoulder.” It usually fades within a few days.
What is the difference between laparoscopic and robotic surgery?
Robotic surgery is a form of laparoscopic surgery in which the surgeon controls the instruments from a console instead of holding them directly. Same keyholes, fancier chair.
Hear it on the show
- Standing on the Shoulders of Physicists in the Operating Room The Physics of Laparoscopic Surgery: Key Points Overview This humorous dissertation written and read by Leo A. Gordon, MD presents ten "laws of physics" that humorously explain the…
- Out of Touch Dr. Leo A. Gordon’s essay on the vanishing sense of touch in modern surgery, from the “tissue sense” of open operations to laparoscopy and robotic consoles.
- Out of Touch: From Healing Touch to Digital Distance Written and read by Leo A. Gordon, MD, The American Bard of Medicine. Join a veteran surgeon's poignant and humorous journey through the evolution of modern surgery, where the intimate art…
- Fourth and Gall (Play by Play Coverage) This satirical nail-biting episode covers a cholecystectomy with bile duct exploration and extraction of a left hepatic duct stone. The Southwestern Conference of the American Surgical…
Not medical advice. This page is general information, written to explain terms our satire leans on; it isn't a substitute for advice from your own clinician. In an emergency, call 911.