Wiesbaden/Krefeld: This is how a laparoscopy works

Most people can imagine a colonoscopy. But a tummy tuck?

Laparoscopy is a minimally invasive procedure. It is not only used for inguinal hernias, gallbladder or appendix removals, but also for cancer operations.

A laparoscopy is also often used to clarify unclear symptoms in the abdominal and pelvic area – for example if endometriosis is suspected.

Gentler than an abdominal incision

Advantage of laparoscopy: It offers an alternative to a large abdominal incision, which can be up to 30 centimeters long. Instead, there are several small steps.

“Patients of all ages benefit from a minimally invasive procedure,” says Prof. Stefan Farkas, chief physician in the department for general and visceral surgery at St. Josefs-Hospital in Wiesbaden.

Christoph Wullstein is also convinced that older and weakened people who suffer from multiple illnesses need a gentler operation. He is chief physician of the clinic for general, visceral and minimally invasive surgery at the Helios Klinikum Krefeld.

This is how you look inside

But how does a tummy tuck work? A small camera and surgical instruments are inserted into the abdomen through several small incisions. Under general anesthesia, of course.

First, the abdominal cavity is filled with CO2 gas through the navel in order to lift the abdominal wall so that there is enough space for the procedure. Special surgical instruments are inserted into the abdominal cavity via so-called “locks” – known in technical terms as trocars.

The first is the endoscopic camera, which transmits the image of the inside of the abdomen to a monitor. The operator can use the camera, which can be flexibly controlled, to examine the abdomen. Depending on the intervention, he or she can also create additional working channels of around 5 millimeters in diameter for instruments.

Modern technology on the operating table

Only then does the freestyle, the actual surgery, follow. The operator can see exactly what needs to be done on the screen. The instruments are controlled accordingly via the screen.

Larger pieces of tissue such as cysts are removed through a canal of approximately 12 mm. It is usually hidden at the pubic hairline. Once the surgery is done, the gas is released. Plasters are placed on the 5 to 12 mm small wounds.

A relatively short hospital stay

The hospital stay after laparoscopy is usually shorter than after open surgery. “The length is partly determined by the type of operation,” says Christoph Wullstein.

“Short stays of two to three days exist, for example, after gallbladder removal and minor gynecological operations,” says the surgeon. If parts of the intestine are removed, you have to reckon with four to six days in the hospital. In the case of complex oncological operations, the length of stay can be longer, according to Wullstein.

Get on your feet quickly

Before an operation, most people have a queasy feeling in their stomach. “The fitter and calmer patients go into the operation, the quicker and less complicated they will recover,” says Christoph Wullstein.

Stefan Farkas also observes that people get back on their feet relatively quickly after a laparoscopy: “Previously, patients were not allowed to do any sport for six weeks after an inguinal hernia operation, today they are usually fit again after a week, and some people are even after a short time back at a bike race.”

Keyword movement: It even drives healing forward – provided it is used in the right amount. After the operation, patients often get up for the first time in the recovery room, accompanied by the nursing staff, in order to walk a few steps.

“We do everything to ensure that our patients get back on their feet quickly – we feed them up before the operation, operate gently and motivate them to get up and walk,” says Farkas.

You can shower on the second day after the operation

According to the specialist in surgery, this also includes keeping the time short when there is nothing to eat, “so that the intestines can start functioning again immediately and the patient remains strong”. As soon as the patients are on the ward after the procedure, they are given a first meal to strengthen them.

On the second day after the operation, you can shower and the patches will come off. “The body is excellent at healing small wounds itself,” says Stefan Farkas. “All you need is air – and sunscreen outdoors to keep the scars from pigmenting.”

After every operation, temporary wound pain and sometimes a feeling of exhaustion can occur. “Both are significantly less pronounced after laparoscopic surgery than after open surgery and improve quickly,” says Christoph Wullstein.

According to the surgeon, the feeling of still having gas in the abdominal cavity quickly returns. The gas is released during the operation itself and the feeling is more an expression of being a bit “bloated”. His advice: “Exercise helps to accelerate normalization”.

Swimming is only possible again after a few weeks

Light exercise – such as cycling – is possible again after a few days after laparoscopic operations. According to Wullstein, you should avoid bathing and swimming for a few weeks. Otherwise it can happen that the wounds soften due to the long and intensive contact with water.

You should pause for a few weeks with sports that require a significant use of the abdominal muscles, such as strength training.

A laparoscopy is often possible – but not always

By the way: In many cases, a laparoscopy is possible, but not in all. If, for example, a large number of previous operations with abdominal incisions have led to strong adhesions, a laparoscopy could be too cumbersome.

Severe lung diseases could also speak against a laparoscopy. Because the gas in the abdomen causes the diaphragm to rise higher – lung problems can worsen.

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