Laparoscopy

How the Test is Performed

The procedure is usually done in the hospital or outpatient surgical center under general anesthesia(while you are asleep and pain-free). The procedure is performed in the following way:

  • The surgeon makes a small cut (incision) below the belly button (navel).
  • A needle or tube is inserted into the incision. Carbon dioxide gas is passed into the abdomen through the needle or tube. The gas helps expand the area, giving the surgeon more room to work, and helping the surgeon see the organs more clearly.
  • A tube is placed through the cut in your abdomen. A tiny video camera (laparoscope) goes through this tube and is used to see the inside of your pelvis and abdomen. More small cuts may be made if other instruments are needed to get a better view of certain organs.
  • If you are having gynecologic laparoscopy, dye may be injected into your cervix area so the surgeon can view your fallopian tubes.
  • After the exam, the gas, laparoscope, and instruments are removed, and the cuts are closed. You will have bandages over those areas.

Preparing for a gynaecological laparoscopy

You’ll meet the surgeon carrying out your procedure to discuss your care. It may differ from what is described here as it will be designed to meet your individual needs.

Your surgeon will explain how to prepare for your procedure. For example, if you smoke, you’ll be asked to stop. Smoking increases your risk of getting a chest problem or wound infection and slows your healing. If you’re having a gynaecological laparoscopy to diagnose a condition, you’ll usually have it done as a day-case procedure. This means you have the procedure and go home the same day. If you have a gynaecological laparoscopy to treat a condition, you may need to stay in hospital overnight.

You may be asked not to eat or drink for some hours before your operation. At the hospital, you may have some tests to check you’re healthy for surgery. These include checking your heart function, your blood count and testing your urine.

You may be asked to wear compression stockings to help prevent blood clots forming in the veins in your legs. Also, you may be given an anticlotting medicine.

Your surgeon will discuss with you what will happen before, during and after your procedure, and any pain you might have. This is your opportunity to understand what will happen. You may want to ask questions about the risks, benefits and any alternatives to the procedure. This will help you to be informed, so you can give your consent for the procedure to go ahead. You’ll be asked to do this by signing a consent form.

What are the alternatives to gynaecological laparoscopy?

Gynaecological laparoscopy isn’t suitable for everyone. Depending on your symptoms and circumstances there may be other investigations or treatments available.

An ultrasound or MRI scan can also be used to diagnose some gynaecological conditions such as fibroids. An ultrasound investigation uses sound waves to produce an image of the inside of part of your body. Most commonly, a trans-vaginal ultrasound is used, which involves an ultrasound probe being put into your vagina. An MRI scan uses magnets and radio waves to produce images of the inside of your body.

Your surgeon will recommend the best treatment option for you.

What happens during a gynaecological laparoscopy?

A gynaecological laparoscopy is usually done with general anaesthetic. This means you’ll be asleep during the procedure.

Laparoscopy is a type of ‘key-hole surgery’. It uses a piece of equipment called a laparoscope. A laparoscope is a small telescope with an attached camera, which your surgeon will use to see inside your abdomen (tummy). It’s put through a small cut in your belly button. The procedure can take between 30 minutes and three hours, depending on what type of examination or treatment you need.

Your surgeon will make a cut in your belly button. He or she will then put a tube through the cut and pump some gas in, which expands your abdomen and separates your organs. This makes it easier for your surgeon to look at your organs with the laparoscope and to perform surgery if you need it.

Your surgeon may need to move some of your organs to get a good view. He or she may make one or more small cuts lower down on your abdomen. Any surgical instruments (such as a grasper) that are needed for your treatment can be inserted through these cuts.

At the end of the procedure, your surgeon will carefully take the instruments out of your abdomen and allow the gas to escape. He or she will close the cuts with stitches, clips or glue.

Gyn Laparoscopy Procedures

Gynecologic Laparoscopy

Gynecologic laparoscopy is an alternative to open surgery. It uses a laparoscope to look inside your pelvic area. Open surgery often requires a large incision.

A laparoscope is a slender, lighted telescope. It allows a doctor to see inside your body. Diagnostic laparoscopy can determine whether you have conditions such as endometriosis or fibroids. It can also be a form of treatment. With miniaturized instruments, your doctor can perform a variety of surgeries. These include:

  • ovarian cyst removal
  • tubal ligation (surgical contraception)
  • hysterectomy

Laparoscopy generally has a shorter healing time than open surgery. It also leaves smaller scars. A gynecologist, general surgeon, or other specialist may perform this procedure.

Reasons for Gynecologic Laparoscopy

Laparoscopy can be used for diagnosis, treatment, or both. A diagnostic procedure can turn into treatment.

Some reasons for diagnostic laparoscopy are:

  • unexplained pelvic pain
  • unexplained infertility
  • history of pelvic infection

Conditions that might be diagnosed include:

  • endometriosis
  • uterine fibroids
  • ovarian cysts or tumors
  • ectopic pregnancy
  • pelvic abscess (pus)
  • pelvic adhesions (painful scar tissue)
  • infertility
  • pelvic inflammatory disease
  • reproductive cancers

Some types of laparoscopic treatment include:

  • hysterectomy (removal of the uterus)
  • removal of the ovaries
  • removal of ovarian cysts
  • removal of fibroids
  • blocking blood flow to fibroids
  • endometrial tissue ablation (endometriosis treatment)
  • adhesion removal
  • reversal of tubal ligation (contraceptive surgery)
  • burch procedure for incontinence
  • vault suspension to treat prolapse

Preparing for Gynecologic Laparoscopy

Preparation depends on the type of surgery. You may need imaging tests. Your doctor might order fasting or an enema.

Tell your doctor about any medication you take. This includes over-the-counter drugs and supplements. You may need to stop them before the procedure.

Plan to have someone drive you home after surgery. A friend can pick you up or you can schedule a car service. You will not be allowed to drive yourself.

Procedure

Laparoscopy is almost always performed under general anesthesia. This means you will be unconscious for the procedure. However, you may still be able to go home the same day.

Once you are asleep, a small tube called a catheter will be inserted. This collects your urine. Then your abdomen will be filled with carbon dioxide gas. This is done with a small needle. The gas keeps the abdominal wall away from your organs. It reduces the risk of injury.

The surgeon will make a small cut in your navel. The laparoscope will be inserted. It transmits images to a screen. This gives your doctor a clear view of your organs.

What happens next depends on the type of procedure. For diagnosis, your doctor might take a look and then be done. If you need surgery, other incisions will be made. Instruments will be inserted through these holes. Then surgery is performed using the laparoscope as a guide.

Once the procedure is over, all instruments are removed. Incisions are closed with stitches. Then you will be bandaged and sent to recovery.

Advances in Laparoscopy

Robotic surgery is sometimes used for gynecological laparoscopy. Robotic arms are steadier than human hands. They may also be better at fine manipulations.

Microlaparoscopy is a newer approach. It uses even smaller scopes. This procedure can be done with local anesthesia in your doctor’s office. You won’t be completely unconscious.

Recovery After Laparoscopy

Once the procedure is over, nurses will monitor your vital signs. You will stay in recovery until the effects of anesthesia fade. You will not be released until you can urinate on your own. Difficulty urinating is a possible side effect of catheter use.

Recovery time varies. It depends on what procedure was performed. You may be free to go home a few hours after surgery. You might also have to stay in the hospital for one or more nights.

After surgery, your belly button might be tender. There may be bruises on your stomach. The gas inside you can make your chest, middle, and shoulders ache. There is a chance that you will feel nauseated for the rest of the day.

Before you go home, your doctor will give you instructions regarding medication and side effects. Your doctor may prescribe pain medication. You may also receive antibiotics to prevent infection.

Depending on the surgery, you may be told to rest for a few days or weeks. It may take a month or more to return to normal activities.

Serious complications of laparoscopy are rare. However, you should call your doctor if you experience:

  • serious abdominal pain
  • prolonged nausea and vomiting
  • fever of 101 degrees F or higher
  • pus or significant bleeding at your incision
  • pain during urination or bowel movements

Risks of Laparoscopy

Skin irritation and bladder infection are common side effects of this procedure.

More serious complications are rare. However, they include

  • damage to the abdominal blood vessel, bladder, bowel, uterus, and other pelvic structures
  • nerve damage
  • allergic reactions
  • blood clots
  • problems urinating

Conditions that increase your risk of complications include:

  • previous abdominal surgery
  • obesity
  • being very thin
  • extreme endometriosis
  • pelvic infection
  • chronic bowel disease

The gas used to fill the abdominal cavity can also cause complications, if it enters a blood vessel.

Pay close attention during the recovery period. Write down any complications and discuss them with your doctor.

Outcomes of Laparoscopy

The results of these procedures are usually good. This technology allows the surgeon to easily see and diagnose many problems. Recovery time is also shorter compared to open surgery.

How to Prepare for the Test

Do not eat or drink anything for 8 hours before the test.

You may need to stop taking medications, including narcotic pain relievers, on or before the day of the exam. Do not change or stop taking any medications without first talking to your health care provider.

Follow any other instructions for how to prepare for the procedure.

How the Test will Feel

You will feel no pain during the procedure.

Afterward, the incisions may be sore. Your doctor may prescribe a pain reliever.

You may also have shoulder pain for a few days. The gas used during the procedure can irritate the diaphragm, which shares some of the same nerves as the shoulder. You may also have an increased urge to urinate, since the gas can put pressure on the bladder.

You will recover for a few hours at the hospital before going home. You will probably not stay overnight after a laparoscopy.

You will not be allowed to drive home. Someone should be available to pick you up after the procedure.

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You should call and schedule a follow-up appointment within two weeks after your procedure.

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